Arthroscopic management of late complications of calcaneal fractures

Arthroscopic treatment of ankle impingement syndrome

Arthroscopic treatment of ankle impingement syndrome (AIS) is a minimally invasive surgical procedure used to address symptoms caused by impingement in the ankle joint. This syndrome occurs when there is abnormal contact between certain bones or soft tissues in the ankle, leading to pain, swelling, or limited range of motion. Traditionally, open surgery was the standard approach for treating AIS. However, with advancements in technology and surgical techniques, arthroscopic treatment has become a preferred method for many patients and surgeons. With improved visualization and precise treatment of the arthroscopy, patients can experience reduced pain and improved functionality, allowing them to return to their daily activities sooner. In this paper, we reviewed the application and clinical efficacy the of arthroscopic approach for treating AIS, hoping to provide a reference for its future promotion.

Endoscopic Screw Removal, Debridement of the Peroneal Tendons and Subtalar Joint and Lateral Calcaneal Ostectomy for Management of Chronic Heel Pain after Calcaneal Fracture

Calcaneal fracture is one of the most common foot and ankle fractures, but the best treatment of this fracture is still under debate. No matter the treatment strategy of this intra-articular calcaneal fracture, early and late complications frequently occur. In order to treat these complications, combination of various ostectomy, osteotomy, and arthrodesis techniques have been proposed to re-establish the calcaneal height, restore the talocalcaneal relationship, and create a stable, plantigrade foot. In contrast to this approach of addressing all the deformities, another feasible approach is concentrating on those aspects that are the most clinically pressing.10, 11, 12, 13, 14, 15 Different arthroscopic and endoscopic approaches focused on the patient's symptoms and not the correction of the talocalcaneal relationship or restoration of the height or length of the calcaneus have been proposed to deal with late complications of calcaneal fractures. The purpose of this technical note is to describe the details of endoscopic screw removal, debridement of the peroneal tendons, and subtalar joint and lateral calcaneal ostectomy for management of chronic heel pain after calcaneal fracture. It has the advantage of dealing with various sources of lateral heel pain after calcaneal fracture, including the subtalar joint, peroneal tendons, lateral calcaneal cortical bulge and screws.

Isolated Arthroscopic-Assisted Subtalar Fusion: A Systematic Review

BACKGROUND

The subtalar joint has a complex anatomic function that includes inversion and eversion of the hindfoot, assisting in walking on uneven surfaces. Arthritis is the most common pathological condition affecting this joint and can require fusion. The surgery can be performed open or with arthroscopic assistance. This systematic review assesses articles written on the safety and efficacy of isolated arthroscopic subtalar fusion.

METHODS

Using MEDLINE and Embase, we systematically reviewed articles published before May 21, 2020.

RESULTS

Of 395 articles, 17 on a total of 395 patients (409 operations) were included in the review. The average duration of follow-up was 40.0 months (range, 3 to 105 months). Radiographic evidence of union was reported for 95.8% of cases at an average of 11.9 weeks (range, 6 to 56 weeks) postoperatively. Delayed union was reported in 1.0% of patients and nonunion, in 4.3% of patients. In the articles reporting patient satisfaction, including pain relief, 95.4% of patients had positive outcomes. Postoperative complications were reported in 64 patients (16.2%), including 37 (9.4%) with symptomatic implants, 11 (2.8%) with dysesthesia or neuropathic pain, and 3 (0.8%) with postoperative infection.

CONCLUSIONS

Arthroscopic subtalar fusion is a safe and effective alternative to open subtalar arthrodesis, with high patient satisfaction rates, high union rates at similar follow-up intervals, and low complication rates. The aim of future research should be to determine the ideal cases for this approach as well as the most efficient arthroscopic surgical technique and postoperative rehabilitation to optimize function and union as seen on radiographs.

LEVEL OF EVIDENCE

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Endoscopic Lateral Calcaneal Ostectomy and Peroneal Tendon Decompression With the Patient in the Prone Position as Management of Subfibular Impingement After Calcaneal Fracture

Subfibular impingement is a common cause of lateral heel pain after calcaneal fracture. It can be caused by calcaneofibular impingement, peroneal impingement, or a combination thereof. It may not be easy to differentiate bony impingement from soft-tissue impingement. Simultaneous lateral calcaneal ostectomy and peroneal tendon decompression may increase the chance of pain relief. The purpose of this Technical Note was to report the technical details of endoscopic lateral calcaneal ostectomy and peroneal tendon decompression with the patient in the prone position. This technique is indicated for symptomatic subfibular impingement recalcitrant to conservative treatment. It has the advantages of being minimally invasive surgery and allowing early mobilization of the foot and ankle.

Arthroscopic and Endoscopic Management of Common Complications After Displaced Intra-Articular Calcaneal Fractures

The list of late complications after calcaneal fracture that can be treated through arthroscopic and/or endoscopic approach continues to expand. The late complications of calcaneal fractures can be classified into 3 groups: (1) those causing focal hindfoot or ankle pain, (2) those causing functional deficit, and (3) those present with diffuse and poorly localized pain. Many group 1 and some group 2 complications can be managed arthroscopically and/or endoscopically. There are usually multiple coexisting sources of the pain. Careful evaluation and analysis of a problem and detailed surgical planning with combination of arthroscopic/endoscopic and open procedures are key to success.

