Advertisement

Safety and Efficiency of a 2-Portal Lateral Approach to Arthroscopic Subtalar Arthrodesis: A Cadaveric Study

      Purpose

      To investigate the safety and efficiency of a 2-portal lateral (anterior and middle) approach to arthroscopic subtalar arthrodesis.

      Methods

      A cadaveric study was performed on 30 feet of 15 fresh cadaveric bodies (15 right and 15 left; 21 female specimens and 9 male specimens). The mean age at death was 78 ± 6.7 years. The procedure was performed with the specimen in the supine position through 2 lateral (anterior and middle) sinus tarsi portals by use of a 4.0-mm arthroscope. A 3.5-mm synovial shaver was used for debridement, and a 4.5-mm shielded bur was used to resect posterior subtalar facets. The feet were then dissected. The primary outcomes were the percentage of resected joint surface and the distances between portals and both sural and superficial peroneal nerves. The secondary outcomes were injury of sinus tarsi ligaments and lateral arterial network, calcaneofibular ligament, peroneal tendons, flexor hallucis longus tendon, and posterior tibial neurovascular bundle.

      Results

      The mean percentages of resected talar and calcaneal posterior subtalar facets were 94% ± 7.2% and 91% ± 6.8%, respectively. The minimum distance of either subtalar portal to the nerves was 4 mm. No nerve injury was observed. In 28 of 30 cases, the lateral sinus tarsi arterial network was found intact. In all cases the inferior retinaculum extensor was transfixed by the portals. In all cases both cervical and interosseous talocalcaneal ligaments were found intact. In 3 cases a shaving lesion was observed on the peroneus brevis tendon.

      Conclusions

      According to this cadaveric study, more than 90% freshening of the posterior subtalar articular facets can be achieved through a 2-portal lateral (anterior and middle) approach. This technique is reproducible and safe with regard to the surrounding nerves.

