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Lui TH, Tsang CY. Metatarsosesamoid Arthroscopy for Management of Plantar Pain of the First Metatarsophalangeal Joint After Surgical Correction of Hallux Valgus Deformity. Arthrosc Tech 2024; 13:102990. [PMID: 39100266 PMCID: PMC11293320 DOI: 10.1016/j.eats.2024.102990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 02/17/2024] [Indexed: 08/06/2024] Open
Abstract
Residual pain in the early postoperative phase after hallux valgus surgery is common, but persistent plantar pain of the first metatarsophalangeal joint after surgery is rare. This can be due to intra- or extra-articular causes. Metatarsosesamoid arthroscopy is effective for the management of intra-articular causes of plantar pain. The purpose of this technical note is to describe the details of metatarsosesamoid arthroscopy for the management of plantar pain of the first metatarsophalangeal joint after surgical correction of hallux valgus deformity.
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Affiliation(s)
- Tun Hing Lui
- Department of Orthopaedics and Traumatology, North District Hospital, Sheung Shui, Hong Kong
| | - Cho Yin Tsang
- Department of Orthopaedics and Traumatology, Tuen Mun Hospital, Tuen Mun, Hong Kong
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Feng SM, Maffulli N, Oliva F, Saxena A, Hao YF, Hua YH, Xu HL, Tao X, Xu W, Migliorini F, Ma C. Surgical management of chronic Achilles tendon rupture: evidence-based guidelines. J Orthop Surg Res 2024; 19:132. [PMID: 38341569 PMCID: PMC10858558 DOI: 10.1186/s13018-024-04559-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 01/11/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Chronic Achilles tendon ruptures (CATR) often require surgical intervention to restore function. Despite numerous treatment modalities available, the optimal management strategy remains controversial given the limited high-quality evidence available. This article aims to provide evidence-based guidelines for the surgical management of CATR through a comprehensive systematic review of the available data. The consensus reached by synthesizing the findings will assist clinicians in making informed decisions and improving patient outcomes. METHODS A group of 9 foot surgeons in three continents was consulted to gather their expertise on guidelines regarding the surgical management of CATR. Following the proposal of 9 clinical topics, a thorough and comprehensive search of relevant literature published since 1980 was conducted for each topic using electronic databases, including PubMed, MEDLINE, and Cochrane Library, to identify relevant studies published until 1 October 2023. All authors collaborated in drafting, discussing, and finalizing the recommendations and statements. The recommendations were then categorized into two grades: grade a (strong) and grade b (weak), following the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) concept. Additionally, feedback from 21 external specialists, who were independent from the authors, was taken into account to further refine and finalize the clinical guidelines. RESULTS Nine statements and guidelines were completed regarding surgical indications, surgical strategies, and postoperative rehabilitation protocol. CONCLUSION Based on the findings of the systematic review, this guideline provides recommendations for the surgical management of CATR. We are confident that this guideline will serve as a valuable resource for physicians when making decisions regarding the surgical treatment of patients with CATR.
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Affiliation(s)
- Shi-Ming Feng
- Orthopaedic Department, Sports Medicine Department, Xuzhou Central Hospital, No. 199, the Jiefang South Road, Xuzhou, 221009, Jiangsu, China.
| | - Nicola Maffulli
- Department of Medicine and Psychology, University "La Sapienza", Rome, Italy
- Guy Hilton Research Centre, School of Pharmacy and Bioengineering, Keele University, Stoke-On-Trent, Staffordshire, ST4 7QB, England
- Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, England
| | - Francesco Oliva
- Department of Sports Traumatology, Universita' Telematica San Raffaele, Rome, Italy
| | - Amol Saxena
- Department of Sports Medicine, Sutter-PAMF, Palo Alto, CA, USA
| | - Yue-Feng Hao
- Orthopedics and Sports Medicine Center, Suzhou Municipal Hospital, Nanjing Medical University Affiliated Suzhou Hospital, Suzhou, Jiangsu, People's Republic of China
| | - Ying-Hui Hua
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Hai-Lin Xu
- Department of Trauma and Orthopedic, People's Hospital, Peking University, Beijing, People's Republic of China
| | - Xu Tao
- Department of Sports Medicine, Southwest Hospital, Army Medical University, Chongqing, People's Republic of China
| | - Wei Xu
- Department of Orthopaedics, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People's Republic of China
| | - Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Medical Centre, Pauwelsstraße 30, 52074, Aachen, Germany.
- Department of Orthopedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical University, 39100, Bolzano, Italy.
| | - Chao Ma
- Orthopaedic Department, Sports Medicine Department, Xuzhou Central Hospital, No. 199, the Jiefang South Road, Xuzhou, 221009, Jiangsu, China
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Kam SK, Lui TH. Arthroscopic Release of the First Metatarsophalangeal Joint: The 3-Portal Approach. Arthrosc Tech 2024; 13:102838. [PMID: 38312873 PMCID: PMC10838061 DOI: 10.1016/j.eats.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 10/05/2023] [Indexed: 02/06/2024] Open
Abstract
Arthrofibrosis of the first metatarsophalangeal joint may cause significant limitation of sport and daily activities. Surgical release is indicated if conservative management fails. Open release may have a high recurrence rate of joint stiffness because the surgical trauma will induce fibrous tissue formation and the presence of lengthy surgical wounds may hinder early joint mobilization. Arthroscopic release of the first metatarsophalangeal joint is a minimally invasive approach that may be the treatment of choice for arthrofibrosis of the joint. The purpose of this Technical Note is to describe the details of the 3-portal approach of arthroscopic release of the first metatarsophalangeal joint.
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Affiliation(s)
- Siu Kei Kam
- Department of Orthopaedics and Traumatology, North District Hospital, Sheung Shui, NT, Hong Kong SAR, China
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Lui TH, Li CCH, Chan SK, Slocum AMY. Modified Endoscopic Distal Soft Tissue Procedure (mEDSTP) and Arthroscopic Lapidus Arthrodesis for Correction of Severe Hallux Valgus. Arthrosc Tech 2023; 12:e1779-e1787. [PMID: 37942098 PMCID: PMC10628012 DOI: 10.1016/j.eats.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 06/23/2023] [Indexed: 11/10/2023] Open
Abstract
Hallux valgus is one of the most common forefoot deformities faced by foot and ankle surgeons. Symptomatic deformity usually needs surgical correction. Endoscopic techniques of hallux valgus correction have been reported that are based on the same principle of the classic distal soft tissue procedure. Recently, the technique has been modified to include reconstruction of the medial metatarsosesamoid ligament and augmentation of the intermetatarsal ligament. In severe deformity or the presence of hypermobility or painful degeneration of the first tarsometatarsal joint, Lapidus arthrodesis of the joint is indicated. Arthroscopic Lapidus arthrodesis has been reported to reduce the complications associated with open procedure, including first metatarsal shortening, metatarsal elevatus, and nonunion. In this technical note, the technical details of a combined modified endoscopic distal soft tissue procedure and arthroscopic Lapidus arthrodesis is described. This is a minimally invasive approach for correction of severe hallux valgus deformity, especially that associated with ligamentous laxity.
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Lui TH, Li CCH, Tam CY, Slocum AMY. Modified Endoscopic Distal Soft Tissue Procedure With Medial Metatarsosesamoid Ligament and Intermetatarsal Ligament Augmentation. Arthrosc Tech 2023; 12:e1399-e1408. [PMID: 37654874 PMCID: PMC10466289 DOI: 10.1016/j.eats.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 04/12/2023] [Indexed: 09/02/2023] Open
Abstract
Hallux valgus is one of the most common foot and ankle conditions faced by orthopaedic surgeons. Surgical correction of hallux valgus is frequently indicated for symptomatic deformity. Recently, the endoscopic technique of hallux valgus correction has been reported, which is basically an endoscopic approach to the classic distal soft tissue procedure. In this technical note, the technical details of the modified endoscopic distal soft tissue procedure with medial metatarsosesamoid ligament and intermetatarsal ligament augmentation is described. In this modified technique, the intact intermetatarsal ligament, plantar capsule of the first metatarsophalangeal joint (including the sesamoid apparatus), and medial metatarsosesamoid ligament form a soft tissue envelop that can wrap around the first metatarsal head to stabilize the first metatarsal in the reduced position.
