Evidence-based clinical practice guidelines for the management of acute ankle injuries according to: a PRISMA systematic review and quality appraisal with AGREE II.

BACKGROUND: Acute ankle injuries are commonly seen in emergency rooms, with significant social impact and potentially devastating consequences. While several clinical practice guidelines (CPGs) related to ankle injuries have been developed by various organizations, there is a lack of critical appraisal of them. The purpose of this systematic review is to identify and critically appraise evidence-based clinical practice guidelines (EB-CPGs) related to acute ankle injuries in adults. METHOD: We conducted searches in the Cochrane Library, MEDLINE, EMBASE databases, WHO, and reviewed 98 worldwide orthopedic association websites up until early 2023. Two authors independently applied the inclusion and exclusion criteria, and each evidence-based clinical practice guideline (EB-CPG) underwent independent critical appraisal of its content by all four authors using the Appraisal of Guidelines for REsearch and Evaluation (AGREE II) instrument. AGREE II scores for each domain were then calculated. RESULTS: This review included five evidence-based clinical practice guidelines. The mean scores for all six domains were as follows: Scope and Purpose (87.8%), Stakeholder Involvement (69.2%), Rigour of Development (72.5%), Clarity of Presentation (86.9%), Applicability (45.6%), and Editorial Independence (53.3%). CONCLUSION: The number of EB-CPGs related to ankle injuries are limited and the overall quality of the existing evidence-based clinical practice guidelines (EB-CPGs) for ankle injuries is not strong, with three of them being outdated. However, valuable guidance related to Ottawa rules, manual therapy, cryotherapy, functional supports, early ambulation, and rehabilitation has been highlighted. Challenges remain in areas such as monitoring and/or auditing criteria, consideration of the target population's views and preferences, and ensuring editorial independence. Future guidelines should prioritize improvements in these domains to enhance the quality and relevance of ankle injury management. SYSTEMATIC REVIEW: Systematic review.

Acute clinical evaluation for the diagnosis of lateral ankle ligament injuries is useful: A comparison between the acute and delayed settings.

PURPOSE: To determine the diagnostic value of seven injury history variables, nine clinical tests (including the combination thereof) and overall clinical suspicion for complete discontinuity of the lateral ankle ligaments in the acute (0-2 days post-injury) and delayed setting (5-8 days post-injury). METHODS: All acute ankle injuries in adult athletes (≥18 years) presenting up to 2 days post-injury were assessed for eligibility. Athletes were excluded if imaging studies demonstrated a frank fracture or 3 T MRI could not be acquired within 10 days post-injury. Using standardized history variables and clinical tests, acute clinical evaluation was performed within 2 days post-injury. Delayed clinical evaluation was performed 5-8 days post-injury. Overall, clinical suspicion was recorded after clinical evaluation. MRI was used as the reference standard. RESULTS: Between February 2018 and February 2020, a total of 117 acute ankle injuries were screened for eligibility, of which 43 were included in this study. Complete discontinuity of lateral ankle ligaments was observed in 23 (53%) acute ankle injuries. In the acute setting, lateral swelling had 100% (95% confidence interval [CI]: 82-100) sensitivity, haematoma had 85% (95% CI: 61-96) specificity and the anterior drawer test had 100% (95% CI: 77-100) specificity. In the delayed setting, sensitivity for the presence of haematoma improved from 43% (95% CI: 24-65) to 91% (95% CI: 70-98; p < 0.01) and the sensitivity of the anterior drawer test improved from 21% (95% CI: 7-46) to 61% (95% CI: 39-80; p = 0.02). Clinical suspicion had a positive likelihood ratio (LR) of 4.35 (95% CI: 0.55-34.17) in the acute setting and a positive LR of 6.09 (95% CI: 1.57-23.60) in the delayed setting. CONCLUSIONS: In the acute setting, clinical evaluation can exclude complete discontinuity (e.g., absent lateral swelling) and identify athletes with a high probability of complete discontinuity (e.g., positive anterior drawer test) of the lateral ankle ligaments. In the delayed setting, the sensitivity of common clinical findings increases resulting in an improved diagnostic accuracy. In clinical practice, this study underlines the importance of meticulous clinical evaluation in the acute setting. LEVEL OF EVIDENCE: Level III.