Endoscopic Revision Subtalar Arthrodesis

Varus malunion after subtalar arthrodesis is considered to be the worst deformity in hindfoot alignment. Poor clinical outcome is expected if there is more than 10° of varus malunion with lateral column overload. Open revision subtalar arthrodesis is associated with high rates of complications, especially involving soft tissue and nonunion. The purpose of this Technical Note is to describe the technical details of endoscopic revision subtalar arthrodesis in which the correction of varus malunion is performed with a minimally invasive technique, which may reduce the risk of soft tissue complications and nonunion.

Endoscopic Management of Calcaneofibular Impingement and Posterior Ankle Impingement Syndrome Caused by Malunion of Joint Depressed-Type Calcaneal Fracture

Identification of the correct source of symptoms is the key in formulating the correct treatment plan for heel pain after calcaneal malunion. Calcaneofibular and posterior ankle impingements can occur due to malunion of a joint depressed-type calcaneal fracture. The purpose of this Technical Note is to report the technical details of posterior and lateral decompression through the posteromedial and posterolateral portals using posterior ankle endoscopy.

Endoscopic Synovectomy of Peroneal Tendon Sheath

Peroneal tenosynovitis usually responds to conservative therapy. Early diagnosis and management are imperative because improper or delayed diagnosis and treatment of peroneal tenosynovitis may lead to progression of the tenosynovitis to peroneal tendon rupture, ultimately limiting the benefit of nonoperative treatment. For refractory cases, endoscopic tenosynovectomy is indicated. The purpose of this Technical Note is to report a minimally invasive approach to perform a synovectomy of zones 1 and 2 of the peroneal tendon sheath.

Synovitis of the Tarsal Canal: An Uncommon Cause of Lateral Heel Pain After Triple Arthrodesis

Lateral heel pain after triple arthrodesis can have numerous causes, including nonunion of the fusion site, hindfoot malalignment, degenerative arthritis in adjacent joints, and deep infection. We present a case of lateral heel pain after triple arthrodesis due to synovitis of the tarsal canal that was successfully treated with anterior subtalar arthroscopy.

[Effectiveness of arthroscopic debridement and release for post-traumatic arthritis of subtalar joint]

Objective

To evaluate the effectiveness of arthroscopic debridement and release for post-traumatic arthritis of subtalar joint.

Methods

Between January 2011 and December 2014, 14 cases of post-traumatic arthritis of the subtalar joint underwent arthroscopic debridement and release, and the clinical data were retrospectively analyzed. All patients were male, aged 42 years on average (range, 32-62 years). Calcaneus fracture was caused by falling from height; 8 cases received conservative treatment and the other 6 cases received open reduction and internal fixation. The mean interval from injury to operation was 3.4 years (range, 2-7 years). The arthroscopic debridement and release were performed through lateral portals. The injury degree of articular cartilage was classified as grade 3 in 4 cases and grade 4 in 10 cases based on Outerbridge rating. The degree of pain was assessed by visual analogue scale (VAS) and the function of joint was assessed by the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle Hindfoot Scale.

Results

All incisions healed by first intention and no complication occurred. The follow-up time was 18 months. Pain was relieved obviously; VAS was significantly decreased to postoperative 3.8±0.9 at 18 months from preoperative 7.7±1.2 ( t=9.728, P=0.000), and AOFAS Ankle Hindfoot Scale was significantly increased to postoperative 59.1±8.8 from preoperative 37.6±8.2 ( t=6.688, P=0.000). During follow-up, no patient was given arthrodesis and no worsened sign was found on the postoperative CT and MRI.

Conclusion

Arthroscopic debridement and release for post-traumatic arthritis of the subtalar joint can relieve clinical symptoms and delay subtalar arthrodesis.

Retrocalcaneal Pain After Open Reduction and Internal Fixation of Avulsion Fracture of the Achilles Tendon Treated by Endoscopic Adhesiolysis and Endoscopic Calcaneoplasty: A Case Report

Avulsion fracture of the Achilles tendon is uncommon. Open reduction and internal fixation is indicated for displaced fracture in order to restore the normal function of the Achilles tendon. We present a patient with avulsion fracture of Achilles tendon that was complicated by the development of secondary Haglund's deformity and fibrous adhesion between the Achilles tendon and the calcaneus. He was successful treated by endoscopic calcaneoplasty and endoscopic adhesiolysis.

LEVELS OF EVIDENCE

Therapeutic, Level IV: Case report.

Arthroscopic Management of Complications Following Total Ankle Replacement

There is great potential of managing the complications of total ankle replacement arthroscopically and endoscopically, and these procedures can be summarized into 3 groups. Group 1 includes procedures of the ankle joint proper with close proximity to the articular components of the total ankle replacement. Group 2 includes procedures of the tibia and talus with close proximity to the nonarticular parts of the total ankle replacement. Group 3 includes procedures that are away from the total ankle replacement. However, these remain master arthroscopist procedures and should be performed by foot and ankle surgeons who perform them with regularity.