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Affiliation(s)
- Tun Hing Lui
- Department of Orthopaedics and Traumatology, North District Hospital, Hong Kong, China
| | - Charles Churk Hang Li
- Department of Orthopaedics and Traumatology, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, China
| | - Cheuk Yin Tam
- Department of Orthopaedics and Traumatology, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, China
| | - Amanda Mun Yee Slocum
- Department of Orthopaedics and Traumatology, North District Hospital, Hong Kong, China
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Chong HC, Lui TH. Arthroscopic Arthrodesis of the First Metatarsophalangeal Joint in Hallux Valgus Deformity Using Medial and Toe Web Portals. Arthrosc Tech 2023; 12:e1171-e1177. [PMID: 37533925 PMCID: PMC10391250 DOI: 10.1016/j.eats.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 03/16/2023] [Indexed: 08/04/2023] Open
Abstract
Arthrodesis of the first metatarsophalangeal joint is indicated for severe hallux valgus deformity. Open arthrodesis requires extensive soft-tissue dissection. Recently, a technique of arthroscopic first metatarsophalangeal arthrodesis in hallux valgus deformity has been reported. This approach includes endoscopic lateral release of the first metatarsophalangeal joint via the plantar and toe web portals, followed by arthroscopic arthrodesis of the joint via the medial and dorsolateral portals. Endoscopic lateral release of the first metatarsophalangeal joint can convert the fixed hallux valgus deformity into a flexible one and reduce the stress over the screws and risk of loss of reduction and nonunion. The purpose of this Technical Note is to report a modified technique of arthroscopic first metatarsophalangeal arthrodesis in hallux valgus deformity. In this modified technique, the arthrodesis is performed via the medial and toe web portals and creation of the dorsolateral portal is not needed. A 2.7-mm arthroscope is used for the arthrodesis procedure instead of a 1.9-mm arthroscope. This can improve fluid inflow and visualization.
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Affiliation(s)
| | - Tun Hing Lui
- Address correspondence to Tun Hing Lui, M.B.B.S.(HK), F.R.C.S.(Edin), F.H.K.A.M., F.H.K.C.O.S., Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong SAR, China.
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Lopes R, Bauer T. Lateral endoscopy of the sinus tarsi: Anatomy, technique and current indications. Orthop Traumatol Surg Res 2022; 108:103383. [PMID: 35926723 DOI: 10.1016/j.otsr.2022.103383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 06/06/2022] [Accepted: 06/22/2022] [Indexed: 02/03/2023]
Abstract
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.
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Affiliation(s)
- Ronny Lopes
- Clinique Brétéché, 3, Rue de la Béraudière, 44000 Nantes, France; Polyclinique de l'Atlantique, avenue Claude-Bernard, 44800 Saint-Herblain, France.
| | - Thomas Bauer
- Service de chirurgie orthopédique, hôpital Ambroise-Paré, hôpitaux Universitaires Paris Île-de-France Ouest, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
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Yeung T, Lui TH. Arthroscopic Lapidus Arthrodesis of the First Tarsometatarsal Joint for Treatment of Hallux Valgus Deformity of the Foot. Arthrosc Tech 2022; 11:e1065-e1069. [PMID: 35782856 PMCID: PMC9244635 DOI: 10.1016/j.eats.2022.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 02/08/2022] [Indexed: 02/03/2023] Open
Abstract
Hypermobility of the first tarsometatarsal joint can associate with different clinical problems, e.g., hallux valgus, hallux elevatus, hallux rigidus, and transverse metatarsalgia or arthritis of the second metarsocuneiform joint. The first tarsometatarsal joint may also contribute to other foot deformities involving the medial foot column. Osteoarthritis of this joint is one of the causes of medial foot pain. Arthrodesis of the first tarsometatarsal joint (modified Lapidus procedure) is indicated for these conditions, which are resistant to conservative treatment. Lapidus arthrodesis has several potential complications, including first metatarsal shortening, metatarsal elevates, and nonunion. Arthroscopic Lapdius arthrodesis has been reported to reduce these complications. In this Technical Note, the technical details of arthroscopic Lapidus arthrodesis is described.
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Affiliation(s)
- Tsang Yeung
- United Christian Hospital, Hong Kong SAR, China
| | - Tun Hing Lui
- Department of Orthopaedics and Traumatology, North District Hospital, Hong Kong SAR, China,Address correspondence to: Tun Hing Lui, M.B.B.S., F.R.C.S.Ed., F.H.K.A.M.(Ortho.), F.H.K.C.O.S., Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong SAR, China.
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Li WS, Lui TH. Supraligamentous Approach of Lateral Release in Endoscopic Lateral Soft Tissue Procedure. Arthrosc Tech 2022; 11:e827-e831. [PMID: 35646582 PMCID: PMC9134000 DOI: 10.1016/j.eats.2021.12.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 12/29/2021] [Indexed: 02/03/2023] Open
Abstract
Many surgical methods are available for hallux valgus, but consensus regarding the best management has yet to be established. Minimally invasive techniques are gaining popularity with the potential advantages of better cosmetic outcome, less postoperative pain, and decreasing recovery time because surgical exposure and deep soft tissue dissection are less extensive and possibly gentler. Recently, techniques of the endoscopic distal soft tissue procedure have been reported, in which an endoscopic approach of the classic distal soft tissue procedure is described. The intermetatarsal ligament, adductor hallucis insertion, and the lateral capsuloligamentous complex of the first metatarsophalangeal joint is released during the endoscopic lateral release. However, the intermetatarsal ligament does not contribute to development of the hallux valgus deformity, and release of the ligament is not necessary for correction of the deformity. Instead, preservation of the intermetatarsal ligament may protect the interdigital nerve and reduce the risk of nerve injury during endoscopic lateral release. In this technical note, the technical details of supraligamentous approach of lateral release in endoscopic lateral soft tissue procedure (or EDSTP) is described. This approach can help to reduce the risk of injury to the interdigital nerve during endoscopic lateral release.
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Affiliation(s)
| | - Tun Hing Lui
- Address correspondence to T. H. Lui, M.B.B.S., F.H.K.A.M. (Ortho), F.H.K.C.O.S., Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Rd., Sheung Shui, NT, Hong Kong SAR, China.
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Lui TH, Pan X, Chan CK. Arthroscopic Resection of Too-Long Anterior Process (TLAP) of the Calcaneus, Anterior Subtalar Synovectomy, Debridement of the Sinus Tarsi, and Posterior Subtalar Adhesiolysis Via Anterolateral Subtalar and Dorsolateral Midtarsal Portals. Arthrosc Tech 2021; 10:e2259-e2264. [PMID: 34754732 PMCID: PMC8556585 DOI: 10.1016/j.eats.2021.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 06/22/2021] [Indexed: 02/03/2023] Open
Abstract
Lateral heel pain can have numerous causes and many of them are intra-articular pathologies of the anterior and posterior subtalar joint. Frequently, there is not a single pathology that account for the lateral heel pain and combination of different pathologies can occur. Symptomatic too-long anterior process of the calcaneus, sinus tarsi syndrome, and subtalar arthrofibrosis can be precipitated by repeated sprain. Cases recalcitrant to conservative treatment are indicated for surgery. The purpose of this Technical Note is to report a 2-portal arthroscopic approach to address these pathologies.
