J Korean Orthop Assoc.  2018 Apr;53(2):112-120. 10.4055/jkoa.2018.53.2.112.

Arthroscopy Techniques in Foot and Ankle Field: Arthroscopic Ankle and Subtalar Fusion

• Gwak HC

• KMID: 2410058
• DOI: http://doi.org/10.4055/jkoa.2018.53.2.112

Abstract

For the arthroscopic fusion procedure, the development of arthroscopic techniques of joint preparation for fusion have made arthroscopic ankle arthrodesis popular, and foot and ankle surgeons also have gained considerable experience in arthroscopic techniques. Arthroscopic techniques offer minimized soft tissue disruption, lower morbidity and mortality, faster recovery, and shorter hospital stay and time to fusion. In addition, they may reduce the risk of wound complications for patients with a poor soft tissue envelope or relevant co-morbidities.

Keyword

arthroscopy; arthrodesis; ankle joint; subtalar joint

MeSH Terms

Ankle Joint
Ankle*
Arthrodesis
Arthroscopy*
Foot*
Humans
Joints
Length of Stay
Mortality
Subtalar Joint
Surgeons
Wounds and Injuries

Figure

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  Figure 1 Before performing arthroscopic ankle arthrodesis, ankle anteroposterior (A), lateral (B), oblique view, routine foot series, lower extremity radiography and hindfoot alignment view (C) with weight bearing were taken to evaluate ankle joint, adjacent joint, status and degree of deformities.

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  Figure 2 Ankle distractor can be used to facilitate observation of ankle joint with arthroscope.

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  Figure 3 For successful fusion, bony spur and synovial membrane within operation field (A), fibrous tissue (B), and loose bodies (C) were removed to facilitate operative manipulation of arthroscope. Furthermore, subchondral bone and cartilage of talus and tibial plafond were removed to obtain enough contact surface between cancellous bones.

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  Figure 4 Because various screw fixation methods used in ankle fusion are for maximal compressive force, operators should select proper screw fixation method.

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  Figure 5 Because hindfoot joint pain may be somewhat ambigous and there are many structures that cause pain, targeted injection can be performed to access that cause of pain is subtalar joint or extraarticular structures of subtalar joint. It is important to confirm resolution of symptom after local targeted injection toward desired structures under fluoroscopy rather than blind technique.

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  Figure 6 Anterolateral portal for arthroscopic subtalar fusion is 1.5 cm anterior to midline of fibula and 1 cm inferior to tip of lateral malleolus. Posterolateral portal is located at the level of distal end of fibula from lateral soft spot of Achilles tendon.

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  Figure 7 Unlike the ankle joint, Because subtalar joint is devided into posterior, middle, and anterior joint, operator should be well prepared for these articular surfaces when the subtalar joint is fused.

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  Figure 8 Usually, cannulated screws are inserted from posteroinferior aspect of calcaneus toward talar body. Until now, evidence for optimal location and number of screw to obtain good fusion rate is inadequate.

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  Figure 9 Fusion rate of arthroscopic subtalar fusion is reported to be excellent.

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