Department of Orthopedics, Texas Children's Hospital, Houston, TX, USA.
E. B. Singleton Department of Pediatric Radiology, Texas Children's Hospital, 6701 Fannin St., Suite 470, Houston, TX, 77030, USA.
Pediatr Radiol. 2020 Feb;50(2):216-223. doi: 10.1007/s00247-019-04547-6. Epub 2019 Nov 9.
Posterior ankle impingement syndrome (PAIS) results from the pinching of anatomical structures in the posterior part of the ankle.
To identify the possible role of imaging in the delayed diagnosis of PAIS and identify key findings on imaging to suggest PAIS in pediatric and adolescent patients.
Data were collected prospectively in patients younger than 18 years of age who underwent arthroscopy after being diagnosed with PAIS. Imaging was reviewed retrospectively by two radiologists, compared with findings in literature and an age-matched control group, and correlated with arthroscopic findings. Pre- and postsurgical Visual Analogue Scale (VAS) pain and American Orthopedic Foot Ankle Society (AOFAS) ankle-hindfoot scores were noted.
Thirty-eight patients (20 females, 18 males), 51 ankles, with an average age of 12.9 years had an average 18-month delay in diagnosis. Twenty-seven of the 38 (73%) patients had previously seen multiple medical providers and were given multiple misdiagnoses. Radiographs were reported normal in 34/47 (72%) ankles. Thirty patients had magnetic resonance imaging (MRI) and findings included the presence of an os trigonum/Stieda process (94%) with associated osseous edema (69%), flexor hallucis longus (FHL) tenosynovitis (16%), and edema in Kager's fat pad (63%). Although individual findings were noted, the impression in the MRI reports in 16/32 (50%) did not mention PAIS as the likely diagnosis. There was a significant difference in the MRI findings of ankle impingement in the patient population when compared to the control group. Surgery was indicated after conservative treatment failed. All 51 ankles had a PAIS diagnosis confirmed during arthroscopy. At an average follow-up of 10.2 months, there was improvement of VAS pain (7.0 to 1.1) and AOFAS ankle-hindfoot scores (65.1 to 93.5).
PAIS as a diagnosis is commonly delayed clinically in young patients with radiologic misinterpretation being a contributing factor. Increased awareness about this condition is needed among radiologists and physicians treating young athletes.
踝关节后撞击综合征（PAIS）是由于踝关节后部的解剖结构被夹挤而引起的。
确定影像学在 PAIS 延迟诊断中的可能作用，并确定影像学上的关键发现，以提示儿科和青少年患者的 PAIS。
前瞻性收集经关节镜诊断为 PAIS 后年龄小于 18 岁的患者的数据。两名放射科医生对影像学资料进行回顾性分析，与文献中的发现和年龄匹配的对照组进行比较，并与关节镜检查结果相关联。记录术前和术后视觉模拟量表（VAS）疼痛评分和美国矫形足踝协会（AOFAS）踝关节-后足评分。
38 例患者（20 名女性，18 名男性），51 个踝关节，平均年龄为 12.9 岁，平均诊断延迟 18 个月。38 例患者中的 27 例（73%）曾多次就诊于多个医疗提供者，并被多次误诊。34/47（72%）个踝关节的 X 线片报告正常。30 例患者行磁共振成像（MRI）检查，结果包括存在 Os trigonum/Stieda 体（94%），伴有骨水肿（69%），踇长屈肌腱腱鞘炎（16%），和 Kager 脂肪垫水肿（63%）。尽管在 MRI 报告中注意到了个别发现，但在 16/32（50%）例中，并未提及 PAIS 作为可能的诊断。与对照组相比，患者人群的踝关节撞击 MRI 表现存在显著差异。在保守治疗失败后，行手术治疗。所有 51 个踝关节在关节镜检查中均被确诊为 PAIS。平均随访 10.2 个月后，VAS 疼痛评分（从 7.0 分降至 1.1 分）和 AOFAS 踝关节-后足评分（从 65.1 分提高至 93.5 分）均得到改善。
PAIS 的临床诊断在年轻患者中常常被延迟，影像学的误解是一个促成因素。放射科医生和治疗年轻运动员的医生需要提高对这种疾病的认识。
