Department of Orthopedic Surgery, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA.
Department of Radiology, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA.
Foot (Edinb). 2021 Jun;47:101799. doi: 10.1016/j.foot.2021.101799. Epub 2021 Apr 7.
The purpose of this study was to identify and characterize various causes of delay in the diagnosis of posterior ankle impingement syndrome (PAIS) in pediatric patients.
IRB approved prospective study of patients under 18 years who underwent arthroscopic surgery for the diagnosis of posterior ankle impingement after failed conservative treatment at a tertiary children's hospital. Radiographic findings were compared with an age-matched control group. Descriptive and inferential statistics were employed.
47 patients (61 ankles), mean age 13 years, had an average 14 months delay in diagnosis of PAIS from the initial presentation. 33 (70%) patients had seen multiple medical providers and given other diagnoses. 9 (19%) patients participated in ballet or soccer, and 16 (34%) patients had unrelated associated foot and ankle diagnoses. 25 (41%) of 61 ankles did not have pain on forced plantar flexion; all 61(100%) ankles had tenderness to palpation over the posterior ankle joint line. Radiographs were reported to be normal in 37/52 (71%) ankles, while MRI report did not mention the diagnosis in 20/41 (49%) studies. There was a significant difference in the MRI findings in the patient population when compared to the control group. Indication for surgery was failed conservative treatment. All 61 ankles had posterior ankle impingement pathology confirmed visually during arthroscopy. At average 15 months follow-up, there was significant improvement pre- to post-operatively (p<0.001) for both pain VAS (6.9-0.9) and AOFAS ankle-hindfoot scores (65-94).
Multiple clinical and imaging factors can lead to delayed diagnosis of posterior ankle impingement. An increased awareness about the features of PAIS is needed amongst medical providers involved in treating young patients.
本研究旨在确定和描述导致儿童后踝撞击综合征（PAIS）诊断延迟的各种原因。
在一家三级儿童医院对接受关节镜手术治疗后踝撞击的 18 岁以下患者进行了前瞻性研究，这些患者在保守治疗失败后。将影像学发现与年龄匹配的对照组进行比较。采用描述性和推断性统计方法。
47 名患者（61 侧踝关节），平均年龄 13 岁，PAIS 的初始表现后平均延迟诊断 14 个月。33 名（70%）患者看过多个医疗提供者，并被诊断出其他疾病。9 名（19%）患者参加过芭蕾舞或足球，16 名（34%）患者有其他相关足部和踝关节诊断。25 名（41%）61 侧踝关节在强迫背屈时无疼痛；61 侧踝关节（100%）均有后踝关节线压痛。37/52（71%）踝关节 X 线片报告正常，而 20/41（49%）MRI 报告未提及该诊断。与对照组相比，患者人群的 MRI 结果存在显著差异。手术指征为保守治疗失败。所有 61 例踝关节均在关节镜下证实存在后踝撞击病理。平均随访 15 个月时，疼痛 VAS（6.9-0.9）和 AOFAS 踝关节-后足评分（65-94）均有显著改善（p<0.001）。
多种临床和影像学因素可导致后踝撞击的诊断延迟。参与治疗年轻患者的医疗提供者需要提高对 PAIS 特征的认识。