      Clinical Relevance

      The 2 lateral portals may offer a safe and effective alternative approach for arthroscopic arthrodesis of the posterior subtalar joint.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Parisien J.S.
        • Vangsness T.
        Arthroscopy of the subtalar joint: An experimental approach.
        Arthroscopy. 1985; 1: 53-57
        • Ahn J.H.
        • Lee S.K.
        • Kim K.J.
        • Kim Y.I.
        • Choy W.S.
        Subtalar arthroscopic procedures for the treatment of subtalar pathologic conditions: 115 consecutive cases.
        Orthopedics. 2009; 32: 891
        • Albert A.
        • Deleu P.A.
        • Leemrijse T.
        • Maldague P.
        Devos Bevernage B. Posterior arthroscopic subtalar arthrodesis: Ten cases at one-year follow-up.
        Orthop Traumatol Surg Res. 2011; 97: 401-405
        • Amendola A.
        • Lee K.B.
        • Saltzman C.L.
        • Suh J.S.
        Technique and early experience with posterior arthroscopic subtalar arthrodesis.
        Foot Ankle Int. 2007; 28: 298-302
        • Beimers L.
        • de Leeuw P.A.
        • van Dijk C.N.
        A 3-portal approach for arthroscopic subtalar arthrodesis.
        Knee Surg Sports Traumatol Arthrosc. 2009; 17: 830-834
        • Carro L.P.
        • Golano P.
        • Vega J.
        Arthroscopic subtalar arthrodesis: The posterior approach in the prone position.
        Arthroscopy. 2007; 23: 445.e1-445.e4
        • El Shazly O.
        • Nassar W.
        • El Badrawy A.
        Arthroscopic subtalar fusion for post-traumatic subtalar arthritis.
        Arthroscopy. 2009; 25: 783-787
        • Glanzmann M.C.
        • Sanhueza-Hernandez R.
        Arthroscopic subtalar arthrodesis for symptomatic osteoarthritis of the hindfoot: A prospective study of 41 cases.
        Foot Ankle Int. 2007; 28: 2-7
        • Jerosch J.
        Subtalar arthroscopy—Indications and surgical technique.
        Knee Surg Sports Traumatol Arthrosc. 1998; 6: 122-128
        • Lee K.B.
        • Park C.H.
        • Seon J.K.
        • Kim M.S.
        Arthroscopic subtalar arthrodesis using a posterior 2-portal approach in the prone position.
        Arthroscopy. 2010; 26: 230-238
        • Lee K.B.
        • Saltzman C.L.
        • Suh J.S.
        • Wasserman L.
        • Amendola A.
        A posterior 3-portal arthroscopic approach for isolated subtalar arthrodesis.
        Arthroscopy. 2008; 24: 1306-1310
        • Lui T.H.
        New technique of arthroscopic triple arthrodesis.
        Arthroscopy. 2006; 22: 464.e1-464.e5
        • Lui T.H.
        Case report: Correction of neglected club foot deformity by arthroscopic assisted triple arthrodesis.
        Arch Orthop Trauma Surg. 2010; 130: 1007-1011
        • Lui T.H.
        • Chan K.B.
        • Chan L.K.
        Portal safety and efficacy of anterior subtalar arthroscopy: A cadaveric study.
        Knee Surg Sports Traumatol Arthrosc. 2010; 18: 233-237
        • Lundeen R.O.
        Arthroscopic fusion of the ankle and subtalar joint.
        Clin Podiatr Med Surg. 1994; 11: 395-406
        • Mann R.A.
        • Baumgarten M.
        Subtalar fusion for isolated subtalar disorders. Preliminary report.
        Clin Orthop Relat Res. 1988; : 260-265
        • Mann R.A.
        • Beaman D.N.
        • Horton G.A.
        Isolated subtalar arthrodesis.
        Foot Ankle Int. 1998; 19: 511-519
        • Mi K.
        • Liu P.
        • Liu W.
        • Feng Z.
        Arthroscopical subtalar arthrodesis for malunion of calcaneal fractures.
        Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2010; 24 (in Chinese): 875-877
        • Mouilhade F.
        • Oger P.
        • Roussignol X.
        • et al.
        Risks relating to posterior 2-portal arthroscopic subtalar arthrodesis and articular surfaces abrasion quality achievable with these approaches: A cadaver study.
        Orthop Traumatol Surg Res. 2011; 97: 396-400
        • Muraro G.M.
        • Carvajal P.F.
        Arthroscopic arthodesis of subtalar joint.
        Foot Ankle Clin. 2011; 16: 83-90
        • Pelton K.
        • Hofer J.K.
        • Thordarson D.B.
        Tibiotalocalcaneal arthrodesis using a dynamically locked retrograde intramedullary nail.
        Foot Ankle Int. 2006; 27: 759-763
        • Sekiya H.
        • Horii T.
        • Kariya Y.
        • Hoshino Y.
        Arthroscopic-assisted tibiotalocalcaneal arthrodesis using an intramedullary nail with fins: A case report.
        J Foot Ankle Surg. 2006; 45: 266-270
        • Sekiya H.
        • Horii T.
        • Sugimoto N.
        • Hoshino Y.
        Arthroscopic tibiotalocalcaneal arthrodesis with intramedullary nail with fins: A case series.
        J Foot Ankle Surg. 2011; 50: 589-592
        • Stroud C.C.
        Arthroscopic arthrodesis of the ankle, subtalar, and first metatarsophalangeal joint.
        Foot Ankle Clin. 2002; 7: 135-146
        • Tasto J.P.
        Arthroscopy of the subtalar joint and arthroscopic subtalar arthrodesis.
        Instr Course Lect. 2006; 55: 555-564
        • Thaunat M.
        • Bajard X.
        • Boisrenoult P.
        • Beaufils P.
        • Oger P.
        Computer Tomography assessment of the fusion rate after posterior arthroscopic subtalar arthrodesis.
        Int Orthop. 2012; 36: 1005-1010
        • Tuijthof G.J.
        • Beimers L.
        • Kerkhoffs G.M.
        • Dankelman J.
        • Dijk C.N.
        Overview of subtalar arthrodesis techniques: Options, pitfalls and solutions.
        Foot Ankle Surg. 2010; 16: 107-116
        • Easley M.E.
        • Trnka H.J.
        • Schon L.C.
        • Myerson M.S.
        Isolated subtalar arthrodesis.
        J Bone Joint Surg Am. 2000; 82: 613-624
        • Horibe S.
        • Kita K.
        • Natsu-ume T.
        • et al.
        A novel technique of arthroscopic excision of a symptomatic os trigonum.
        Arthroscopy. 2008; 24: 121.e1-121.e4
        • Lombardi C.M.
        • Silhanek A.D.
        • Connolly F.G.
        Modified arthroscopic excision of the symptomatic os trigonum and release of the flexor hallucis longus tendon: Operative technique and case study.
        J Foot Ankle Surg. 1999; 38: 347-351
        • van Dijk C.N.
        Hindfoot endoscopy for posterior ankle pain.
        Instr Course Lect. 2006; 55: 545-554
        • Cronier P.
        • Steiger V.
        • Talha A.
        • Sourice S.
        • Grandpierre J.
        Vascularisation artérielle du talus, conséquences chirurgicales.
        in: Besse J.L. Leemrijse T. Maestro M. Monographie AFCP N° 5. Journée de spécialité SOFCOT 2009. Sauramps Medical, Montpellier2009: 169-176
        • Cronier P.
        • Talha A.
        • Massin P.
        Central talar fractures—Therapeutic considerations.
        Injury. 2004; 35: SB10-SB22
        • Haliburton R.A.
        • Sullivan C.R.
        • Kelly P.J.
        • Peterson L.F.
        The extra-osseous and intra-osseous blood supply of the talus.
        J Bone Joint Surg Am. 1958; 40: 1115-1120
        • Lee K.B.
        • Chung J.Y.
        • Song E.K.
        • Seon J.K.
        • Bai L.B.
        Arthroscopic release for painful subtalar stiffness after intra-articular fractures of the calcaneum.
        J Bone Joint Surg Br. 2008; 90: 1457-1461
        • Beimers L.
        • Frey C.
        • van Dijk C.N.
        Arthroscopy of the posterior subtalar joint.
        Foot Ankle Clin. 2006; 11 (vii): 369-390
        • Frey C.
        • Gasser S.
        • Feder K.
        Arthroscopy of the subtalar joint.
        Foot Ankle Int. 1994; 15: 424-428
        • Williams M.M.
        • Ferkel R.D.
        Subtalar arthroscopy: Indications, technique, and results.
        Arthroscopy. 1998; 14: 373-381
        • Phisitkul P.
        • Tochigi Y.
        • Saltzman C.L.
        • Amendola A.
        Arthroscopic visualization of the posterior subtalar joint in the prone position: A cadaver study.
        Arthroscopy. 2006; 22: 511-515
        • van Dijk C.N.
        • Scholten P.E.
        • Krips R.
        A 2-portal endoscopic approach for diagnosis and treatment of posterior ankle pathology.
        Arthroscopy. 2000; 16: 871-876
        • Kelly P.J.
        • Sullivan C.R.
        Blood supply of the talus.
        Clin Orthop Relat Res. 1963; 30: 37-44