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Affiliation(s)
- Tun Hing Lui
- Department of Orthopaedics and Traumatology, North District Hospital, Sheung Shui, NT, Hong Kong SAR, China,Shenzhen University, Shenzhen, China,Address correspondence to Dr. T. H. Lui, North District Hospital, 9 Po Kin Rd., Sheung Shui, NT, Hong Kong SAR, China.
| | - Xiaohua Pan
- Department of Trauma and Orthopedics, Second Affiliated Hospital of Shenzhen University & Affiliated Baoan Hospital of Shenzhen, Southern Medical University, The 8th People’s Hospital of Shenzhen, Shenzhen, Guangdong, China,Guangdong Provincial Engineering Research Center of Wound Repair and Regenerative Medicine, Guangdong Provincial Academician Workstation of Wound Repair and Regenerative Medicine, China
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Knörr J, Diaz-Gallardo P, Soldado F, Domenech P, Torres-Perez A, Sales de Gauzy J, Bergua-Domingo JM. Arthroscopic Calcaneonavicular Coalition and Too-long Anterior Process of the Calcaneus Resection in Children. J Foot Ankle Surg 2021; 60:228-232. [PMID: 33461922 DOI: 10.1053/j.jfas.2019.03.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Revised: 01/23/2019] [Accepted: 03/31/2019] [Indexed: 02/03/2023]
Abstract
Persistent symptomatic calcaneonavicular coalition (CNC) and too-long anterior process of the calcaneus (TLAP) are congenital disorders that can benefit from surgical treatment. The arthroscopic technique for CNC and TLAP resection has previously been described. The aim of this prospective study was to describe outcomes following arthroscopic resection of 12 (38.71%) CNC and 19 (61.29%) TLAP cases in 30 consecutive pediatric patients treated between July 2009 and March 2013. There mean age was 12.4 (range 10 to 15) years, and the mean follow-up was 55.2 (range 24 to 79) months. Radiographs, American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scores, AOFAS pain scores, and patient satisfaction were assessed. All final postoperative imaging scans revealed complete synostosis resection without recurrence. The mean overall AOFAS Ankle-Hindfoot Score increased from 78.87 (95% confidence interval [CI] 76.74 to 81.01) to 93.06 (95% CI 91.10 to 95.03) (p < .001). All patients showed pain reduction after surgery; even 1 patient (3.23%) who initially developed complex regional pain syndrome eventually had a successful outcome. The mean AOFAS pain score increased from 23.87 (95% CI 22.05 to 25.69) to 34.84 (95% CI 32.97 to 36.70) (p < .001). All patients were either satisfied (n = 9 [30%]) or very satisfied (n = 21 [70%]) with the intervention at the final follow-up. Although both arthroscopic CNC and TLAP resection are demanding techniques, they allow for precise coalition resection through a less invasive approach, which may ultimately lead to faster recovery and improved outcomes.
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Affiliation(s)
- Jorge Knörr
- Surgeon, Orthopaedic Surgery Department, Vall Hebron Barcelona Hospital Campus, Universistat Autonoma de Barcelona, Barcelona, Spain.
| | - Paula Diaz-Gallardo
- Surgeon, Orthopaedic Surgery Department, Vall Hebron Barcelona Hospital Campus, Universistat Autonoma de Barcelona, Barcelona, Spain
| | - Francisco Soldado
- Surgeon, Orthopaedic Surgery Department, Vall Hebron Barcelona Hospital Campus, Universistat Autonoma de Barcelona, Barcelona, Spain; Surgeon, Pediatric Hand Surgery and Microsurgery Department, Vall Hebron Barcelona Hospital Campus, Universistat Autonoma de Barcelona, Barcelona, Spain
| | - Pedro Domenech
- Surgeon, Orthopaedic Surgery Department, Vall Hebron Barcelona Hospital Campus, Universistat Autonoma de Barcelona, Barcelona, Spain
| | - Ana Torres-Perez
- Surgeon, Hospital Universitario Santa Lucia de Cartagena, Cartagena, Spain
| | - Jérôme Sales de Gauzy
- Surgeon, Pediatric Orthopedic Surgery Department, Hôpital des Enfants, CHU Toulouse, France
| | - Josep Maria Bergua-Domingo
- Surgeon, Orthopaedic Surgery Department, Vall Hebron Barcelona Hospital Campus, Universistat Autonoma de Barcelona, Barcelona, Spain
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Nery C, Baumfeld D. Anterior and Posterior Ankle Impingement Syndromes: Arthroscopic and Endoscopic Anatomy and Approaches to Treatment. Foot Ankle Clin 2021; 26:155-172. [PMID: 33487238 DOI: 10.1016/j.fcl.2020.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Ankle impingement refers to a chronic painful mechanical limitation of ankle motion caused by soft tissue or osseous abnormality affecting the anterior or posterior tibiotalar joint. Impingement can be associated with a single traumatic event or repetitive microtrauma. These syndromes are a possible etiology of persistent ankle pain. An arthroscopic approach to this pathology, when indicated, is considered as ideal treatment with its high safety and low complication rate. We describe the clinical and potential imaging features, and the arthroscopic/endoscopic management strategies, for the 4 main impingement syndromes of the ankle: anterolateral, anterior, antero-medial, and posterior.
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Affiliation(s)
- Caio Nery
- UNIFESP - Federal University of São Paulo, Brazil
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Six out of ten patients with sinus tarsi syndrome returned to pre-injury type of sport after subtalar arthroscopy. Knee Surg Sports Traumatol Arthrosc 2021; 29:2485-2494. [PMID: 33340335 PMCID: PMC8298340 DOI: 10.1007/s00167-020-06385-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 11/24/2020] [Indexed: 11/03/2022]
Abstract
PURPOSE The purpose of this study was to determine multiple return to sport rates, long-term clinical outcomes and safety for subtalar arthroscopy for sinus tarsi syndrome. METHODS Subtalar arthroscopies performed for sinus tarsi syndrome between 2013 and 2018 were analyzed. Twenty-two patients were assessed (median age: 28 (IQR 20-40), median follow-up 60 months (IQR 42-76). All patients were active in sports prior to the injury. The primary outcome was the return to pre-injury type of sport rate. Secondary outcomes were time and rate of return to any type of sports, return to performance and to improved performance. Clinical outcomes consisted of Numerous Rating Scale of pain, Foot and Ankle Outcome Score, 36-item Short Form Survey and complications and re-operations. RESULTS Fifty-five percent of the patients returned to their preoperative type of sport at a median time of 23 weeks post-operatively (IQR 9.0-49), 95% of the patients returned to any type and level sport at a median time of 12 weeks post-operatively (IQR 4.0-39), 18% returned to their preoperative performance level at a median time of 25 weeks post-operatively (IQR 8.0-46) and 5% returned to improved performance postoperatively at 28 weeks postoperatively (one patient). Median NRS in rest was 1.0 (IQR 0.0-4.0), 2.0 during walking (IQR 0.0-5.3) during walking, 3.0 during running (IQR 1.0-8.0) and 2.0 during stair-climbing (IQR 0.0-4.5). The summarized FAOS score was 62 (IQR 50-90). The median SF-36 PCSS and the MCSS were 46 (IQR 41-54) and 55 (IQR 49-58), respectively. No complications and one re-do subtalar arthroscopy were reported. CONCLUSION Six out of ten patients with sinus tarsi syndrome returned to their pre-injury type of sport after being treated with a subtalar arthroscopy. Subtalar arthroscopy yields effective outcomes at long-term follow-up concerning patient-reported outcome measures in athletic population, with favorable return to sport level, return to sport time, clinical outcomes and safety outcome measures. LEVEL OF EVIDENCE IV.
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Velasco BT, Patel SS, Broughton KK, Frumberg DB, Kwon JY, Miller CP. Arthrofibrosis of the Ankle. FOOT & ANKLE ORTHOPAEDICS 2020; 5:2473011420970463. [PMID: 35097416 PMCID: PMC8564948 DOI: 10.1177/2473011420970463] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Arthrofibrosis is a common, but often overlooked, condition that imparts significant morbidity following injuries and surgery to the foot and ankle. The most common etiologies are related to soft tissue trauma with subsequent fibrotic and contractile scar tissue formation within the ligaments and capsule of the ankle. This leads to pain, alterations in gait, and ankle dysfunction. Initial treatment often includes extensive physical therapy, however, if severe enough surgical options exist. Although the literature regarding ankle arthrofibrosis is scarce, this review article provides a greater understanding of the pathogenesis of arthrofibrosis and describes the current and future therapeutic options to treat fibrotic joints. Level of Evidence: Level V, expert opinion.
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Affiliation(s)
- Brian Timothy Velasco
- Hospital of the University of Pennsylvania, University of Pennsylvania, Philadelphia, PA, USA
| | - Shalin S. Patel
- Harvard Combined Orthopaedic Residency Program, Massachusetts General Hospital, Boston, MA, USA
| | | | - David B. Frumberg
- Department of Orthopaedic Surgery, Yale School of Medicine, Yale-New Haven Hospital, New Haven, CT, USA
| | - John Y. Kwon
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Christopher P. Miller
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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State of the Art in Lesser Metatarsophalangeal Instability. Foot Ankle Clin 2019; 24:627-640. [PMID: 31653367 DOI: 10.1016/j.fcl.2019.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Advancements in lesser metatarsophalangeal (MTP) instability have involved the use of minimally invasive surgery techniques, synthetic augmentation of existing transfers, and use of arthroscopy for both diagnosing and addressing MTP disorder. Advances in imaging modalities, particularly MRI, have aided in diagnosing subtle instability. Clinical outcomes seem to be similar to traditional approaches as the indications and applicability continue to evolve.
