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Arthroscopic Anterior Ankle Decompression Is Successful in National Football League Players

January 26, 2018 | Surgery
Christopher L. McCrum, MD ; Justin W. Arner, MD ; Bryson Lesniak, MD ; James P. Bradley, MD
Author and Disclosure Information

Authors’ Disclosure Statement: Dr. Bradley reports that he receives royalties from Arthrex. The other authors report no actual or potential conflict of interest in relation to this article.  

Dr. McCrum is an Orthopaedic Surgery Sports Fellow, Dr. Arner is an Orthopaedic Surgery Resident, and Dr. Lesniak is Associate Professor, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. Dr. Bradley is Clinical Professor, University of Pittsburgh Medical Center and Burke and Bradley Orthopedics, Pittsburgh, Pennsylvania.

Address correspondence to: James P. Bradley, MD, Burke and Bradley Orthopedics, 200 Medical Arts Building, Suite 4010, 200 Delafield Rd, Pittsburgh, PA 15215 (tel, 412-784-5770; fax, 412-784-5776; email, bradleyjp@upmc.edu).

Christopher L. McCrum, MD Justin W. Arner, MD Bryson Lesniak, MD James P. Bradley, MD . Arthroscopic Anterior Ankle Decompression Is Successful in National Football League Players. Am J Orthop. January 26, 2018

TAKE-HOME POINTS

  • Anterior ankle impingement can be very debilitating in elite athletes and may lead to significantly decreased performance.
  • First line treatment for anterior ankle impingement is conservative which includes rest, ankle bracing, and avoidance of repetitive dorsiflexing activities such as jumping.
  • Arthroscopic débridement of anterior ankle impingement reliably relieves pain, and restores ROM and function.
  • Arthroscopic débridement of anterior ankle impingement results in reliable RTP in professional football players.
  • RTP after arthroscopic anterior ankle débridement for impingement averaged 2 months in professional football players.

During diagnostic arthroscopy, changes to the articular cartilage were noted: grade 0 in 38% of patients, grade 1 in 17%, grade 2 in 21%, grade 3 in 21%, and grade 4 in 3%. Four patients had an osteochondral lesion (<1 cm in each case), which was treated with chondroplasty without microfracture.

Each included patient returned to NFL play. Mean (SD) time to RTP without restrictions was 8.4 (4.1) weeks after surgery (range, 2-20 weeks). There was a poor correlation between degree of chondrosis and time to RTP (r = 0.305). In addition, there was a poor correlation between age and time to RTP (r = 0.106).

Dorsiflexion improved significantly (P < .001), patients had significantly less pain after surgery (P < .001), and AOFAS hindfoot scores improved significantly (P < .001) (Table 2).

Table 2. Preoperative and Postoperative Dorsiflexion, Pain, and AOFAS Score Before and After Arthroscopic Débridement of Anterior Ankle Impingementa
 Mean (SD)
 PreoperativePostoperative
Dorsiflexion8.28º (4.14º)18.86° (2.62°)
VAS pain score4.21 (1.52)0.38 (0.89)
AOFAS score70.62 (10.39)97.45 (4.72)

aAll values were significantly improved after surgery (P < .001).

Abbreviations: AOFAS, American Orthopaedic Foot and Ankle Society; VAS, visual analog scale.

The athletes played in the NFL for a mean (SD) of 3.43 (2.57) years after surgery (range, 1-10 seasons). These players included 6 who were still active at time of publication. No patient required revision surgery or additional surgery on the ipsilateral ankle. The one patient who was treated for superficial thrombophlebitis after surgery reported symptoms before surgery as well.

DISCUSSION

Arthroscopic decompression of anterior ankle impingement is safe and significantly improves pain and ROM in professional American football players. The procedure results in reliable RTP at an elite level, with durable results over the time remaining in their NFL careers.

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