Clinical Outcomes of Posterior Hindfoot Endoscopic Surgery Using 1.9-mm Diameter Needle Arthroscopy for Posterior Ankle Impingement in Athletes

Introduction Posterior hindfoot endoscopy is a safe and effective treatment for posterior ankle impingement syndrome (PAIS). However, data on the outcomes of needle arthroscopy for PAIS in athletes are still lacking. The purpose of this study is to investigate the clinical outcomes and return to sports following hindfoot endoscopic surgery utilizing 1.9-mm diameter needle arthroscopy in the treatment of PAIS, especially in athletes, including ballet dancers. Materials and Methods A retrospective cohort study was conducted to evaluate patients who underwent hindfoot endoscopic surgery using 1.9-mm diameter needle arthroscopy for PAIS between 2021 and 2023. Clinical outcomes were evaluated preoperatively and 12 months after surgery using the Japanese Society for Surgery of the Foot (JSSF) scale and the Self-Administered Foot Evaluation Questionnaire (SAFE-Q). The time to return to sports training, and complete return to sports activities were also evaluated. Results Thirteen patients (5 male and 8 female) with a mean age of 21.1 years were included. The mean follow-up time was 17.1 months. Sports activities included ballet (7 patients), soccer (3 patients), lacrosse (2 patients), and tennis (1 patient). The mean JSSF scale significantly improved from 79.1 preoperatively to 98.3 at the final follow-up (p < 0.001). The mean SAFE-Q scores improved significantly postoperatively in all subscales, except the shoe-related subscale. The mean time to return to sports-specific training was 3.8 weeks. All patients were able to return to full sports activities, and the mean time to return to full sports activities at the pre-injury levels was 6.3 weeks. The ballet dancers returned to full activity at the pre-injury levels at a mean time of 7.3 weeks. Conclusions Posterior hindfoot endoscopy employing 1.9-mm diameter needle arthroscopy demonstrated excellent clinical outcomes in the management of PAIS, with patients experiencing a relatively earlier return to sports, including ballet dancers. Level of Evidence: Level IV, case series