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Severyns M, Andriamananaivo T, Rollet ME, Kajetanek C, Lopes R, Renard G, Noailles T, Odri GA, Rouvillain JL. Acute Achilles Tendon Rupture: Ultrasonography and Endoscopy-Assisted Percutaneous Repair. Arthrosc Tech 2019; 8:e489-e493. [PMID: 31194136 PMCID: PMC6551569 DOI: 10.1016/j.eats.2019.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 01/18/2019] [Indexed: 02/03/2023] Open
Abstract
To date, there is no consensus concerning the treatment of acute Achilles tendon ruptures. Although surgical treatment decreases the risk of a recurrent rupture, it is not without complications. In particular, percutaneous sutures may cause a lesion of the sural nerve. The purpose of this Technical Note is to describe a reliable and reproducible surgical procedure for treating these lesions. The first operative phase consists of an ultrasound detection that makes it possible to identify the tendon extremities and the sural nerve, which is necessary to secure the posterolateral arthroscopic tract as well as to perform the percutaneous suture. The entry point is thus centered on the lesion and placed at a distance from any surrounding nerve risk. The second arthroscopic phase makes it possible to release the tendon lesion, control the transtendon passage of the surgical threads, and evaluate the dynamic contact of the tendon edges. At the end of the intervention, the complete disappearance from the transillumination via the rupture also makes it possible to ensure the disappearance of the tendon gap. Achilles tendon percutaneous sutures after the ultrasound detection and under arthroscopic control thus makes it possible to control the contact of the tendon edges, while at the same time decreasing the risk of a lesion of the sural nerve, with minimal scarring.
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Affiliation(s)
- Mathieu Severyns
- Orthopaedics and Traumatology Department, CHU Martinique, Martinique, France,Address correspondence to Mathieu Severyns, M.D., Orthopaedic and Traumatology Department, CHU Martinique, Pierre Zobda-Quitman Hospital, CS 90632, F- 97261, Fort-de-France, Martinique, France.
| | | | - Marie-Eva Rollet
- Orthopaedics and Traumatology Department, CHU Martinique, Martinique, France
| | | | - Ronny Lopes
- Orthopaedic Department, Polyclinique de L'Atlantique, Nantes, France
| | - Guillaume Renard
- Orthopaedics and Traumatology Department, CHU Martinique, Martinique, France
| | - Thibaut Noailles
- Orthopaedic Department, Polyclinique Bordeaux Nord Aquitaine Bordeaux, France
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Lui TH, Pan XH, Pan Y. Arthroscopic and Endoscopic Management of Common Complications After Displaced Intra-Articular Calcaneal Fractures. Clin Podiatr Med Surg 2019; 36:279-293. [PMID: 30784537 DOI: 10.1016/j.cpm.2018.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
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.
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Affiliation(s)
- Tun-Hing Lui
- Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong, China.
| | - Xiao-Hua Pan
- Guangdong Provincial Engineering Research Center of Wound Repair and Regenerative Medicine, Affiliated Baoan Hospital of Shenzhen, Southern Medical University, The 8th People's Hospital of Shenzhen, Shenzhen, Guangdong 518101, China; Guangdong Provincial Academician Workstation of Wound Repair and Regenerative Medicine, Affiliated Baoan Hospital of Shenzhen, Southern Medical University, The 8th People's Hospital of Shenzhen, Shenzhen, Guangdong 518101, China; Department of Trauma and Orthopedics, Affiliated Baoan Hospital of Shenzhen, Southern Medical University, The 8th People's Hospital of Shenzhen, Shenzhen, Guangdong 518101, China
| | - Yu Pan
- Guangdong Provincial Engineering Research Center of Wound Repair and Regenerative Medicine, Affiliated Baoan Hospital of Shenzhen, Southern Medical University, The 8th People's Hospital of Shenzhen, Shenzhen, Guangdong 518101, China; Guangdong Provincial Academician Workstation of Wound Repair and Regenerative Medicine, Affiliated Baoan Hospital of Shenzhen, Southern Medical University, The 8th People's Hospital of Shenzhen, Shenzhen, Guangdong 518101, China; Department of Trauma and Orthopedics, Affiliated Baoan Hospital of Shenzhen, Southern Medical University, The 8th People's Hospital of Shenzhen, Shenzhen, Guangdong 518101, China
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Unal M, Alfidan S, Gultekin A, Budeyri A, Ercan S. A new study of hindfoot endoscopy: Foreign body excision from the hindfoot. SAGE Open Med Case Rep 2019; 7:2050313X18823328. [PMID: 30719300 PMCID: PMC6349976 DOI: 10.1177/2050313x18823328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 12/13/2018] [Indexed: 11/24/2022] Open
Abstract
Residual foreign bodies are usually observed inside the body after foreign body penetration injuries. However, foreign bodies inside or near the joints are rarely encountered. In the case study included in this report, the case of a foreign body in the posterior ankle region of a 10-year-old child is presented, along with a new study highlighting the technique of its excision with hindfoot endoscopy. The visualization and capture of a foreign body within this region, and its relation to endoscopic excision, has been reported as being a support for hindfoot endoscopy. The aim of this article is to highlight the need for the provision of a low threshold arthroscopic hindfoot surgery in children who display the appropriate symptoms. The purpose of this surgery is to efficiently remove intra-articular hindfoot loose bodies and to gain functionally improved results, when compared with open techniques.
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Affiliation(s)
- Meric Unal
- Department of Sports Medicine, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
| | - Serdar Alfidan
- Department of Orthopedics and Traumatology, Bucak Lider Hospital, Bucak, Turkey
| | - Alper Gultekin
- Department of Orthopaedics and Traumatology, Derince Research Hospital, Derince, Turkey
| | - Aydin Budeyri
- Department of Orthopaedics and Traumatology, Faculty of Medicine, SANKO University, Gaziantep, Turkey
| | - Sabriye Ercan
- Department of Sports Medicine, Dr. Ersin Arslan Education and Research Hospital, Gaziantep, Turkey
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Bernasconi A, Sadile F, Smeraglia F, Mehdi N, Laborde J, Lintz F. Tendoscopy of Achilles, peroneal and tibialis posterior tendons: An evidence-based update. Foot Ankle Surg 2018; 24:374-382. [PMID: 29409273 DOI: 10.1016/j.fas.2017.06.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 04/05/2017] [Accepted: 06/10/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Tendoscopy has been proposed in treating several conditions affecting tendons around the ankle. We reviewed literature to investigate the efficacy of Achilles, peroneal and tibialis posterior tendoscopy. METHODS Following the PRISMA checklist, the Medline, Scopus and EMBASE databases were searched, including studies reporting patients affected by disorders of Achilles, peroneal and tibialis posterior tendons and treated by tendoscopy (or tendoscopic-assisted procedures). The tendoscopic technique, rehabilitation protocol, clinical scores, patient satisfaction, success and failure rates and complications were evaluated. RESULTS Sixteen studies (319 procedures) dealt with Achilles tendoscopy, nine (108) and six (78) about peroneal and tibialis posterior, respectively. Wound healing, cosmetic results, complication rate, work and sport resumption delay were satisfactory. Clinical scores, classification methods and rehabilitation protocols adopted were heterogeneous. CONCLUSIONS The recent scientific evidence suggests that tendoscopy and endoscopic-assisted percutaneous procedures are a safe and effective treatment in chronic and acute disorders of tendons around the ankle.
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Affiliation(s)
- Alessio Bernasconi
- Department of Public Health, "Federico II" Naples University School of Medicine and Surgery, Orthopaedic and Traumatology Unit, Via S. Pansini 5, Napoli 80131, Italy.
| | - Francesco Sadile
- Department of Public Health, "Federico II" Naples University School of Medicine and Surgery, Orthopaedic and Traumatology Unit, Via S. Pansini 5, Napoli 80131, Italy.
| | - Francesco Smeraglia
- Department of Public Health, "Federico II" Naples University School of Medicine and Surgery, Orthopaedic and Traumatology Unit, Via S. Pansini 5, Napoli 80131, Italy.
| | - Nazim Mehdi
- Clinique de l'Union, Ankle and Foot Surgery Center, Boulevard de Ratalens, 31240 Saint-Jean, France.
| | - Julien Laborde
- Clinique de l'Union, Ankle and Foot Surgery Center, Boulevard de Ratalens, 31240 Saint-Jean, France.
| | - François Lintz
- Clinique de l'Union, Ankle and Foot Surgery Center, Boulevard de Ratalens, 31240 Saint-Jean, France.