MRI findings of peroneal tendon tears do not necessarily correlate to clinical findings in paediatric and adolescent patients.

PURPOSE: Pathologic abnormality of the peroneal tendons are thought to be an under-appreciated source of vague ankle and hindfoot pain in paediatric patients, partly because they can be difficult to diagnose and differentiate from lateral ankle ligament injuries. While magnetic resonance imaging (MRI) is the primary imaging modality used to detect peroneal tendon pathology, previous studies in adults have found that positive MRIs demonstrate a positive predictive value (PPV) of associated clinical findings around 48%. There are no similar known published studies in the paediatric population. Our objective was to determine the positive predictive value of peroneal tendon pathology as diagnosed by MRI as related to positive clinical exam findings in the paediatric and adolescent population. METHODS: This IRB approved retrospective study was conducted at a tertiary children's hospital. Inclusion criteria included patients under 18 years from our tertiary care institution with (a) ankle MRI findings indicating pathology of the peroneus brevis/longus tendons confirmed by a board certified paediatric musculoskeletal radiologist and (b) formal review of the clinical examination by a fellowship trained paediatric orthopaedic surgeon. Patients with congenital deformities or previous surgical intervention of the lateral ankle were excluded. RESULTS: Forty-seven patients (with 48 MRIs) met inclusion criteria over a ten year period. The majority of the positive MRI scans (70%) demonstrated a peroneus brevis split tear. Of the patients with positive findings on MRI, 17 patients had an associated positive clinical exam. The positive predictive value of MRI for peroneal tendon tears with positive clinical findings was 35.41% (95% confidence interval = 31.1% to 41.6%). There were 31 patients with MRI positive findings with a negative clinical exam. CONCLUSION: Despite having a negative clinical exam, a high percentage of patients had positive MRI findings suggestive of peroneal tendon pathology which confirms findings of adult populations demonstrating a high rate of incidental finding of peroneal tendon pathology on MRI in paediatric patients.

[Injuries of the ankle ligaments]. / Bandverletzungen des oberen Sprunggelenks.

Lateral ligament injuries are the most common injuries of the ankle joint and are usually treated with early weight bearing after a short period of immobilization. If the clinical presentation is suspicious, additional injuries to the deltoid ligament complex and the syndesmosis should be considered. The indications for additional diagnostics should be generously applied. Injuries to the deltoid ligament usually occur as part of a complex ankle injury and should also be addressed in the surgical treatment of accompanying injuries. Chronic instability in this area necessitates complex bony and soft tissue procedures. Syndesmotic injuries with insufficiency of the capsule-ligament apparatus are frequent in ankle fractures and are stabilized during fracture treatment. Isolated syndesmotic instability should also be surgically treated as chronic injuries are usually associated with poor clinical results and early osteoarthritis.

Validity and reliability of the Modified Four Square Step Test in individuals with ankle sprain.

BACKGROUND: Postural instability and gait abnormalities are frequently observed after an ankle sprain. A modified Four Square Step Test (mFSST) was developed to assess dynamic balance during gait. The aim of this study was to evaluate the reliability and validity of the mFSST in individuals with ankle sprains. METHODS: The study included 39 individuals with grade 1 and 2 ankle sprains with a mean age of 30.36 ± 6.21 years. The dynamic balance of the participants was assessed with the mFSST and Timed Up & Go test (TUG). To determine the test-retest reliability of the mFSST, the test was repeated approximately 1 h apart. RESULTS: The test-retest reliability of the mFSST was excellent (ICC = 0.85). Furthermore, when the concurrent validity of the mFSST was examined, a high correlation was found between with the TUG (r = 0.78, p < 0.001). CONCLUSION: The mFSST is a valid and reliable clinical assessment method for evaluating dynamic balance during walking in individuals with ankle sprains. We think that the mFSST is preferable in clinical evaluations because its platform is easy to prepare and requires very little equipment.

