Instability Impingement

A. Ankle Instability

Acute Ankle Sprains

Understand the Ottawa Ankle Rules. Review grading (I-III) and RICE/POLICE protocol. Principles of early functional rehabilitation.

Chronic Lateral Ankle Instability

Clinical and imaging assessment (stress views). Master the modified Broström-Gould procedure (anatomic repair). Discuss indications for non-anatomic tenodesis (e.g., Chrisman-Snook) and allograft/autograft ligament reconstruction for revision or poor tissue quality.

Syndesmotic Injuries

Assess stability (stress imaging, hook test). Compare fixation methods: syndesmotic screws vs. suture button devices. Understand the post-operative protocol for screw removal vs. permanent devices.

B. Impingement Syndromes

Anterior Ankle Impingement

Differentiate between soft tissue (meniscoid lesion) and osseous (tibiotalar exostoses) impingement. Techniques for anterior ankle arthroscopy, including synovectomy and osteophyte resection.

Posterior Ankle Impingement

Clinical triad (Os Trigonum, FHL tenosynovitis, capsular thickening). Indications for surgical management (failure of non-op care). Techniques for posterior ankle arthroscopy or open approach for removal of Os Trigonum and FHL tenolysis/debridement.