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Lee KB, Jeong SY. Arthroscopic Microfracture for Traumatic Arthritis of Lateral Tarsometatarsal Joints A Case Report. J Am Podiatr Med Assoc 2018; 108:344-348. [PMID: 30156887 DOI: 10.7547/17-003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Conservative treatment is generally successful in treating early tarsometatarsal joint arthritis. However, if such treatment fails, invasive arthrodesis or arthroplasty may be needed. Arthroscopy is a less invasive alternative and can provide a precise diagnosis of early osteoarthritis or cartilage injury. Furthermore, arthroscopic treatments such as microfracture, chondroplasty, or loose-body removal are expected to delay progression of the osteoarthritis. We describe a 52-year-old man with early tarsometatarsal joint arthritis after calcaneal fracture healing who underwent a successful arthroscopic microfracture for cartilage defects. Arthroscopic findings show cartilage defects on the fourth and fifth tarsometatarsal joints. The patient underwent shaving and microfracture. The patient continues to experience effective symptom relief 3 months after surgery.
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Affiliation(s)
- Kwang-Bok Lee
- Department of Orthopedic Surgery, Chonbuk National University Medical School, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Seong-Yup Jeong
- Department of Orthopedic Surgery, Chonbuk National University Medical School, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
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21
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Ling SKK, Chan V, Ho K, Ling F, Lui TH. Reliability and validity analysis of the open-source Chinese Foot and Ankle Outcome Score (FAOS). Foot (Edinb) 2018; 35:48-51. [PMID: 29787992 DOI: 10.1016/j.foot.2017.12.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 12/14/2017] [Accepted: 12/18/2017] [Indexed: 02/04/2023]
Abstract
AIM Develop the first reliable and validated open-source outcome scoring system in the Chinese language for foot and ankle problems. METHODS Translation of the English FAOS into Chinese following regular protocols. First, two forward-translations were created separately, these were then combined into a preliminary version by an expert committee, and was subsequently back-translated into English. The process was repeated until the original and back translations were congruent. This version was then field tested on actual patients who provided feedback for modification. The final Chinese FAOS version was then tested for reliability and validity. Reliability analysis was performed on 20 subjects while validity analysis was performed on 50 subjects. Tools used to validate the Chinese FAOS were the SF36 and Pain Numeric Rating Scale (NRS). Internal consistency between the FAOS subgroups was measured using Cronbach's alpha. Spearman's correlation was calculated between each subgroup in the FAOS, SF36 and NRS. RESULTS The Chinese FAOS passed both reliability and validity testing; meaning it is reliable, internally consistent and correlates positively with the SF36 and the NRS. DISCUSSION AND CONCLUSIONS The Chinese FAOS is a free, open-source scoring system that can be used to provide a relatively standardised outcome measure for foot and ankle studies.
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Affiliation(s)
- Samuel K K Ling
- Department of Orthopaedics & Traumatology, North District Hospital, Hong Kong Special Administrative Region.
| | - Vincent Chan
- Department of Orthopaedics & Traumatology, North District Hospital, Hong Kong Special Administrative Region
| | - Karen Ho
- Private Practice, Room 1510-1512, Prince's Building, 10 Chater Road, Central, Hong Kong Special Administrative Region
| | - Fona Ling
- Freelance, Hong Kong Special Administrative Region
| | - T H Lui
- Department of Orthopaedics & Traumatology, North District Hospital, Hong Kong Special Administrative Region
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22
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Arthroscopic Arthrodesis of the First Metatarsophalangeal Joint in Hallux Valgus Deformity. Arthrosc Tech 2017; 6:e1481-e1487. [PMID: 29354462 PMCID: PMC5709661 DOI: 10.1016/j.eats.2017.06.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 06/02/2017] [Indexed: 02/03/2023] Open
Abstract
Arthrodesis of the first metatarsophalangeal joint is indicated for hallux valgus associated with degenerative changes, severe deformity, or rheumatoid arthritis and those for whom primary hallux valgus surgery has failed. Open approach requires extensive soft tissue dissection. The purpose of this Technical Note was to report the details of arthroscopic arthrodesis of the first metatarsophalangeal joint in severe and rigid hallux valgus deformity. This is a combination of endoscopic lateral release of the first metatarsophalangeal joint and arthroscopic arthrodesis of the joint. Endoscopic lateral release will convert the deformity into a flexible one and facilitate a subsequent arthrodesis procedure.
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Arthroscopic Arthrodesis of the Lesser Ray Tarsometatarsal Joints: 2-Portal Technique. Arthrosc Tech 2017; 6:e1495-e1499. [PMID: 29354464 PMCID: PMC5709659 DOI: 10.1016/j.eats.2017.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 06/02/2017] [Indexed: 02/03/2023] Open
Abstract
Tarsometatarsal (Lisfranc) destruction of the tarsometatarsal articulation of the lesser rays is most commonly due to midfoot Charcot neuroarthropathy. Tarsometatarsal arthrodesis is indicated when conservative management cannot relieve the symptoms. The purpose of this Technical Note is to describe a minimally invasive approach of arthroscopic arthrodesis of the destructed lesser ray tarsometatarsal joints. The arthroscopic procedure is performed through the lateral and P1-2 Lisfranc portals. It has the advantages of better cosmesis, less wound complication, less bone resection, and more thorough joint debridement. However, it is contraindicated if there is associated significant foot deformity or shortening of the lesser foot rays.
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24
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Ling SKK, Lui TH. Posterior Tibial Tendon Dysfunction: An Overview. Open Orthop J 2017; 11:714-723. [PMID: 28979585 PMCID: PMC5620404 DOI: 10.2174/1874325001711010714] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 07/23/2016] [Accepted: 07/23/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Adult acquired flatfoot deformity is a commonly seen condition with a large clinical spectrum. It ranges from asymptomatic subjects to severely disabled arthritic patients. Posterior tibialis tendon dysfunction is a common cause of adult acquired flatfoot deformity. METHODS This article systematically reviews the published literature from books and journals that were either originally written or later translated into the English language regarding the subject of posterior tibialis tendon dysfunction. RESULTS Posterior tibialis tendon dysfunction is a primary soft tissue tendinopathy of the posterior tibialis that leads to altered foot biomechanics. Although the natural history of posterior tibialis tendon dysfunction is not fully known, it has mostly been agreed that it is a progressive disorder. While clinical examination is important in diagnosing adult acquired flat-feet; further investigation is often required to delineate the different aetiologies and stage of the disease. The literature describes many different management choices for the different stages of posterior tibialis tendon dysfunction. CONCLUSION Because of the wide range of symptom and deformity severity, surgical reconstruction is based on a-la-carte. The consensus is that a plethora of reconstructive options needs to be available and the list of procedures should be tailored to tackle the different symptoms, especially when managing complex multi-planar reconstructions.
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Affiliation(s)
- Samuel Ka-Kin Ling
- Department of Orthopaedics and Traumatology, North District Hospital, Hong Kong SAR
| | - Tun Hing Lui
- Department of Orthopaedics and Traumatology, North District Hospital, Hong Kong SAR
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25
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Lui TH. Correction of Recurred Hallux Valgus Deformity by Endoscopic Distal Soft Tissue Procedure. Arthrosc Tech 2017; 6:e435-e440. [PMID: 28580264 PMCID: PMC5443353 DOI: 10.1016/j.eats.2016.10.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 10/25/2016] [Indexed: 02/03/2023] Open
Abstract
The underlying reason for recurrence of hallux valgus deformity after bunion surgery is multifactorial and includes surgeon-based and patient-based factors as well as original components of deformity initially unaddressed at the index procedure. Surgical treatment of a recurred hallux valgus deformity should be undertaken using the same guidelines for correction of a primary hallux valgus deformity. It requires correction of bony alignment, restoration of joint congruity, and achievement of soft tissue balance. The purpose of this Technical Note is to describe the details of endoscopic soft tissue procedure to correct a recurred hallux valgus deformity. To successfully complete this procedure, adequate lateral release to achieve soft tissue balance around the first metatarsophalangeal joint with reduction of the sesamoid bones is mandatory.
