Anterolateral Gutter Ankle

The anterolateral ankle gutter is the most common site of ankle impingement. 3 over time a meniscoid lesion is often the result of the lateral ankle injury. 3 during an inversion ankle injury the anterior talofibular ligament and calcaneofibular ligament are affected as is the distal syndesmosis.

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Anterolateral impingement of the ankle is a relatively uncommon cause of chronic lateral ankle pain produced by entrapment of abnormal soft tissue in the anterolateral gutter of the ankle 2 4 fig.

Anterolateral gutter ankle.

Typically the capsule and synovial lining of the ankle joint get inflamed and can develop scar tissue in either the anteromedial gutter or anterolateral gutter between the ankle bones. However there is no associated ligamentous ankle instability. Anterolateral impingement is thought to occur subsequent to relatively minor inversion injuries of the ankle. The leading causes of impingement lesions are posttraumatic injuries usually ankle sprains leading to chronic pain.

Significant scarring and irregularity of the anterior talofibular ligament with chronic appearing periosteal stripping occurring at the fibular origin. Patients with anterolateral impingement present with chronic ankle pain swelling along the anterolateral aspect of the ankle and limited dorsiflexion. Anterolateral impingement syndrome of the ankle is caused by entrapment of the hypertrophic soft tissue in the lateral gutter. This irritation and hypertrophy of the tissue can cause pain with ankle dorsiflexion and subsequently symptoms with athletic activities.

Soft tissue swelling is present in the anterolateral shoulder of the ankle joint and palpable masses are occasionally noted within the lateral gutter. Patients may have a history of ankles sprains or chronic ankle instability and now present with constant lateral ankle pain upon ambulation. 9 pain can be elicited with passive dorsiflexion and eversion. These likely present sources of anterolateral gutter impingement.

Abrasion of the anterolateral talar dome ar ticular surface and secondary chondral inju ry may develop 15. The impingement process begins when an inversion sprain tears the anterior talofibular and or the calcaneofibular ligament. There is scar tissue and synovitis within the anterolateral gutter as well as a 5 mm osteochondral loose body. This click has been attributed to aitfl impingement.

Anterolateral ankle impingement has been known under the term anterolateral meniscoid lesion which is the result of synovitis in the anterolateral gutter. Patients experience anterolateral ankle pain that is intensified with supination or pronation of the foot anterolateral point tenderness pain with a single leg squat and swelling. An audible click may also be heard during ankle range of motion. Ankle impingement syndromes may also be congenital in origin.

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