Arthroscopic treatment of antirior synovitis of the ankle in athletes

In a retrospective study we analysed the results of arthroscopic treatment of anterior synovitis of the ankle in 35 athletes. Five athletes additionally suffered from anterior osteophytes, and three presented with an anterolateral plica. Their average age was 25 years (SD 8.3), and the follow-up interval was 32.4 months (SD 19.4). Eight patients suffered from additional hyperlaxity of the ankle joint. At the time of follow-up, the patients were examined clinically as well as radiologically. The results were scored according to an ankle index containing the criteria pain, function, athletic activity, walking aids, range of motion and swelling. During surgery a partial synovectomy was performed and removal of anterior osteophytes or anterolateral plica as necessary. The overall score increased non-significantly from 66.2 preoperatively to 78.7 postoperatively (P>0.05). Comparing the different criteria, the score parameter pain significantly increased after arthroscopy. All other parameters (function, athletic activity, walking aids, range of motion, swelling) showed only slight changes in this patient group. Athletes with a hypermobile joint showed worse results compared with the others. Even after surgery we documented severe restriction concerning athletic activity. Only 9 patients performed their activities at their previous level, 19 had reduced their activity level, and 7 had discontinued their athletic activity. In 6 cases we found temporary iatrogenic neurological damage. Regarding the uncertain clinical outcome and the documented high risk for neurovascular complication, patient selection for arthroscopic partial synovectomy in the athletic population should be extremely carefully performed. Prior to surgery all other conservative options including changes of running shoes as well as modifications in the exercise programme and athletic activiy should be taken into account.