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Affiliation(s)
- Tun Hing Lui
- Address correspondence to Tun Hing Lui, M.B.B.S.(HK), F.R.C.S.(Edin), F.H.K.A.M., F.H.K.C.O.S., Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong SAR, China.Department of Orthopaedics and TraumatologyNorth District Hospital9 Po Kin RoadSheung Shui, NTHong Kong SARChina
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Abstract
Tendoscopy is an apparently safe and reliable procedure to manage some foot and ankle disorders.The most common foot and ankle tendoscopies are: Achilles; peroneal; and posterior tibial tendon.Tendoscopy may be used as an adjacent procedure to other techniques.Caution is recommended to avoid neurovascular injuries.Predominantly level IV and V studies are found in the literature, with no level I studies still available.There are many promising and evolving endoscopic techniques for tendinopathies around the foot and ankle, but studies of higher levels of evidence are needed to strongly recommend these procedures. Cite this article: EFORT Open Rev 2016;1:440-447. DOI: 10.1302/2058-5241.160028.
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Abstract
Tarsometatarsal (Lisfranc) osteoarthritis can be a disabling condition and is commonly due to posttraumatic causes. Tarsometatarsal arthrodesis is indicated if the pain does not subdue with conservative treatment. Classically, this is performed as an open procedure. The purpose of this technical note is to describe a minimally invasive approach of arthroscopic arthrodesis of the involved tarsometatarsal joints. The arthroscopic procedure is performed through the junction portals of the involved articulation. It has the advantages of better cosmesis, less wound complication, less bone resection, and more thorough joint debridement. However, it is contraindicated if there is an associated significant foot deformity or shortening of the involved foot rays.
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Affiliation(s)
- Tun Hing Lui
- Address correspondence to Tun Hing Lui, M.B.B.S.(HK), F.R.C.S.(Edin), F.H.K.A.M., F.H.K.C.O.S., Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong SAR, China.Department of Orthopaedics and TraumatologyNorth District Hospital9 Po Kin RoadSheung Shui, NTHong Kong SARChina
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28
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Ultrasound-guided arthroscopic management of hallux rigidus. Wideochir Inne Tech Maloinwazyjne 2016; 11:144-148. [PMID: 27829936 PMCID: PMC5095280 DOI: 10.5114/wiitm.2016.62811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 09/15/2016] [Indexed: 11/23/2022] Open
Abstract
Introduction The use of metatarso-phalangeal joint arthroscopy in the treatment of osteochondritis dissecans was first described in 1988. The technique produces good results. However, it can be difficult to enter a joint when it is deformed by degenerative disease. Sonography is a modern visualisation modality which can be used in orthopaedic surgery. Aim To describe a method of intraoperative sonographic navigation during first metatarso-phalangeal joint arthroscopy. Material and methods The modality was used in 3 patients. The joint was visualised in the ultrasound scanner. After confirming the intra-articular position of the guide needle, a medial portal was established. The procedure started with the removal and vaporisation of the hypertrophic synovium. Gradual resection of the osteophytes was then carried out. The procedure was terminated after the ultrasound image showed that a smooth upper surface of the metatarsal head had been achieved. Results All 3 patients were satisfied with the procedure and function of the treated feet. Average surgery time was 81 min. No complications were found. Conclusions Mini-invasive treatment of hallux rigidus with sonography-guided arthroscopic cheilectomy appears to be a reproducible procedure leading to good clinical results. We encourage surgeons familiar with ultrasound visualisation of the joints to use the technique described in this paper in the arthroscopic treatment of hallux rigidus.
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Lui TH. Arthroscopic Resection of Too-Long Anterior Process of the Calcaneus. Arthrosc Tech 2016; 5:e1179-e1183. [PMID: 28224074 PMCID: PMC5310192 DOI: 10.1016/j.eats.2016.07.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 07/05/2016] [Indexed: 02/03/2023] Open
Abstract
A too-long anterior process (TLAP) of the calcaneus is an elongated anteromedial process of the calcaneus impinging the navicular or the talar head. TLAP can cause recurrent ankle sprain, peroneal muscle spasm, or persistent tarsal pain in adolescents. Arthroscopic resection is indicated if the symptoms do not respond to conservative treatment. It has the advantage of assessment of completeness of bone resection and treatment of associated lesions of the adjacent joints. The purpose of this technical note is to report an arthroscopic approach of the resection of the TLAP with the lateral midtarsal portal as the viewing portal.
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Affiliation(s)
- Tun Hing Lui
- Address correspondence to Tun Hing Lui, M.B.B.S.(HK), F.R.C.S.(Edin), F.H.K.A.M., F.H.K.C.O.S., Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong SAR, China.Department of Orthopaedics and TraumatologyNorth District Hospital9 Po Kin RoadSheung Shui, NTHong Kong SARChina
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30
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Abstract
Endoscopic distal soft-tissue procedure is one of the minimally invasive techniques for correction of the hallux valgus deformity. It employs the same principle as the open procedure. The intermetatarsal angle is corrected by screw and interosseous suture instead of first metatarsal osteotomy. The associated procedures of first metatarsal derotation, medial collateral ligament reconstruction, and arthroscopic Lapidus arthrodesis can tackle various problems faced during the endoscopic distal soft-tissue procedure.
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Ultrasound Guidance in Performing a Tendoscopic Surgery to Treat Posterior Tibial Tendinitis: A Useful Tool? Case Rep Orthop 2016; 2016:7262413. [PMID: 27478666 PMCID: PMC4960336 DOI: 10.1155/2016/7262413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 06/26/2016] [Indexed: 11/25/2022] Open
Abstract
A 25-year-old man with a pronation-external rotation type of fracture was surgically treated using a fibular plate. Five years later, he underwent resection of bone hyperplasia because of the ankle pain and limitation of range of motion. Thereafter, the left ankle became intermittently painful, which persisted for about one year. He presented at the age of 43 with persistent ankle pain. Physical and image analysis findings indicated a diagnosis of posttraumatic posterior tibial tendinitis, which we surgically treated using tendoscopy. Endoscopic findings showed tenosynovitis and fibrillation on the tendon surface. We cleaned and removed the synovium surrounding the tendon and deepened the posterior tibial tendon groove to allow sufficient space for the posterior tibial tendon. Full weight-bearing ambulation was permitted one day after surgery and he returned to his occupation in the construction industry six weeks after surgery. The medial aspect of the ankle was free of pain and symptoms at a review two years after surgery. Although tendoscopic surgery for stage 1 posterior tibial tendon dysfunction has been reported, tendoscopic surgery to treat posttraumatic posterior tibial tendinitis has not. Our experience with this patient showed that tendoscopic surgery is useful not only for stage 1 posterior tibial dysfunction, but also for posttraumatic posterior tibial tendinitis.
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Lui TH. Revision Lapidus Arthrodesis by Bone Endoscopy. Arthrosc Tech 2016; 5:e699-e704. [PMID: 27709024 PMCID: PMC5039734 DOI: 10.1016/j.eats.2016.02.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 02/10/2016] [Indexed: 02/03/2023] Open
Abstract
Revision arthrodesis is indicated in symptomatic nonunion of the first tarsometatarsal joint. Revision by first tarsometatarsal arthroscopy cannot deal with the dilated screw tract and associated bone cysts. Revision by bone endoscopy is indicated in symptomatic nonunion of the first tarsometatarsal joint, which is previously fixed by transarticular screw along with loosening of the screw and bone cyst formation. The screw tract makes up the portal tract, with the proximal and distal ends of the tract corresponding to the proximal and distal portals, respectively. In this technical note, we describe zonal debridement and bone grafting of the bone cysts, nonunion site, and the screw tract via the bone endoscopy. This can resolve all the co-pathologies of nonunion of the first tarsometatarsal fusion.
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Affiliation(s)
- Tun Hing Lui
- Department of Orthopaedics and Traumatology, North District Hospital, Sheung Shui, NT, Hong Kong SAR, China
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Abstract
Posterior tarsal tunnel syndrome is the result of compression of the posterior tibial nerve. Anterior tarsal tunnel syndrome (entrapment of the deep peroneal nerve) typically presents with pain radiating to the first dorsal web space. Distal tarsal tunnel syndrome results from entrapment of the first branch of the lateral plantar nerve and is often misdiagnosed initially as plantar fasciitis. Medial plantar nerve compression is seen most often in running athletes, typically with pain radiating to the medial arch. Morton neuroma is often seen in athletes who place their metatarsal arches repetitively in excessive hyperextension.
