Return to activity after excision of the symptomatic Os trigonum: A systematic review comparing arthroscopic versus open excision

Abstract

The os trigonum, an irregular, accessory ossicle at the posterior lateral process of the talus, is known to be one of the main causes of posterior ankle impingement. It is unclear if an arthroscopic technique offers a superior outcome over an open technique when surgical excision is indicated. The purpose of this study is to better understand the outcomes and complications after os trigonum excision using an open versus arthroscopic technique. Using PRISMA guidelines, a systematic review of studies published in PubMed, Cochrane Reviews, and CINAHL databases through November 2021 was conducted to identify articles that evaluated postoperative outcomes and complications following os trigonum excision. Studies involving concurrent procedures, arthroscopic approaches varying from the technique described by Van Dijk et. al (2000), and case studies (where n ≤ 2) were excluded 1996 unique articles were identified. 18 studies were included representing 242 patients undergoing the arthroscopic technique and 217 undergoing the open technique. The arthroscopic group returned to activity sooner than the open group (9.86 weeks versus 13.074 weeks, respectively; p-value <0.001). Sural nerve damage occurred in 11 patients in the open group (5.07%), while the arthroscopic group reported 1 complication (0.41%). Arthroscopic os trigonum excision may offer a quicker return to activity. Further data is required to compare additional clinical outcome measures of these two surgical strategies.

Keywords

• Os trigonum
• Excision
• Resection
• Arthroscopic
• Talus
• Outcome