1. IN THE NAME OF GOD

2. IMPACT OF OBESITY ON THE ARTHROSCOPIC TREATMENT OF ANTEROLATERAL IMPINGEMENT SYNDROME OF THE ANKLE (ALISA) Mohsen Mardani-Kivi, M.D. Orthopedic Department, Guilan University Of Medical Sciences

3. INTRODUCTION :  Obesity: a serious problem / one in three adults in some countries.  obesity significantly increased the chances of having tendinitis, plantar fasciitis, and OA and increased stress on the soft tissues and joints.

4. INTRODUCTION :  ALISA:  chronic ankle pain for > 3months with tenderness of anterolateral region worsened with dorsiflexion  chronic pain secondary to hypertrophy or disruption of the anterolateral ligament or capsule of the ankle (repeated traumatic injuries or tensions)

5. THE PURPOSE OF THE STUDY :  To determine the effect of obesity on the arthroscopic findings and functional outcomes following arthroscopic treatment of the ALISA

6. MATERIALS AND METHODS: A retrospective case series study, 36 patients, 2008-2011 chronic ankle pain for > 3months with tenderness of anterolateral region worsened with dorsiflexion Hx. of repetitive traumatic inversion injuries of the ankle Unresponsive to conservative therapy with NSAIDs, PT and CSI for at least 3 months. Excluded: Overweight patients -patients with a BMI>24.9 but <30.

7. MATERIALS AND METHODS: Scranton criteria I: impingement of the soft tissue or spurs of less than 3mm II: tibial spurs more than 3mm III: fragmentation or tibial and talar spurs of more than 3mm IV: Tibio-talar osteoarthritis The patients with instability of the ankle joint and/or OA of the ankle (Scranton IV) were excluded from the study.

8. ARTHROSCOPIC INTERVENTION:  GA anesthesia / supine position /  Standard portals of the anterolateral and anteromedial of the ankle joint  Debridement of the synovial hypertrophy and anterolateral scarring and scraping of any possible spurs.

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14. RESULTS: Sample size: 36 cases Non-obese group: patients with a BMI between 18.5 and 24.9 (10 patients) Obese group: patients with a BMI ≥ 30. (26 patients)

15. RESULTS: significant improvement  AOFAS scores of both obese and non-obese group showed significant improvement in 6 th and 12 th follow up visits (P<0.001). not  AOFAS scores of the non-obese patients were improved more than those of the obese patients, yet it was not statistically significance.

16.  joints. not The non-obese patients had a higher AOFAS score in compare with the obese individuals but it was not statistically significant.

17. RESULTS:  patients with chondral lesion had higher BMI than those who did not have this lesion (P<0.05). none  Other diagnosed lesions were poorly related to higher BMI, and none of them reached significant difference. BMI INCIDENCE OF CHONDRAL LESION

18. RESULTS: THE ARTHROSCOPY RESULTS BY BMI

19. DISCUSSION:  In our previous study, we reported that arthroscopic treatment relieved the symptoms of pain and improved ankle function considerably both for patients with or without chondral lesions

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21. DISCUSSION: not  While many surgeons expect that increased BMI has a negative effect on surgical morbidity, this is not the case about ALISA, with regards to the present study.

22. CONCLUSION:  Our findings indicate that arthroscopic treatment of the ankle is effective on both obese and non-obese patients.

23. THANK YOU FOR YOUR ATTENTION