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Affiliation(s)
- Eric Ferkel
- Southern California Orthopaedic Institute, 6815 Noble Avenue, Van Nuys, CA 91405, USA.
| | - William Hodges Davis
- OrthoCarolina Foot and Ankle Institute, 2001 Vail Avenue, #200B, Charlotte, NC 28207, USA
| | - John Kent Ellington
- OrthoCarolina Foot and Ankle Institute, 2001 Vail Avenue, #200B, Charlotte, NC 28207, USA
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Endoscopic Flexor Hallucis Longus Tendon Transfer for Chronic Achilles Tendon Rupture. Sports Med Arthrosc Rev 2016; 24:38-41. [DOI: 10.1097/jsa.0000000000000086] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
BACKGROUND Understanding the plantar nerve anatomy is crucial for safe endoscopic surgery of the sole. We aimed to anatomically dissect the lateral aspect and soles of cadaveric feet to investigate the safety of peroneus longus tendoscopy with a plantar lateral portal and the safe zones for plantar portals. METHODS We studied 36 feet of 24 cadavers (mean age, 86.5 years). A cannula for 2.7-mm scope was inserted from the plantar lateral portal to the peroneus longus tendon, and the positional relationship between the cannula and sural nerve was observed. Then, the soft tissue of the sole was dissected, and the relationships between the plantar nerve and flexor digitorum longus tendon and flexor hallucis longus tendon was observed. The plantar nerve course was digitally imaged and uploaded into Image J software to determine nerve position. We further observed the positional relationship between the cannula and plantar nerve. RESULT The mean minimum distance between the cannula and sural nerve was 13.8 mm, and the closest distance was 4.2 mm, allowing for the relatively safe creation of a plantar lateral portal. The use of the plantar lateral portal and evaluation of the peroneal tendon was safe with respect to the lateral plantar nerve as the nerve was in a different tissue layer of the foot. Dissection of the plantar foot demonstrated a relatively safe zone, 36.4% to 56% along a line between the medial aspect of the base of the first metatarsal bone to the proximal tip of the fifth metatarsal. This region may allow for a plantar endoscopic portal; however an anatomic variation may result in the plantar nerve being within this zone. The flexor digitorum longus tendon and peroneus longus tendon passed through the deep layer of the relatively safe zone. CONCLUSION Peroneus longus tendoscopy was relatively safe to perform from a plantar lateral portal. No neurovascular structure exists on the slightly medial aspect of the central region of the sole, potentially allowing for a relatively safe creation of plantar central portal. An approach from the plantar central portal to the flexor digitorum longus tendon, flexor hallucis longus tendon, and peroneus longus tendon allows for a greater range of vision and treatment options as compared with conventional approaches. The combination of the plantar central portal with portals such as the plantar lateral portal may further the development of endoscopic surgery of the sole. CLINICAL RELEVANCE We found the anatomic characteristics of a relatively safe zone for the plantar portal for plantar lateral portal.
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Affiliation(s)
- Shingo Maeda
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Hisateru Niki
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Takaaki Hirano
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Yui Akiyama
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
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Lui TH. Endoscopic Intermetatarsal Ligament Decompression. Arthrosc Tech 2015; 4:e807-10. [PMID: 27284515 PMCID: PMC4887115 DOI: 10.1016/j.eats.2015.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 08/04/2015] [Indexed: 02/03/2023] Open
Abstract
Morton neuroma is an entrapment of the intermetatarsal nerve by the deep intermetatarsal ligament. It is usually treated conservatively. Surgery is considered if there is recalcitrant pain that is resistant to conservative treatment. The surgical options include resection of the neuroma or decompression of the involved nerve. Decompression of the nerve by release of the intermetatarsal ligament can be performed by either an open or minimally invasive approach. We describe 2-portal endoscopic decompression of the intermetatarsal nerve. The ligament is released by a retrograde knife through the toe-web portal under arthroscopic guidance through the plantar portal.
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Affiliation(s)
- Tun Hing Lui
- Address correspondence to Tun Hing Lui, M.B.B.S.(HK), F.R.C.S.(Edin), F.H.K.A.M., F.H.K.C.O.S., Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong SAR, China.
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Lui TH. Endoscopic-Assisted Flexor Hallucis Longus Transfer: Harvest of the Tendon at Zone 2 or Zone 3. Arthrosc Tech 2015; 4:e811-4. [PMID: 27284516 PMCID: PMC4886619 DOI: 10.1016/j.eats.2015.08.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Accepted: 08/04/2015] [Indexed: 02/03/2023] Open
Abstract
Flexor hallucis longus (FHL) tendon transfer is indicated for reconstruction of the Achilles tendon with a gap larger than 5 cm. The tendon can be harvested at zone 2 or zone 3 by minimally invasive techniques with the advantage of minimal soft-tissue dissection. The tendon can be harvested under the sustentaculum tali by zone 2 FHL tendoscopy. It is adequate for FHL transfer to the posterior calcaneal tubercle. If a double-thickness reconstruction of a huge gap of the Achilles tendon is indicated, the tendon can be harvested at the level of the hallux by means of a tendon stripper. However, the interconnection tendon of the master knot of Henry can be split together with the FHL or flexor digitorum longus tendon instead of being cut. Zone 2 FHL tendoscopy can be used to release the split tendon to complete the FHL harvest.
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Affiliation(s)
- Tun Hing Lui
- Address correspondence to Tun Hing Lui, M.B.B.S.(HK), F.R.C.S.(Edin), F.H.K.A.M., F.H.K.C.O.S., Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong SAR, China.
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Lui TH. Arthroscopic Lysis of Arthrofibrosis of the Fifth Tarsometatarsal Joint. Arthrosc Tech 2015; 4:e707-10. [PMID: 26870650 PMCID: PMC4739069 DOI: 10.1016/j.eats.2015.07.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 07/24/2015] [Indexed: 02/03/2023] Open
Abstract
Loss of motion of the fifth tarsometatarsal joint can be a cause of lateral foot pain after Lisfranc fracture-dislocation or fracture of the fifth metatarsal tubercle. Arthroscopic lysis of the joint can be an effective surgical treatment with the advantage of minimal soft-tissue trauma and early vigorous mobilization of the joint. The lysis can be extended to the fourth tarsometatarsal joint and the adjacent tendons if indicated.
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Affiliation(s)
- Tun Hing Lui
- Address correspondence to Tun Hing Lui, M.B.B.S.(HK), F.R.C.S.(Edin), F.H.K.A.M., F.H.K.C.O.S., Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong SAR, China.
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Flexor Digitorum Accessorius Longus: Importance of Posterior Ankle Endoscopy. Case Rep Orthop 2015; 2015:823107. [PMID: 26060592 PMCID: PMC4427770 DOI: 10.1155/2015/823107] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 04/04/2015] [Accepted: 04/12/2015] [Indexed: 11/17/2022] Open
Abstract
Endoscopy for the posterior region of the ankle through two portals is becoming more widespread for the treatment of a large number of conditions which used to be treated with open surgery years ago. The tendon of the flexor hallucis longus (FHL) travels along an osteofibrous tunnel between the posterolateral and posteromedial tubercles of the talus. Chronic inflammation of this tendon may lead to painful stenosing tenosynovitis. The aim of this report is to describe two cases depicting an accessory tendon which is an anatomical variation of the flexor hallucis longus in patients with posterior friction syndrome due to posterior ankle impingement and associated with a posteromedial osteochondral lesion of the talus. The anatomical variation (FDAL) described was a finding during an endoscopy of the posterior region of the ankle, and we have spared it by sectioning the superior flexor retinaculum only. The accessory flexor digitorum longus is an anatomical variation and should be taken into account when performing an arthroscopy of the posterior region of the ankle. We recommend this treatment on this type of injury although we admit this does not make a definite conclusion.
