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Supine patient positioning and portal designation. (A) Supine position with the affected ankle (arrow) elevated and hip bumped. (B) Waist distraction is used to improve access to the joint. (C) Anterior approach portals. TA, tibialis anterior; AL, anterolateral portal; AM, anteromedial portal; SPN, superficial peroneal nerve. (Image courtesy of Dr Kirk A. McCullough.) (D) A posterior thigh pad elevates the knee, creating a counter for the distractor.
Source publication
The role of arthroscopy in the management of ankle and hindfoot pathology management has increased greatly in recent years with the potential for lower complication rates, faster recovery, improved access, and improved outcomes when compared to open techniques. Procedural variations exist as techniques aim to optimize lesion access, decrease operat...
Contexts in source publication
Context 1
... distraction is usually recommended for evaluating the intra-articular space (Figure 2A, B). 10 In the anterior approach, the standard anteromedial portal is established first, at the level of the joint line immediately medial to the tibialis anterior tendon with care taken to avoid the saphenous nerve and greater saphenous vein ( Figure 2C). Under needle localization, the anterolateral portal is created immediately lateral to the peroneus tertius tendon at the joint line. ...
Context 2
... distraction is usually recommended for evaluating the intra-articular space (Figure 2A, B). 10 In the anterior approach, the standard anteromedial portal is established first, at the level of the joint line immediately medial to the tibialis anterior tendon with care taken to avoid the saphenous nerve and greater saphenous vein ( Figure 2C). Under needle localization, the anterolateral portal is created immediately lateral to the peroneus tertius tendon at the joint line. ...
Context 3
... and as described by Marumoto and Ferkel, 19 the patient may be placed supine with the hip flexed at 45 degrees using a padded thigh support ( Figure 2D). Standard anterolateral and posterolateral portals are used with the incorporation of accessory portals as needed. ...
Context 4
... approach, supine position. The patient is placed in the supine position and a posterior thigh holder is utilized for countertraction ( Figure 2C). Standard anteromedial and anterolateral portals are established, and an accessory portal for outflow can be considered either with a standard posterolateral portal or a retromalleolar tendoscopic portal located 1 cm posterior to the tip of the lateral malleolus. ...
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Citations
... Pathologies and thus indications in this region are numerous [17]; we classify them as malformative, degenerative and post-traumatic (Table 1). ...
Numerous pathologies are reported in the lateral mid- and hind-foot. Access to the sinus tarsi is difficult, making lateral endoscopy the preferred approach.
The present technical note describes the anatomy, technique and current indications for lateral endoscopy of the sinus tarsi.
A fracture of the posterior talar process is easily missed because of its hidden position. Inappropriate treatment is likely to result in complications, such as nonunion of the fracture and traumatic arthritis. This study evaluated the outcomes of arthroscopy-assisted reduction combined with robotic-assisted screw placement in the treatment of fractures of the posterior talar process.
The clinical data for nine patients who underwent surgical treatment of a fracture of the posterior talar process at our institution between September 2017 and January 2021 were retrospectively reviewed. Arthroscopy-assisted reduction of the fracture was performed, and a cannulated screw was placed using three-dimensional orthopedic robotic-assisted navigation.
The patients (seven men, two women) had a mean age of 36.33 ± 9.77 years and were followed up for 21 ± 5.43 months. The operation time was 106.67 ± 24.5 min with blood loss of 47.78 ± 9.05 ml. Primary healing was obtained in all cases, and no patient sustained a nerve or tendon injury, had fracture nonunion, or developed talar osteonecrosis. One patient developed subtalar arthritis, for which subtalar joint fusion was performed; pain was markedly less severe after cleaning.
Arthroscopy-assisted reduction and robotic-assisted screw placement have the advantages of visualization of fracture reduction, minimal injury, and precise screw placement in the treatment of fractures of the posterior talar process.
Résumé
De nombreuses pathologies sont rapportées à l’arrière et au médio pied latéral. La difficulté d’accessibilité du sinus fait de l’endoscopie latérale sa voie d’abord préférentielle. L’objectif de cette note technique est de décrire les bases anatomiques, la technique et les indications actuelles de l’endoscopie latérale du sinus du tarse.