Pediatric Trauma.

Pediatric foot and ankle trauma includes a range of injuries affecting the lower extremities in children, typically aged from infancy to adolescence. These incidents can arise from various causes, including sports-related accidents, falls, and high-velocity injuries. Due to the dynamic growth and development of bones and soft tissues in pediatric patients, managing these injuries requires specialized knowledge and care. Early diagnosis and appropriate treatment are crucial to ensure optimal recovery and prevent potential long-term consequences. Treatment depends on severity and type of injury but may involve a combination of immobilization, physical therapy, or surgical intervention.

Standardized analysis of syndesmosis stability in ankle trauma with an innovative syndesmosis-test-tool: a biomechanical study.

When treating ankle fractures, the question of syndesmosis complex involvement often arises. So far, there is no standardized method to reliably detect syndesmosis injuries in the surgical treatment of ankle fractures. For this reason, an intraoperative syndesmosis-test-tool (STT) was developed and compared to the recommended and established hook-test (HT). Tests were performed on cadaveric lower legs (n = 20) and the diastasis was visualized by 3D camera. Tests were performed at 50, 80, and 100 N in native conditions and four instability levels. Instability was induced from anterior to posterior and the reverse on the opposite side. The impact on diastasis regarding the direction, the force level, the instability level, and the device used was checked using a general linear model for repeated measurement. The direction of the induced instability showed no influence on the diastasis during the stability tests. The diastasis measured with the STT increased from 0.5 to 3.0 mm depending on the instability, while the range was lower with the HT (1.1 to 2.3 mm). The results showed that the differentiation between the instability levels was statistically significantly better for the developed STT. The last level of maximum instability was significantly better differentiable with the STT compared to the HT. An average visualizable diastasis of more than 2 mm could only be achieved at maximum instability. In conclusion, the newly developed STT was superior to the commonly used HT to detect instability.

Syndesmotic Injuries.

Syndesmotic ankle injuries, though rare in isolation, are complex destabilizing injuries often accompanied by fractures. Misdiagnoses, particularly overlooking posterior malleolus fractures, are common in ankle sprains. Thorough physical examinations, emphasizing high fibular pain and anterior tibia palpation, aid in accurate diagnosis. Grading helps assess injury severity and guiding treatment. Initial imaging involves three ankle views, with stress radiographs enhancing accuracy. If conservative care fails, MRI reveals ligament and tendon damage. Physical therapy may suffice for functional instability; surgical intervention addresses mechanical instability. Syndesmotic fixation debates center on cortices, screw size, reduction methods, and optimal positioning.

[Current diagnostics and treatment of ankle sprains in German]. / Aktuelle Diagnostik und Behandlung der Sprunggelenks-Distorsion in Deutschland.

