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Sports Medicine Feature

Source: Wikimedia Commons and Mr.schultz

NFL: Return to Sport Rates High After Ankle Decompression

Tracey Romero • Fri, February 9th, 2018

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Ankle impingement which results from repetitive dorsiflexion trauma and causes pain and decreased range of motion in the injured ankle is very common in football players because of maneuvers like sprinting, back-peddling, and offensive and defensive stances.

To see if arthroscopic anterior ankle decompression could help get National Football Players (NFL) back on the field at their pre-injury level, a new study in the American Journal of Orthopedics, “Arthroscopic Anterior Ankle Decompression Is Successful in National Football League Players” published in January 2018, analyzed the results of 29 arthroscopic ankle debridements by James Bradley, M.D., of the Burke and Bradley Orthopedics in Pittsburgh, Pennsylvania.

During the analysis, preoperative and postoperative visual analog scale (VAS) pain scores, American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot scores, and ankle range of motion were compared, and time to return to play and any complications were recorded.

According to the results, all of the athletes return to the same level of NFL play at a mean of 8.4 (4.1) weeks after surgery and continued to play for a mean of 3.43 years after surgery. All players also saw significant improvements in VAS pain scores, AOFAS hindfoot scores and range of motion. Mean VAS pain scores decreased significantly (p < .001) to 0.38 (0.89) from 4.21 (1.52) and mean active ankle dorsiflexion increased significantly (p < .001).

Bradley told OTW, “Arthroscopic debridement of anterior ankle impingement relieves pain, restores ROM [range of motion] and function, and results in reliable RTP [return to play] in professional football players.”

He described the technique used as “first, a diagnostic arthroscopy was performed and a full radius resector was used to perform a synovectomy and debridement of impinging soft tissue of the anterior talofibular ligament or anterior inferior talofibular ligament. A small burr was used to remove any osteophytes on the talus and/or tibia until the contours were normal and ankle ROM was done to confirm complete resolution of symptoms.”

He added, “All athletes should first undergo conservative treatment including rest, ankle bracing, and avoidance of repetitive dorsiflexing activities. This is obviously difficult in NFL players leading to a more aggressive approach.”

Bradley acknowledged certain limitations in the study like the fact that there was no non-operative comparison group and that the newest validated outcome scores like Sports subscale of the Foot and Ankle Ability Measure were not included because the study predated them.

He said, “However, we believe return to play at an elite NFL level is the outcome measure of most interest and importance.”

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