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Arthroscopic Antero-superior Ancillary Portals for Addressing Surgical Repair perpendicularly on Talar Dome: Sixteen Years’ Experience

      Introduction

      Restore of talar dome cartilage disorders are generally achieved with open surgery, considering malleolar osteotomy as main surgical choice. Concerns are on fate of ankles submitted to this procedure, being still unclear even this may influence further evolution in DJD. Aiming to avoid open surgery, authors have set up an arthroscopic technique by antero-superior portal, placed medially or laterally to permit vertical instruments position for addressing surgery to chondral lesions.

      Methods

      Since 1998, 123patients underwent arthroscopic OLT repair by superior portals in addition to 2standard anterior ones. Maintaining foot in maximum plantar flexion, a spinal needle is inserted 5-to-7 centimetres superiorly to anterior standard portal: slipping along anterior tibial bone surface, it reaches talar dome vertically. Trying several times until correct perpendicular placement to OLT is achieved, portal is opened. Along switching stick the scope is inserted, showing upper view of anterior compartment, keeping 2anterior portals for working. Moving instruments inside joint space from “above” while talar dome is rolled on, better exposition of talus surface is reached. Furthermore, to gain room for those disorders placed on middle transverse talar line and beyond, additional dorsal capsulotomy is performed. Removing eventually some superficial bone at Harty’s notch by bur, repair instruments reach defected talar dome, achieving visualization and shaver into anterior portals.

      Results

      Patients reported immediate significant improvement because of whole procedure without aggressive open approach and because no immobilization. Authors’ malleolar osteotomy indication dropped down in last 16years, except selected cases where arthroscopy itself was hardly difficult to be lead out.

      Conclusion

      At outcome, Authors experience confirmed medial and lateral antero-superior ancillary portals have strong value in addressing repair procedures to ankle joint compartments, blind to traditional arthroscopic access. Easy to place and interchangeable, they help avoiding bony osteotomy and limiting articular further problems