BACKGROUND: Ankle sprains are one of the most frequent injuries of the musculoskeletal system. The injury pattern determines the treatment and are crucial for the outcome. Nonoperative treatment is commonly recommended for isolated injuries of the lateral ligaments but no standard strategy exists in combined ankle ligament injuries. The goal of this national survey was to achieve an overview about the current diagnostic strategies and common treatment concepts in Germany. MATERIAL AND METHODS: All members of the German Society for Orthopaedics and Trauma Surgery (DGOU) were invited to participate in an anonymous survey about the diagnostic and therapeutic approach in cases of ankle sprains. The online survey consisted of 20 questions. Besides questions about the speciality and scope of activities the participants were ask to depict their diagnostic and therapeutic strategy. RESULTS: A total of 806 participants completed the survey. Most of them were orthopedic trauma surgeons and worked in a hospital. During the first presentation the anterior drawer test (89.5%) and the inversion/eversion test (81.6%) were most commonly used, 88.1% always make an X­ray examination and 26.5% an ultrasonography examination. Isolated injuries of the anterior fibulotalar ligament (LFTA) were treated nonoperatively by 99.7% of the participants, 78.8% recommend full weight bearing in an orthesis, 78.8% treat the complete rupture of the lateral ligaments without operation whereas 30.1% stated that they would treat a combined lateral ligaments rupture with an injury of the syndesmosis nonoperatively. DISCUSSION: Due to the heterogeneity of injury patterns after ankle sprain no consistent recommendations for diagnostics and treatment exist. The Ottawa ankle rules and ultrasonography were not often utilized despite of the good evidence. The isolated rupture of the LFTA is diagnosed and treated according to the national guidelines by most of the participants. In cases of combined injuries of the lateral and medial ankle ligaments the majority choose a nonoperative treatment strategy which is justified by the guidelines with a low level of evidence. Combined injuries of the syndesmosis and the lateral ankle ligaments were treated operatively, which also correlates with the recommendations in the literature. The standard care of ankle sprain in Germany is in accordance with the recommendations from the current literature.

Subtle Syndesmotic Instability.

Latent or subtle syndesmotic instability is defined as an injury to the syndesmosis which is not apparent on static radiographs of the ankle. Syndesmotic injuries have also been referred to as high ankle sprains. Injury to the syndesmosis typically occurs with collision sports and often involves an external rotation force to the ankle. Diagnosis can be delayed because of negative initial imaging studies. Physical examination tests including the external rotation test, proximal squeeze test, and fibular shuck test can assist in the diagnosis. Advanced imaging modalities such as MRI and weight-bearing CT have been studied and can provide prognostic indications for management, although arthroscopic stress evaluation remains the benchmark for diagnosis. Both surgical and nonsurgical management techniques have been described, which can assist patients in returning to their preinjury level of function.

Advances in Diagnosis and Management of Lateral Ankle Instability: A Review of Current Literature.

Lateral ankle sprains and instability are an increasingly identified pain point for patients, accounting for 20 to 25% of musculoskeletal injuries. Lateral ankle injuries are especially concerning given the propensity for patients to develop chronic lateral ankle instability and for the high risk of reinjury on an unstable ankle. With the complex articulation of the tibiofibular syndesmosis, subtalar, and talocrural joints, pinpointing ankle dysfunction remains difficult. Multiple reviews have evaluated management and diagnosis of lateral ankle instability, but with newer treatment options available, a more comprehensive assessment of the current literature was conducted. Although multiple surgical options exist, many nonsurgical functional options have also been developed for patients that may help patients prevent the development of chronic lateral ankle instability. In recent times, many new options have come up, including in-office needle arthroscopy and continual advancements in diagnosis and our understanding of this difficult topic. Multiple reviews have evaluated the management and diagnosis of lateral ankle instability, but with newer treatment options available, a more comprehensive assessment of the current literature was conducted. Given this, this review will help to highlight new diagnostic and nonsurgical therapeutic options for the management of lateral ankle instability.

Utilidad de la artrografía intraoperatoria para el tratamiento de fracturas en niños / Usefulness of intraoperative arthrogram in the treatment of pediatric fractures

