however , some patients remain symptomatic . both biedert   and takao et al .   showed the importance of ankle arthroscopy in cases where the cause of residual pain after an ankle sprain was , after clinical examination and complementary investigations , undiagnosable .
biedert   described several conditions showing good results after arthroscopic interventions in two - thirds of all patients .
one - third showed unsatisfactory results mainly because of degenerative changes . in this article ,
two patients with ankle complaints were referred to our out - patient clinic with identical symptoms . a 21-year - old male ( patient 1 ) reported a right ankle sprain one year before , and a 38-year - old male ( patient 2 ) sustained an identical trauma two years before to his left ankle .
sports activities ( jumping , running , soccer ) were restricted due to pain on the anteromedial side of the ankle joint .
a recognizable superficial ankle pain could be provoked by compressing the anteromedial side of the ankle joint .
standard anteroposterior and lateral radiographs and a complementary oblique anteromedial impingement ( ami ) radiograph   of the ankle displayed no abnormalities .
magnetic resonance imaging ( mri ) evaluation was performed 3  months ( patient 1 ) and 12  months ( patient 2 ) post trauma . in both cases
a standard anterior ankle arthroscopy was performed , and although mri evaluation was not conclusive , soft - tissue impingement was suspected . during the operation , a web - like intra - articular fibrous band was discovered in both cases , extending from the medial malleolus to the anterior distal tibia rim and talus , creating a web over the anteromedial portion of the talus ( fig . 
after the removal of the band , a superficial fraying of the talus ( a sign of the impingement of the band on the talar surface ) was noticed in patient 1 ( fig .  2 ) .
at a 1-year follow - up , both patients had no swelling , a pain - free full range of motion and a maximum aofas score.fig . 
1intra - articular fibrous bands creating a web over the anteromedial talus with its attachments to the medial malleolus , distal tibia rim and talusfig . 
the asterisk indicates a partially resected fibrous band intra - articular fibrous bands creating a web over the anteromedial talus with its attachments to the medial malleolus , distal tibia rim and talus detail of the anteromedial talus with a chondral lesion illustrated by arrows .
the asterisk indicates a partially resected fibrous band histology of the fibrous band showed fibrous tissue with broad collagen and normal fibroblasts resembling ligamentous tissue .
the most important findings of the present study were the discovery of an intra - articular fibrous web over the anteromedial talus causing anterior ankle impingement and the value of ankle arthroscopy both as a diagnostic tool and as a treatment modality .
it can be classified according to its location ( anterolateral , anterocentral , anteromedial ) and to its biological substrate causing the impingement ; most commonly : post - traumatic synovitis , capsular scarring or bony osteophytes .
bony osteophytes may lead to entrapment of the adjacent anterior joint capsule and give rise to the actual pain sensation .
soft - tissue pathology can also cause anterior ankle impingement in the absence of underlying osteophytes .
excellent functional outcomes after arthroscopic resection of anteromedial ankle impingement were reported by murawski and kennedy .
transarticular fibrous bands are distinct band - like structures which are firmly attached to capsule , articular surface or bone .
guhl attributes the origin of these bands to a cellular reaction following an intra - articular hematoma .
an explanation for the fibrous bands occurring more frequently in the anterior recess of the ankle is the larger volume of the anterior recess compared to the posterior recess , allowing more blood to accumulate after a trauma . because of the frequent association of fibrous bands with fractures
, a careful inventory of the ankle joint should be performed if a fibrous band is encountered during an ankle arthroscopy .
ankle fractures are known to cause arthrofibrosis with its negative effect on joint function . considering the etiology of intra - articular fibrous bands , the consequence of finding one should prompt a careful inspection of the ankle joint for occult pathology [ 1 , 9 , 10 ] .
the main distinction being that the meniscoid is attached at one end and the fibrous band is attached at both ends .
the meniscoid is flattened and usually tapering at its free end and has its origin at the inferolateral gutter on the anterior talofibular ligament [ 2 , 10 ] or on the deltoid ligament on the medial side [ 3 , 7 ] .
a fibrous band is cord - like in cross section and can be found anywhere in the joint .
a specimen was prepared by golan in order to illustrate fibrous bands in the anterior ankle recess causing a web over the anterior dome of the talus ( fig . 
3 ) . following repetitive impingement of the talar surface on the web with active dorsiflexion
, a superficial fraying of the cartilage of the anterior dome of the talus can be found ( fig .  2 ) .
the arrows indicate a fibrous band extending from the distal tibia to the talus and fibula .
lateral malleolus ( 1 ) , medial malleolus ( 2 ) , anterior tibiofibular ligament ( 3 ) , anterior talofibular ligament ( 4 ) , tibionavicular part of deltoid ligament ( 5 ) , anterior tibiotalar part of deltoid ligament ( 6 ) , dorsal talonavicular ligament ( 7 ) , subtalar joint ( 8) , tarsal sinus ( 9 ) anatomical ankle specimen .
the arrows indicate a fibrous band extending from the distal tibia to the talus and fibula .
lateral malleolus ( 1 ) , medial malleolus ( 2 ) , anterior tibiofibular ligament ( 3 ) , anterior talofibular ligament ( 4 ) , tibionavicular part of deltoid ligament ( 5 ) , anterior tibiotalar part of deltoid ligament ( 6 ) , dorsal talonavicular ligament ( 7 ) , subtalar joint ( 8) , tarsal sinus ( 9 ) limitations of the present study are the small patient group and short follow - up .
.   showed excellent or good results after a 58-year follow - up for the arthroscopic treatment of anterior soft - tissue ankle impingement .
comparable long - term results for the treatment of the pathology of the present study are lacking .
mri is valuable in the diagnostic workup of ankle impingement lesions . in cases of fibrous bands of the ankle
however , the bands are most evident on axial and sagittal proton - density images [ 5 , 9 ] . in both patients , mri evaluation was negative for the intraoperatively diagnosed fibrous band . in our opinion , it is the clinical suspicion for soft - tissue impingement that sets the indication for anterior ankle arthroscopy .
an ankle distortion can result in the formation of intra - articular fibrous bands causing  web impingement  of the ankle .
anterior ankle arthroscopy is of great value in the diagnostic work - up and treatment . if intra - articular fibrous bands are encountered , inspection of the ankle for the coexistence of occult pathology is indicated . in the present study ,
 this case report presents two patients with persisting anterior ankle impingement pain after an ankle distortion . 
 a web - like intra - articular fibrous band was discovered and resected . 
 the patients presented were , after a 1-year follow - up , pain free . 
 level of evidence iv . 
Introduction
Case report
Discussion
Conclusion