Subtalar arthroscopy: When, why and how

Technique of subtalar arthroscopy is rapidly evolving. Increasing number of traditional open procedures for the subtalar joint can now be done arthroscopically. It is hoped that less wound complications, faster rehabilitation and better cosmetic outcomes can be achieved with this minimally invasive technique.

Simultaneous use of lateral calcaneal ostectomy and subtalar arthroscopic debridement for residual pain after a calcaneal fracture

Inadequate primary treatment of calcaneal fractures frequently results in persistent, residual pain. This can be caused by subtalar arthritis, an increased calcaneal width, and/or calcaneal fibular impingement of the peroneal tendons. Many patients experience multiple disorders simultaneously, requiring a combination of procedures to treat the injury. The purpose of the present study was to evaluate the clinical outcomes of arthroscopic debridement with lateral calcaneal ostectomy for residual pain after a calcaneal fracture. Four feet (4 patients) were treated with arthroscopic debridement and lateral calcaneal ostectomy. The patients were 3 males and 1 female, with a mean age of 55.3 ± 14.1 years. The mean follow-up duration was 33.5 ± 10.5 months postoperatively. Three patients received worker's compensation as a result of their condition. The patients were examined for improvement in pain levels using the numeric pain intensity scale and healing was assessed using the Japanese Society of Surgery of the Foot score. The mean Japanese Society of Surgery of the Foot score improved from 64.5 ± 13.8 preoperatively to 82.5 ± 7.1 postoperatively. The mean postoperative numeric pain intensity scale score was 2.3 ± 1.9. No complications, such as deep infection or problems with wound healing, were observed in any of the patients. The simultaneous use of arthroscopic subtalar debridement and lateral calcaneal ostectomy is a valuable intervention for the treatment of residual pain after a calcaneal fracture in patients who present with increased calcaneal width and mild or no degenerative changes in the subtalar joint.

Foot and ankle tendoscopy: evidence-based recommendations

PURPOSE

The purpose of this study was to provide a comprehensive review of the current literature on tendoscopy of the foot and ankle and assign an evidence-based grade of recommendation for or against intervention.

METHODS

A comprehensive review of the literature was performed on May 26, 2013, using the PubMed, Cochrane, and Scopus databases. Studies focusing on the use of foot and ankle tendoscopy were isolated, and these articles were then reviewed and assigned a Level of Evidence (I through V). The literature was then analyzed, and a grade of recommendation was assigned for tendoscopy of the tendons of the foot and ankle on which the procedure is generally performed.

RESULTS

There is weak evidence (grade Cf) to support the use of tendoscopy on the Achilles, flexor hallucis longus, and peroneal tendons. Insufficient evidence (grade I) exists to assign a grade of recommendation for tendoscopy of the tibialis posterior, tibialis anterior, flexor digitorum longus, extensor hallucis longus, and extensor digitorum longus.

CONCLUSIONS

A comprehensive review of the literature on foot and ankle tendoscopy has shown predominantly Level IV and V studies, with just 1 Level II study. On the basis of the current literature available, there is poor evidence (grade Cf) in support of Achilles, flexor hallucis longus, and peroneal tendoscopy for the common indications. There is insufficient evidence to make a recommendation (grade I) for or against tendoscopy of the tibialis posterior, tibialis anterior, flexor digitorum longus, extensor hallucis longus, and extensor digitorum longus. Although current literature suggests that tendoscopy is a safe and effective procedure, original scientific articles of higher levels of evidence are needed before a stronger recommendation can be assigned.

LEVEL OF EVIDENCE

Level IV, systematic review of Level II, IV, and V studies.

Symptomatic anterior subtalar arthrosis after ankle arthrodesis

A 76-year-old man reported right lateral heel pain 11 years after ankle arthrodesis. Clinically, there was tenderness in the right sinus tarsi and over the junction point between the talonavicular and calcaneocuboid joints. Radiographs showed that the joint spaces of the posterior subtalar joint and the talonavicular joint were preserved although there were osteophytes at both joints. Arthroscopic findings showed degeneration of the anterior subtalar and talonavicular joints. The symptoms subsided after arthroscopic debridement.

Retrocalcaneal pain after the repair of acute Achilles tendon rupture

Pain in the posterosuperior portion of the calcaneus can be caused by a retrocalcaneal bursitis, enlargement of the superior bursal prominence of the calcaneus, insertional Achilles tendinopathy, stress fracture of the calcaneus, or inflammation of an adventitious bursa between the Achilles tendon and the skin. Hypertrophied tendon impinging on the posterosuperior calcaneal tuberosity can be a cause of retrocalcaneal pain after repair of acute rupture of the Achilles tendon. This can be effectively treated by endoscopic calcaneoplasty.

LEVELS OF EVIDENCE

Therapeutic, Level IV, Case Report.