Introducción: El objetivo de este estudio fue evaluar las indicaciones y las complicaciones de una serie consecutiva de niños con fracturas a quienes se les realizó artrografía intraoperatoria. Materiales y Métodos: Se evaluó retrospectivamente a pacientes pediátricos con fracturas de codo o tobillo sometidos a una artrografía intraoperatoria, entre enero de 2009 y julio de 2014. Se analizaron los datos demográficos, la evolución clínica posoperatoria (criterios de la Clínica Mayo y puntaje de la AOFAS), la evolución radiográfica y las complicaciones derivadas del uso de material de contraste intrarticular. Resultados: Se evaluaron 25 pacientes (16 niños, 9 niñas) con una edad promedio de 7.6 años (rango 4-15). El seguimiento promedio fue de 30.1 meses. Quince tenían fracturas de codo y 10, de tobillo. Según el puntaje de la Clínica Mayo, 14 pacientes tuvieron resultados excelentes y uno fue bueno (promedio 99; rango 85-100). Los 10 pacientes con fracturas de tobillo obtuvieron resultados excelentes según el puntaje de la AOFAS (promedio 98,5; rango 95-100). No ocurrieron infecciones ni reacciones adversas relacionadas con el uso del medio de contraste. Tres pacientes tuvieron complicaciones no relacionadas con el uso del medio de contraste. Conclusión: La artrografía es un procedimiento simple, de bajo costo, que agrega poco tiempo quirúrgico y permite una mejor evaluación de estructuras intrarticulares para la toma de decisiones intraoperatorias. Es una herramienta útil que debe ser tenida en cuenta en el tratamiento de algunas fracturas en pediatría. Nivel de Evidencia: IV

Introduction: The objective of this study is to assess the indications and complications of a consecutive series of children with fractures where intraoperative arthrogram was performed. Methods: We retrospectively evaluated children with elbow or ankle fractures who underwent intraoperative arthrogram between January 2009 and July 2014. We assessed demographic data, postoperative clinical outcomes (Mayo Clinic and AOFAS scores), radiographic outcome and complications arising from the use of intra-articular contrast material. Results: Twenty-five patients (16 boys, 9 girls) with an average age of 7.6 years (range 4-15) were evaluated. The average follow-up was 30.1 months. There were 15 patients with elbow fractures and 10 with ankle fractures. According to Mayo Clinic score, results were excellent in 14 patients and good in one patient (average 99; range 85-100). Ten patients with ankle fractures presented excellent results according to AOFAS score (average 98.5; range 95-100). There were no in fections or adverse reactions related to the use of contrast. Three patients presented complications unrelated to the use of contrast. Conclusion: Arthrogram is a simple, low-cost procedure, adds short surgical time and allows better assessment of intraarticular structures for intraoperative decision-making. It is a useful tool that should be taken into account in the treatment of some pediatric fractures. Level of Evidence: IV

Diagnosis and treatment of osteochondral lesions of the ankle: current concepts / Diagnóstico e tratamento das lesões osteocondrais do tornozelo: conceitos atuais

ABSTRACT We conducted a wide-ranging review of the literature regarding osteochondral lesions of the ankle, with the aim of presenting the current concepts, treatment options, trends and future perspectives relating to this topic.

RESUMO Os autores fazem uma revisão ampla da literatura a respeito das lesões osteocondrais do tornozelo, com o intuito de expor os conceitos atuais sobre o tema, as opções de tratamento, as tendências e as perspectivas.

Ruptura del ligamento tibioperoneo inferior posterior en un niño / Tear of the posterior-inferior tibiofibular ligament in a child

Las fracturas-luxación del tobillo son muy frecuentes en los adultos y las lesiones descritas por Salter y Harris en pacientes en desarrollo también son comunes. Los autores presentan un caso de ruptura del ligamento tibio-peroneo inferior posterior en el tobillo izquierdo, en un paciente de 13 años de edad, cuyo diagnóstico inicial en radiografías simples fue de esguince de tobillo; sin embargo, se solicitó una TC del tobillo en donde se corroboró la lesión de este paciente tratado en el Hospital Infantil de Morelia. La TC como elemento de apoyo en el diagnóstico de la diástasis tibio-peronea inferior es de gran ayuda pues la ruptura del ligamento tibio-peroneo distal posterior de la mortaja en el tobillo pasa desapercibida en estos pacientes que son diagnosticados inicialmente como esguinces de tobillo.

