الفهرس 
Acknowledgements
Review Arthroscopic Anatomy of the Ankle JointOnly 14 pages are availabe for public view
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Abstract
Chronic ankle painafter differenttypesoftraumais oneofthecommonankle problemsnowadays,the presenceofmany importantstructuresat the anklejoint make itdifficult todetect the actualcause of the chronic ankle pain.Accurate history takingfollowedby properclinicalexaminationandinvestigationplay an importantrole inthediagnosisof chronicanklepain.
Impingementsyndromesoftheanklejoint andosteochondrallesionsof thetalus occurfrequently afterankletrauma,itisconsideredthemostcommoncauseof chronicanklepain.Inthisstudy,mostofthecasesofchronicanklepainweredue to impingement lesions,whether the soft tissue and/or the osseous type.Other cases had osteochondrallesions of the talar dome,arthrofibrosisandmild arthrosis.
Meticulousexaminationofthefootandankleisvery importantindetermination ofthepaingeneratingintra-articularpathologiesandexclusionofany extra- articularstructure thatcanbe contributinginthe complaintofthe patient.
PlainX-ray APview andlateralviewarethe primarydiagnosticinvestigations. MRIandMRAplayavery importantrolealsoinevaluatingthesecases particularly incasesofsofttissueimpingement.Goodquality MRIand experiencedradiologistarevery importanttodetecttheexactlesion(s).CTscan is also very important in selected cases such as osseous impingement and
osteochondrallesions.
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Summary
Arthroscopyisconsideredthegoldenwaytodetecttheexactcauseofthechronic ankle painandassessalltheintra-articularstructuresoftheankle.Ankle arthroscopy can modify the final diagnosis compared to the preoperative
diagnosisbasedonclinicalexaminationandreviewoftheimagingstudies.So
anklearthroscopyhelpsustocompletetheevaluationoftheanklejointand
togetherwiththeclinicalexaminationandimagingstudies,they give usfull detailsinordertoplanforthe proper surgicalmanagement.
Inthisstudy thereweresixty threecases,anklearthroscopy wasusedinallthe cases, thirty sixpatientswithankleimpingementsyndromesofdifferenttypes whichwere treatedwithresectionof theimpingementtissue,twocaseswith arthrofibrosisandweretreatedbyarthrolysisandthreecaseshadmilddegenerative changes which weretreated withdebridement.Wehadtwentytwo cases of osteochondraltalarlesions, twentyoftheseweretreatedwithdebridementand microfractureandtwotreatedby retrograde drilling.Patientswereassessed accordingtoAOFASandVASFAscores.Therangeofmotion,patientsatisfaction andreturntoactivitywere alsoevaluated.
Allpatientshadhigherfunctionalscorescomparedtothepreoperativevaluesand morethan80%ofpatientshadexcellent andgoodAOFASscoresat final follow up.Sixpatientshadfairandpoorresult,threeofthemhadchondrallesionsofthe talardome,twopatientshadrecurrenceofsofttissueimpingementandonepatient
hadincompleteresectionofanteriorosteophytes.Completeresectionofthe
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Summary
impinging tissueand debridementof thecartilagelesionstoa stableverticalrim andoptimalpenetration ofthe subchondralboneplateduring microfractureare importantfactorsinachievingsatisfactoryoutcome.
Morethan90%ofpatientsweresatisfiedwiththeirsurgeriesandreturnedtotheir pre-injury levelofactivity. Impingementsyndromesfailtorespondtonon- surgicaltreatmentandearly arthroscopicsurgery canpreventdelay inreturnto activity.
Almosthalfofthe studypatientshada slightincreaseinthepostoperativeactive rangeofmotionandnopatientshadany decreaseinthepreoperativerangeof motion.Clinically Significantincrease intherange ofmotionshouldnotbe expectedafter arthroscopicsurgeryfor ankle impingementandpainreliefshould be the mainaimof surgery.
Complications in this studywere few, some patients showed complications relatedtothe superficialperonealnerve forfew monthsafter surgery,butcareful skinincisionandbluntdissectiontogetherwithintermittentdistractiononlywhen necessarywould decreasetheincidenceofthisnerveinjury.Failureofhealingof a small to mid-sizedosteochondral talar lesion after debridement and microfracturedrawsattentiontotheimportanceofaccuratemeasurementofthe
area ofthe lesionand meticuloussurgicaltechnique.
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Summary
Ourstudyrevealedthatage,sex,smokingandlesionsitedonotaffecttheoutcome of debridementandmarrowstimulationfora small tomid-sized osteochondral talarlesionandthissupports other papersinliteraturethatconsider lesionareaas themostimportantfactorforthe outcomeofthis typeof surgeryandthatmarrow stimulationtechniquescanbeusedforlesionslessthan150mm2 regardlessof
other factors.