Learning Curve in the Posterior Endoscopy of the Ankle

Abstract

Category: Arthroscopy Introduction/Purpose: The Posterior Ankle Impingement Syndrome (PAIS) can be treated by the endoscopic technique with posterior portals and patient in prone position. There is discussion whether this would be the best method, given the possible difficulty in learning and applying this technique, risks of complications and prolonged time of surgery. We conducted this retrospective study to assess the time spent to perform the posterior endoscopy along the learning curve and the relationship of the duration of the procedure to the presence of complications. Methods: We evaluated 39 patients undergoing endoscopic treatment through posterior ankle portals technique and prone position, operated by a single surgeon between 2005 and 2014. We divided the patients into four groups of ten subjects according to the chronological sequence of the surgeries. We used the Jonckheere-Terpstra test to compare the surgery time between the four analyzed groups. We used the Mann-Whitney test to compare operative time and the occurrence of complications, and the relationship between surgical procedure time and presence of intraoperative fibrosis. We used the Wilcoxon signed-rank test to compare preoperative and postoperative AOFAS Ankle-Hindfoot Score. For all statistical analysis, p-values <0.05 were considered to be significant. Results: We found a significant decreasing of the surgery duration over time (p=0.0273) (Figure). Figure: Representing surgery time (in minutes) to groups of patients (Groups 1 to 4, being Group 1 patients 1-10, Group 2 patients 11-20, Group 3 patients 21- 30 and Group 4 patients 31-39).There were three complications not related to the duration of the surgery (p=0.6909). The presence of extensive fibrosis had an impact on the operative time (p=0.0387). The AOFAS Score evolved from 64.0±16.9 preoperatively to 93.7±8.9 postoperatively (p<0.0001). Conclusion: The time of the procedure decreased as the surgeon’s experience increased, and our complications showed no relationship with the surgery time.