Fracture-dislocations of the ankle are very frequent in adults. The injuries described by Salter and Harris in developing patients are also common. The authors present a case of tear of the posterior-inferior tibiofibular ligament of the left ankle in a 13 year-old patient. The initial diagnosis with plain X-rays was ankle sprain; however, an ankle CT scan confirmed the patient's injury and he was treated at Morelia's Children's Hospital. CT scan is an extremely useful aid in diagnosing inferior tibiofibular diastasis because the tear of the posterior distal tibiofibular ligament of the ankle mortise is missed in these patients, who initially are diagnosed as having an ankle sprain.

Resonancia magnética en fractura por estrés de calcáneo / Magnetic resonance imaging in calcaneal stress fractures

Las fracturas por estrés predominan en miembro inferior. Fueron descriptas por primera vez en 1855 antes del descubrimiento de los rayos X. Se encuentran relacionadas a diferentes actividades físicas recreacionales o profesionales. Se producen por sobrecarga repetitiva sobre un hueso con resistencia elástica normal. Las fracturas de estrés del calcáneo son poco frecuentes y consideradas de bajo riesgo. En las imágenes de RM se constató edema de la médula con patrón característico en etapa inicial previo al compromiso de la cortical evidenciable en TC. La RM debe ser la metodología diagnóstica de elección para el diagnóstico de fracturas de estrés del calcáneo en estadía agudo...

Comparación entre la clasificación AO pediátrica y la de Dias-Tachdjian en fracturas de tobillo infantiles / Comparison between the pediatric AO classification and the Dias-Tachdjian classification in pediatric ankle fractures

Introducción: El objetivo del presente estudio fue analizar el grado de confiabilidad entre dos clasificaciones globalmente empleadas para fracturas de tobillo en la edad pediátrica. Materiales y métodos: Se estudiaron 53 pacientes: 34 de sexo masculino y 19 de sexo femenino, con antecedentes de fractura de tobillo. Se emplearon dos clasificaciones. Se llevó a cabo un estudio detallado calculando el valor Kappa de Cohen para la confiabilidad intraobservador y, para calcular el acuerdo interobservador, se dedujo el valor Kappa utilizando el método de Fleiss. Resultados: El acuerdo intraobservador e interobservador en las dos clasificaciones no fue convincentemente diferente entre los distintos grupos de examinadores. Conclusiones: Durante la edad pediátrica, es posible encontrar diferentes tipos fracturarios y distintos mecanismos en una misma fractura. Se observó que estos patrones no quedaban englobados en ninguna de las dos clasificaciones, que fueron improductivas para la planificación quirúrgica.

Posterior ankle impingement in fast bowlers in cricket / Pinzamiento posterior del tobillo en lanzadores de críquet rápidos

OBJECTIVES: To determine common features of posterior ankle impingement in fast bowlers in the West Indies and to compare modes of treatment with respect to return to play without pain. METHODS: Retrospective analysis of ankle impingement injuries treated in fast bowlers in the West Indies. RESULTS: Six fast bowlers had evidence of os trigonum in the front foot only. Pain was felt on forced plantar flexion and dorsiflexion on front foot landing; no pain was felt with running. Four had large os trigonum on radiographs, and one was only detectable on Magnetic Resonance (MRI) Imaging. The condition resolved in two bowlers with low workloads who had injections with steroid. The remainder had surgical excision which led to recovery. CONCLUSION: This injury is being seen increasingly in fast bowlers. Steroid injections are useful in bowlers with low workloads but surgical excision is recommended in bowlers with heavy workloads. Further investigation is required in the biomechanics of bowling to determine the cause for the increase in this condition.

