Original Research

Arthroscopic Anterior Ankle Decompression Is Successful in National Football League Players

Publish date: January 26, 2018

References

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For the NFL players in our study, RTP at their elite level was 100% after arthroscopic débridement of anterior ankle impingement. In the literature, time to RTP varies. Table 3 lists RTP rates for recreational athletes in published studies.^18-27 In their recent systematic literature review, Zwiers and colleagues¹⁰ noted that 24% to 96.4% of recreational athletes returned to play after arthroscopic treatment for anterior ankle impingement. The percentage was significantly higher for the professional athletes in our study. Historical comparison supports an evolution in the indications and techniques for this procedure, with more recent literature suggesting a RTP rate much higher than earlier rates. In addition, compared with recreational athletes, professional athletes have strong financial incentives to return to their sports. Furthermore, our professional cohort was significantly younger than the recreational cohorts in those studies.

Table 3. Frequency of Recreational Athletes’ Return to Play After Arthroscopic Débridement of Anterior Ankle Impingement, as Reported in the Literature

Study	Year	Journal	Return to Play
			n/N	%
Akseki et al¹⁸	1999	Acta Orthop Scand	10/11	91
Baums et al¹⁹	2006	Knee Surg Sports Traumatol Arthrosc	25/26	96
Branca et al²⁰	1997	Foot Ankle Int	13/27	48
Di Palma et al²¹	1999	J Sports Traumatol Relat Res	21/32	66
Ferkel et al²²	1991	Am J Sports Med	27/31	87.1
Hassan²³	2007	Knee Surg Sports Traumatol Arthrosc	9/11	82
Jerosch et al²⁴	1994	Knee Surg Sports Traumatol Arthrosc	9/38	24
Murawski & Kennedy²⁵	2010	Am J Sports Med	27/28	96.4
Ogilvie-Harris et al²⁶	1993	J Bone Joint Surg Br	21/28	75
Rouvillain et al²⁷	2014	Eur J Orthop Surg Traumatol	10/11	90
Total			172/243	70

Current recommendations for recreational athletes include initial conservative treatment with rest, ankle bracing, and avoidance of jumping and other repetitive dorsiflexing activities. Physical therapy should include joint mobilization and work along the entire kinetic chain. Night splints or a removable walking boot can be used temporarily, as can a single intra-articular corticosteroid injection to reduce inflammation and evaluate improvement in more refractory cases.²⁸ Commonly, conservative treatments fail if patients remain active, and soft tissue and/or osteophytes can be resected, though resection typically is reserved for recreational athletes for whom nonoperative treatments have been exhausted.^29,30

This study had several limitations, including its retrospective nature and lack of control group. In addition, follow-up was relatively short, and we did not use more recently described outcome measures, such as the Sports subscale of the Foot and Ankle Ability Measure, which may be more sensitive in describing function in elite athletes. However, many of the cases in our study predated these measures, but the rate of RTP at the NFL level requires a very high degree of postoperative ankle function, making this outcome the most meaningful. In the context of professional athletes, specifically the length of their careers, our study results provide valuable information regarding expectations about RTP and the durability of arthroscopic débridement of anterior ankle impingement in a high-demand setting.

CONCLUSION

For all the NFL players in this study, arthroscopic débridement of anterior ankle impingement resulted in return to preoperative level of play at a mean of 2 months after surgery. There were significant improvements in VAS pain scores, AOFAS hindfoot scores, and ROM. Arthroscopic débridement of anterior ankle impingement relieves pain, restores ROM and function, and results in reliable RTP in professional football players.