Operative Treatment of Posterior Ankle Impingement Syndrome and Flexor Hallucis Longus Tendinopathy in Dancers Open Versus Endoscopic Approach.

Posterior ankle impingement syndrome (PAIS) is a painful, usually limited plantar flexion of the ankle joint due to soft tissue impingement or a bony impediment often coinciding with tendinopathy of the flexor hallucis longus (FHL) behind the medial malleolus. In persistent complaints, the bony impediment is removed, the tunnel of the FHL tendon is released, or a combination of both procedures has traditionally been performed by open surgery. In 2000, an endoscopic surgical technique for PAIS and FHL tendinopathy was introduced. To date there is no evidence of the superiority of one surgical technique over the other in dancers; both the open and the endoscopic approach provide up to 90% good and excellent long-term results. We compared the first 20 consecutive open procedures with the first 19 consecutive endoscopic procedures in dancers, all operated by the same orthopaedic surgeon. The postoperative outcomes were reviewed by studying the patient files, clinical evaluation, American Orthopaedic Foot and Ankle Society (AOFAS) scoring, and we administered a dance-specific questionnaire. The results in the open group were: nine excellent, nine good, one moderate, and one poor (90% excellent and good). In the endoscopic group: nine excellent, six good, three moderate, one poor (79% excellent and good). Both groups returned to dance (barre) at a median of 8 weeks (IQR: 2). The direct postoperative morbidity in the endoscopic group was less favorable and was mainly related to hematomas and an inflammatory response or deep scar tissue formation. There were no major complications requiring re-intervention. Although the two small groups of patients and the retrospective character of our descriptive study do not allow firm conclusions or statistical analysis of subgroups, the results of this study indicate that the open approach seems to be better than the endoscopic approach in the surgical treatment of PAIS and FHL tendinopathy in dancers.