OBJETIVO: Determinar rasgos comunes del pinzamiento posterior del tobillo en lanzadores rápidos de West Indies, y comparar modos de tratamiento dirigidos a que puedan volver a jugar sin dolor. MÉTODO: Análisis retrospectivo del tratamiento de lesiones por pinzamiento del tobillo en lanzadores rápidos de West Indies. RESULTADOS: Seis lanzadores rápidos presentaban evidencia de os trigonum en el pie delantero solamente. Sentían dolor en la flexión plantar forzada y dorsiflexión al aterrizar con el pie delantero; no sentían ningún dolor al correr. Cuatro tenían os trigonum grandes según podía observarse en las radiografías, y un os trigonum era sólo detectable mediante imagen por resonancia magnética (IRM). La condición se resolvió en dos lanzadores con baja carga de trabajo, que recibieron inyecciones de esteroides. El resto recibió una escisión quirúrgica que condujo finalmente a la recuperación. CONCLUSIÓN: Este tipo de lesión viene observándose cada vez más en lanzadores rápidos. Las inyecciones de esteroide son útiles en lanzadores con baja carga de trabajo, pero en el caso de aquellos con alta carga de trabajo, se recomienda la escisión quirúrgica. Se requiere más investigación de la biomecánica del lanzamiento en el críquet a fin de determinar la causa del aumento de esta condición.

Síndrome do impacto do tornozelo na ressonância magnética: ensaio iconográfico / Magnetic resonance imaging of ankle impingement syndrome: iconographic essay

A síndrome do impacto do tornozelo é uma condição dolorosa causada por atrito de tecidos articulares, que é tanto causa quanto consequência de uma biomecânica alterada desta articulação. A sua principal causa são as lesões pós-traumáticas, principalmente lesões ligamentares, resultando em dor crônica no tornozelo. Do ponto de vista anatômico e clínico, estas síndromes são classificadas em: ântero-lateral, anterior, ântero-medial, póstero-medial e posterior. A ressonância magnética é um ótimo método diagnóstico para demonstrar as alterações ósseas e as partes moles dos vários tipos de impacto do tornozelo, fornecendo dados que auxiliam não só na comprovação desse diagnóstico, como na diferenciação com outras causas de dor articular. Os autores objetivam ilustrar os principais achados de ressonância magnética na síndrome do impacto do tornozelo.

Ankle impingement syndrome is a painful condition resulting from friction of joint tissues that is both cause and effect of an altered joint biomechanics. The leading causes of such condition are post-traumatic lesions, particularly the ligamentous ones, resulting in chronic ankle pain. From an anatomic and clinical point of view, these syndromes may be classified as anterolateral, anterior, anteromedial, posteromedial, and posterior. Magnetic resonance imaging is an excellent diagnostic method for demonstrating bone and soft tissue abnormalities resulting from different types of ankle impingement, providing useful data to confirm the diagnosis as well as to rule out other possible causes of joint pain. The present essay is aimed at illustrating the main magnetic resonance imaging findings in ankle impingement syndrome.

Tradução, adaptação cultural e validação do "American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale" / Translation, cultural adaptation and validity of the "American Orthopaedic Foot and Ankle Society's (AOFAS) Ankle-Hindfoot scale"

INTRODUÇÃO: A utilização em estudos científicos de escalas de avaliação de resultados são necessárias para que diferentes formas de tratamento possam ser comparadas em indivíduos com o mesmo diagnóstico. O objetivo do estudo foi realizar a tradução, adaptação cultural e validação da AOFAS Ankle-Hindfoot Scale para Língua Portuguesa. MÉTODOS: A escala foi administrada em 50 pacientes com problemas na articulação do tornozelo e retropé, duas vezes pelo entrevistador nº 1 e uma vez pelo entrevistador nº 2. Os pacientes foram também avaliados com o questionário genérico de qualidade de vida SF-36 e escala visual analógica da dor (EVA). RESULTADOS: O coeficiente de correlação de Pearson (CCP) e o coeficiente de correlação intra-classe (CCI) foram 0,93 (P<0,001) e 0,96, respectivamente, para reprodutibilidade intra-observador e 0,92 (P<0,001) e 0,95, respectivamente, para reprodutibilidade interobservador. Os componentes capacidade funcional e dor (SF-36) apresentaram as maiores correlações (0,67 e 0,64; P<0,001, respectivamente) com a AOFAS Ankle-Hindfoot Scale. O CCP entre a EVA e a AOFAS Ankle-Hindfoot Scale foi inversamente proporcional (- 0,68 P<0,001). CONCLUSÕES: Concluímos que a tradução e adaptação cultural da versão da AOFAS Ankle-Hindfoot Scale para Língua Portuguesa foi satisfatória para aplicação em pacientes brasileiros, apresentando boa reprodutibilidade e validade construtiva.

