Hamberger Maximilian A, Saller Maximilian M, Böcker Wolfgang, Polzer Hans, Baumbach Sebastian F
Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Ziemssenstraße 5, Munich, 80336, Germany.
Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, Ludwig-Maximilians-University (LMU), Fraunhoferstraße 20, Planegg/Martinsried, 82152, Germany.
BMC Musculoskelet Disord. 2025 Jul 12;26(1):678. doi: 10.1186/s12891-025-08785-8.
Impingement syndrome of the ankle is a multifaceted condition. It can affect all regions within the ankle joint and can be caused either by bony prominences or soft tissue. Exact numbers on the incidences are missing, prevalence rates up to 60% are estimated in certain risk groups. Previous systematic reviews have focused on specific anterior or posterior ankle impingements. Still, a comprehensive overview over impingement syndromes of the ankle and the outcome to be expected is missing. This systematic review aims at giving a comprehensive overview on studies reporting on the outcome of any kind of ankle impingement.
A systematic review was conducted, based on a thorough search strategy in four databases following the PRISMA guidelines. Included were all studies reporting on the outcome for any sort of ankle impingement. Assessed data were the level of evidence, study details, general demographics, injury details, surgical treatment, postoperative treatment protocol, follow-up time, complications, and outcome. Analyzed were comparable outcome parameters presented in at least three studies.
Out of 3083 screened abstracts, 85 studies were eligible for qualitative and 37 studies for quantitative analysis. The AOFAS was assessed by 21 studies, with significant postoperative improvement in all studies. In all but two studies, mean postoperative AOFAS scores above 80 points were achieved. The VAS pain on a 10-point Likert scale was reported in 12 studies and improved in all. Return to sports was reported as a percentage/duration in 17/14 studies. At least 70% of patients returned to sports in all but one study.
This study is the first to provide a comprehensive overview over the expected outcomes following surgical treatment of any ankle impingement syndrome. The great heterogeneity of the studies did not allow a pathology-specific comparison. Surgery apparently improves the symptoms considerably, but the outcome varies between the different types of impingements, with a posterior os trigonum impingement resulting in the most favorable outcomes.
The study was a-priori registered at Prospero (#CRD42022354685) on August 19th, 2022.
Level 1 Systematic Review.
踝关节撞击综合征是一种多方面的病症。它可影响踝关节内的所有区域，可由骨突或软组织引起。目前尚缺乏确切的发病率数据，据估计某些风险人群中的患病率高达60%。以往的系统评价主要集中在特定的踝关节前侧或后侧撞击。然而，目前仍缺乏对踝关节撞击综合征及其预期结果的全面概述。本系统评价旨在全面概述报告任何类型踝关节撞击结果的研究。
按照PRISMA指南，在四个数据库中进行了全面的检索策略，开展了一项系统评价。纳入所有报告任何类型踝关节撞击结果的研究。评估的数据包括证据水平、研究细节、一般人口统计学、损伤细节、手术治疗、术后治疗方案、随访时间、并发症和结果。分析至少三项研究中呈现的可比结果参数。
在3083篇筛选出的摘要中，85项研究符合定性分析要求，37项研究符合定量分析要求。21项研究对美国足踝外科协会（AOFAS）评分进行了评估，所有研究术后均有显著改善。除两项研究外，所有研究术后AOFAS平均评分均高于80分。12项研究报告了10分李克特量表上的视觉模拟评分（VAS）疼痛情况，所有研究中疼痛均有所改善。17/14项研究报告了恢复运动的百分比/持续时间。除一项研究外，所有研究中至少70%的患者恢复了运动。
本研究首次全面概述了任何踝关节撞击综合征手术治疗后的预期结果。研究的高度异质性不允许进行病理特异性比较。手术显然能显著改善症状，但不同类型撞击的结果有所不同，后踝三角骨撞击的结果最为理想。
该研究于2022年8月19日在国际前瞻性系统评价注册库（#CRD42022354685）进行了预注册。
1级系统评价。
