BACKGROUND Posterior ankle impingement syndrome (PAIS) results from the pinching of anatomical structures in the posterior part of the ankle. OBJECTIVE To identify the possible role of imaging in the delayed diagnosis of PAIS and identify key findings on imaging to suggest PAIS in pediatric and adolescent patients. MATERIALS AND METHODS Data were collected prospectively in patients younger than 18 years of age who underwent arthroscopy after being diagnosed with PAIS. Imaging was reviewed retrospectively by two radiologists, compared with findings in literature and an age-matched control group, and correlated with arthroscopic findings. Pre- and postsurgical Visual Analogue Scale (VAS) pain and American Orthopedic Foot Ankle Society (AOFAS) ankle-hindfoot scores were noted. RESULTS Thirty-eight patients (20 females, 18 males), 51 ankles, with an average age of 12.9 years had an average 18-month delay in diagnosis. Twenty-seven of the 38 (73%) patients had previously seen multiple medical providers and were given multiple misdiagnoses. Radiographs were reported normal in 34/47 (72%) ankles. Thirty patients had magnetic resonance imaging (MRI) and findings included the presence of an os trigonum/Stieda process (94%) with associated osseous edema (69%), flexor hallucis longus (FHL) tenosynovitis (16%), and edema in Kager's fat pad (63%). Although individual findings were noted, the impression in the MRI reports in 16/32 (50%) did not mention PAIS as the likely diagnosis. There was a significant difference in the MRI findings of ankle impingement in the patient population when compared to the control group. Surgery was indicated after conservative treatment failed. All 51 ankles had a PAIS diagnosis confirmed during arthroscopy. At an average follow-up of 10.2 months, there was improvement of VAS pain (7.0 to 1.1) and AOFAS ankle-hindfoot scores (65.1 to 93.5). CONCLUSION PAIS as a diagnosis is commonly delayed clinically in young patients with radiologic misinterpretation being a contributing factor. Increased awareness about this condition is needed among radiologists and physicians treating young athletes.

中文翻译：

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小儿和青少年患者后踝撞击的延迟诊断：放射学起一定作用吗？

背景技术后踝撞击综合征（PAIS）是由脚踝后部的解剖结构收缩引起的。目的确定影像学在PAIS延迟诊断中的可能作用，并鉴定影像学的主要发现，以提示儿童和青少年患者的PAIS。材料与方法前瞻性收集18岁以下的患者，这些患者在被诊断为PAIS后接受了关节镜检查。两名放射科医生对影像学进行了回顾性审查，并与文献和年龄匹配的对照组进行了比较，并与关节镜检查结果相关联。注意到术前和术后的视觉模拟量表（VAS）疼痛和美国骨科足踝学会（AOFAS）踝后足评分。结果38例患者中，女性20例，男性18例，踝关节51例，平均年龄为12.9岁，诊断平均延迟18个月。38例患者中有27例（73％）以前曾看过多个医疗提供者，并曾被多次误诊。X线片报道踝关节34/47（72％）正常。30名患者进行了磁共振成像（MRI），发现包括三角骨/ Stieda突突（94％）伴有骨性水肿（69％），屈指长屈（FHL）腱鞘炎（16％）和Kager's水肿脂肪垫（63％）。尽管注意到了个人发现，但MRI报告中16/32的印象（50％）并未提及PAIS作为可能的诊断。与对照组相比，患者人群中踝部撞击的MRI表现有显着差异。保守治疗失败后需手术治疗。在关节镜检查中，所有51个脚踝均得到了PAIS诊断。平均随访10.2个月，VAS疼痛改善（7.0至1.1）和AOFAS踝后足评分改善（65.1至93.5）。结论在年轻患者中，PAIS诊断通常被延迟，放射学误解是一个重要因素。放射治疗者和治疗年轻运动员的医师需要提高对这种状况的认识。