BACKGROUND: The use of outcome assessment scales in scientific studies is necessary so that different treatment forms can be compared among individuals with the same diagnosis. This study targeted the translation, cultural adaptation and validation of AOFAS' Ankle-Hindfoot scale into Portuguese language. METHODS: The scale was applied to 50 patients with ankle-hindfoot joint conditions, twice by the interviewer # 1 and once by the interviewer # 2. The patients were also assessed by using the SF-36 quality-of-life generic questionnaire and the visual analogue scale (VAS). RESULTS: The Pearson Correlation Coefficient (PCC) and the Intra-Class Correlation Coefficient (ICC) were 0.93 (p<0.001) and 0.96, respectively, for intra-observer reliability and 0.92 (p<0.001) and 0.95, respectively, for inter-observer reliability. The functional capacity and pain components (SF-36) presented the highest correlations (0.67 and 0.64; p<0.001, respectively) at the AOFAS' Ankle-hindfoot scale. The PCC between VAS and AOFAS Ankle-Hindfoot scale was inversely proportional (- 0,68; p<0,001). CONCLUSIONS: We conclude that the version of AOFAS Ankle-Hindfoot scale for the Portuguese Language was successfully translated and cultural adapted for application to Brazilian patients, with satisfactory reliability and construct validity.

Tenosinovectomia endoscopica del flexor hallucis longus / Endoscopic synovectomy of the flexor hallucis longus

En las últimas tres décadas la artroscopia de tobillo se convirtió en una importante herramienta de diagnóstico y tratamiento para las afecciones crónicas y postraumáticas de tobillo y retropié. Existe escasa bibliografía internacional sobre patología periarticular tendinosa del tobillo y retropié. Sin embargo existen trabajos que demuestran los beneficios del tratamiento endoscópico con respecto a la cirugía convencional (abierta). El objetivo del presente trabajo es mostrar la experiencia con el tratamiento endoscópico de las tenosinovitis de tlexor hallucis longus y registrar las lesiones asociadas. Material y Métodos: Fueron incluídos en el presente estudio clínico-quirúrgico 5 pacientes intervenidos quirúrgicamente en el Hospital Universitario Austral en un plazo comprendido entre Agosto del 2007 y Agosto del 2008 con un seguimiento promedio de 17,2 meses (Rango de 9 a 23). Las edades pro mediaron los 38,2 años (Rango de 17 a 64). Cuatro pacientes pertenecían al sexo masculino (80%) y una al sexo femenino (20%). Resultados: La totalidad de los pacientes presentaron lesiones asociadas a la tenosinovitis de tlexor hallucis longus. No hubo recurrencia de la sinovitis. Ninguno ha deteriorado sus resultados a largo plazo. Todos han regresado a su actividad la actividad física previa al desarrollo de la patología. No tuvimos complicaciones vasculonerviosas (Disestesias/hipoestesias) en territorio de Nervio Tibial Posterior. Discusión: La tendinopatía del Flexor Hallucis Longus (FHL) es frecuentemente diagnosticada en bailarines, sin embargo algunos trastornos de este tendón son subdiagnosticados en otros grupos de pacientes. Harnilton y cols, reportaron buenos y excelentes resultados en 30 de 40 pacientes (75%) en los cuales se realizó cirugía abierta por síndromes de pinzamiento posterior y tenosinovitis de FHL, con 15% de complicaciones. Ferkel y cols. evidenciaron 9% de complicaciones ocurridas ...