Anatomical safety and clinical efficacy of arthroscopic management of posterior ankle impingement syndrome via a posterolateral dual-portal approach

Li Rui; Li Yuanqiang; Chen Wan; Chen Qianbo; Yuan Chengsong

doi:10.3969/j.issn.1009-4237.2026.01.004

Abstract：Objective To evaluate the anatomical safety and clinical efficacy of arthroscopic management of posterior ankle impingement syndrome via a posterolateral dual-portal approach in the lateral decubitus position.Methods This study employed a three-phase progressive design,i.e.,phase 1:measure the safe operative distance to the sural nerve through the posterolateral dual-portal approach based on 11 specimens;phase 2:measure the dis-tances from the posterior ankle bony landmarks to the posterior tibial artery based on the time-of-flight magnetic reso-nance angiography(TOF-MRA)imaging data of 21 patients treated non-surgically at our center during 2024,to vali-date vascular safety in the operative zone;and phase 3:validate the clinical feasibility,by retrospectively analyzing clinical data of 75 patients with posterior ankle impingement syndrome who underwent arthroscopic treatment via a posterolateral dual-portal approach at our center between Jun.2013 and Dec.2024 after failed non-surgical treat-ment.Among the 75 patients,there were 56 males and 19 females aged 23-41(mean 29.0)years,with 34 cases of chronic overuse,19 biomechanical abnormalities,12 anatomic variations,and 10 trauma.Clinical efficacy was sys-tematically evaluated using the American Orthopaedic Foot&Ankle Society(AOFAS)ankle-hindfoot scale and vis-ual analog scale(VAS)for pain.Results In the 11 specimens,the distance from the lateral/posterior portals to the sural nerve was(13.87±4.51)mm and(13.56±3.95)mm,respectively,without any statistically significant difference(mean difference=0.31 mm,P=0.879).TOF-MRA imaging data of the21 cases revealed that the dis-tance from the posterior tibial artery to the posterior ankle process,posterolateral talar process,and posterior subtalar joint was(12.52±3.05)mm,(12.88±2.05)mm,and(17.64±3.13)mm,respectively(F=33.412,P<0.001,one-way repeated-measures ANOVA).Patients were followed up for a mean of 43(range 19-47)months,which showed that the AOFAS scores improved from 65.3±6.3 to 91.8±4.6(mean improvement 26.5±6.5,P<0.001),and VAS decreased from 6.1±0.8 to 0.7±0.5(mean reduction 5.4±0.9,P<0.001).No complica-tions of infection,nerve injury,etc.occurred.Conclusion This integrated study(anatomic,imaging,and clinical)systematically demonstrates that the posterolateral dual-portal arthroscopic approach can effectively eliminate im-pingement pathology and improve function.It presents the advantages of optimal visualization,high anatomical safe-ty,low complication rates,and significant clinical efficacy,meriting wider clinical adoption.