Operative Treatment of Medial Impingement Syndrome of the Ankle Concomitant With Osteochondral Lesion of the Medial Talar Dome: When and How?

BACKGROUND

Coexisting medial impingement syndrome of the ankle (MIA) is often observed when planning surgical treatment for medial osteochondral lesion of the talus (OLT). To date, there is no clear consensus on the surgical indications for MIA in relation to medial OLT or on whether overtreatment or undertreatment is preferable.

PURPOSE

To investigate when and how MIAs should be treated in patients with concomitant medial OLT.

STUDY DESIGN

Cohort study; Level of evidence, 2.

METHODS

A total of 47 patients diagnosed with medial OLT and concomitant MIA were prospectively evaluated between January 2020 and June 2023. Patients were enrolled when they tested positive for the MIA provocation test (pain at the medial malleolus was exacerbated with ankle varus and dorsiflexion maneuvers) and randomly assigned to either the solitary medial OLT treatment group (group 1; n = 23 patients) or the simultaneous medial OLT and MIA treatment group (group 2; n = 24 patients). In group 2, osteophytes associated with MIA were addressed using a combined arthroscopic and miniopen approach along with the microfracture technique for medial OLT, whereas in group 1, only a solitary arthroscopic microfracture was performed. The minimum follow-up duration for inclusion in this study was 12 months.

RESULTS

The clinical parameters at the final follow-up significantly improved postoperatively in both groups, and the values at the final follow-up did not significantly differ between the 2 groups. However, the rate of pain elicitation during the MIA provocation test at the final follow-up was significantly greater in group 1 than in group 2 (72.2% vs 10.5%; < .001). None of the patients had superficial/deep infections, operation-related neurovascular injuries, or revision surgery during the follow-up period.

CONCLUSION

Although the results of our study alone cannot conclusively determine that surgical treatment is necessarily required for MIA concomitant with medial OLT, the significant postoperative reduction in pain elicited during the MIA provocation test was observed in patients who underwent simultaneous MIA resection. Considering the relatively less technically demanding nature of the surgical technique introduced in this study, we recommend proactive resection in patients with both MIA and medial OLT where pain is elicited during the MIA provocation test preoperatively.