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.
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Article info
Publication history
Accepted:
April 17,
2013
Received:
September 10,
2012
Footnotes
The authors report that they have no conflicts of interest in the authorship and publication of this article.
Identification
Copyright
© 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