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Jagodzinski NA, Parsons AMJ, Parsons SW. Arthroscopic triple and modified double hindfoot arthrodesis. Foot Ankle Surg 2015; 21:97-102. [PMID: 25937408 DOI: 10.1016/j.fas.2014.10.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 10/11/2014] [Accepted: 10/17/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND Arthroscopic arthrodesis is an accepted technique for the ankle but less commonly reported for multiple hindfoot joints. We present a case series review to establish the feasibility of this surgery. METHODS In a consecutive series of 112 arthroscopic hindfoot arthrodeses, 18 involved decortication and fusion of 2 or 3 hindfoot joints. These were reviewed to identify complications, union rates and improvement over preoperative state. RESULTS Mean age was 62 (45-78). Mean follow-up was 4.4 (1.75-7.5) years. There were no perioperative complications. The four patients with triple fusions united with good or excellent outcomes. Of 14 patients with subtalar and talonavicular arthrodeses there were three talonavicular non-unions. CONCLUSIONS Arthroscopic double and triple arthrodeses appear feasible salvage options for pain and deformity. Decortication of all three joints and rotatory correction of deformity is possible whilst preserving the soft tissue envelope. Late adjacent joint pain and arthrosis can occur.
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Affiliation(s)
| | | | - S W Parsons
- The Royal Cornwall Hospital, Truro, United Kingdom
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Abstract
Peroneal tendoscopy is indicated for peroneal tenosynovitis, subluxation or dislocation, snapping, partial tears requiring debridement, and postoperative adhesions and scarring. Peroneal tendoscopy was also found to be valuable as a diagnostic tool in some instances. It is generally reported to have good to excellent outcomes in most patients with a relatively low occurrence of complications.
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Affiliation(s)
- Tun Hing Lui
- Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong 999077, China.
| | - Lung Fung Tse
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Shatin, Hong Kong 999077, China
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Abstract
Anterior ankle arthroscopy is a useful, minimally invasive technique for diagnosing and treating ankle conditions. Arthroscopic treatment offers the benefit of decreased surgical morbidity, less postoperative pain, and earlier return to activities. Indications for anterior ankle arthroscopy continue to expand, including ankle instability, impingement, management of osteochondritis dissecans, synovectomy, and loose body removal. Anterior ankle arthroscopy has its own set of inherent risks and complications. Surgeons can decrease the risk of complications through mastery of ankle anatomy and biomechanics, and by careful preoperative planning and meticulous surgical technique.
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Affiliation(s)
- David M Epstein
- Tri-County Orthopedics & Sports Medicine, 197 Ridgedale Avenue, Suite 300, Cedar Knolls, NJ 07927, USA; Morristown Medical Center, 100, Madison Avenue, Morristown, NJ 07960, USA.
| | - Brandee S Black
- Department of Orthopaedic Surgery, University of Missouri, 1100 Virginia Avenue, Columbia, MO 65212, USA
| | - Seth L Sherman
- Department of Orthopaedic Surgery, University of Missouri, 1100 Virginia Avenue, Columbia, MO 65212, USA
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Abstract
The posterior tibial tendon (PTT) helps the triceps surae to work more efficiently during ambulation. Disorders of the PTT include tenosynovitis, acute rupture, degenerative tears, dislocation, instability, enthesopathies, and chronic tendinopathy with dysfunction and flat foot deformity. Open surgery of the PTT has been the conventional approach to deal with these disorders. However, tendoscopy has become a useful technique to diagnose and treat PTT disorders. This article focuses on PTT tendoscopy and tries to provide an understanding of the pathomechanics of the tendon, indications for surgery, surgical technique, advantages, complications, and limitations of this procedure.
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Affiliation(s)
- Manuel Monteagudo
- Orthopaedic Foot and Ankle Unit, Orthopaedic and Trauma Department, Hospital Universitario Quirón Madrid, Calle Diego de Velázquez n°1, 28223 Pozuelo de Alarcón, Madrid, Spain; Universidad Europea de Madrid, C/Tajo s/n, Villaviciosa de Odón, Madrid 28670, Spain.
| | - Ernesto Maceira
- Orthopaedic Foot and Ankle Unit, Orthopaedic and Trauma Department, Hospital Universitario Quirón Madrid, Calle Diego de Velázquez n°1, 28223 Pozuelo de Alarcón, Madrid, Spain
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Abstract
UNLABELLED Flexor hallucis longus muscle can adhere to the distal tibia after tibial fracture. The patient may complain of deep posteromedial ankle pain, checkrein deformity of the hallux, hallux flexus or development of hallux rigidus. Surgical treatment of release of the FHL muscle or lengthening of the FHL tendon has been proposed. We described an endoscopic approach of release of the FHL muscle from the distal tibia with the advantage of minimal soft tissue dissection. LEVEL OF EVIDENCE Therapeutic Level V: Expert Opinion/Technique.
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Lesser metatarsal phalangeal joint arthroscopy: anatomic description and comparative dissection. Arthroscopy 2014; 30:971-9. [PMID: 24835840 DOI: 10.1016/j.arthro.2014.03.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 03/12/2014] [Accepted: 03/20/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of this article is to describe the normal arthroscopic anatomy of the lesser metatarsophalangeal (MTP) joints and compare it with that seen in open dissection in cadaveric models. METHODS We performed arthroscopic examination of 18 MTP joints of 6 normal fresh frozen feet. The second, third, and fourth MTP joints were studied because of the higher incidence of pathologic conditions found in these joints. During arthroscopy, each anatomic structure identified was named and marked with different colored sutures using straight suture needles. After the arthroscopic procedure of identification and marking, each MTP joint was dissected, and all the anatomic structures were grossly identified. With these data, the correlation between the arthroscopic and the direct visualization of a normal MTP joint was established. RESULTS Considering the joint regions, we found that the examination accuracy of the medial gutter was 91%, whereas the central joint accuracy reached 100% and the accuracy of the lateral gutter was 98%. The overall arthroscopic accuracy for the lesser MTP joints was 96%. CONCLUSIONS There is a high level of anatomic accuracy at the lesser MTP joint with arthroscopy. CLINICAL RELEVANCE The high overall level of anatomic accuracy of lesser MTP joint arthroscopy (96%) allows us to consider this resource as a valuable tool in the diagnosis and treatment of these joints, expanding the spectrum of indications using this method.
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Lui TH. Arthroscopic ganglionectomy of the foot and ankle. Knee Surg Sports Traumatol Arthrosc 2014; 22:1693-700. [PMID: 22648747 DOI: 10.1007/s00167-012-2065-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Accepted: 05/14/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE To study the efficacy of arthroscopic ganglionectomy in the management of ganglia of the foot and ankle. METHODS From 2006 to 2010, arthroscopic ganglionectomy was performed for 89 ganglia in the foot and ankle of 88 patients. Clinical and intra-operative details were reviewed retrospectively. RESULT Ganglion stalk was identified in 6 % of the cases. The overall rate of presence of pathology was 26 %. The overall rate of recurrence or residual lesion was 12 % with high recurrent rate for extensor tendon ganglia and toe pulp ganglia. CONCLUSIONS Arthroscopic ganglionectomy of the foot and ankle ganglion by either internal drainage or complete resection is a feasible approach. Good results can be achieved in case of adequate internal drainage of the ganglion to the joints or fibrous tendon sheath.
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Affiliation(s)
- T H Lui
- Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong SAR, China,
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Hughes AM, Gosling O, McKenzie J, Amirfeyz R, Winson IG. Arthroscopic triple fusion joint preparation using two lateral portals: a cadaveric study to evaluate efficacy and safety. Foot Ankle Surg 2014; 20:135-9. [PMID: 24796834 DOI: 10.1016/j.fas.2014.02.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Revised: 02/05/2014] [Accepted: 02/11/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND Arthroscopic triple fusion has several advantages over open techniques, but its use has yet to become widespread. Preliminary published techniques use five portals with neurovascular risk. Our aim was to assess the safety and efficacy of an alternative lateral two portal technique. METHODS Four cadaveric hindfeet were arthroscopically prepared for a triple fusion using two lateral portals. The distance to relevant subcutaneous nerves was measured as well as the prepared joint surface percentage. RESULTS Mean distance from mid-lateral portal to the nearest sural nerve branch was 22.3mm (range 20-24mm) and from the dorsolateral portal to the intermediate branch of the superficial peroneal nerve was 7.8mm (range 4-11mm). Mean percentages of joint preparation were 63% (talar head), 62% (navicular), 75% (calcaneum) and 74% (cuboid). CONCLUSIONS Two lateral arthroscopic portals allow adequate joint preparation for triple fusion procedures. The proximity of subcutaneous nerves is important to appreciate when using these portals.
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Affiliation(s)
- Adrian M Hughes
- Avon Orthopaedic Centre, North Bristol Trust, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB, UK.
| | - Oliver Gosling
- Avon Orthopaedic Centre, North Bristol Trust, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB, UK
| | - James McKenzie
- Avon Orthopaedic Centre, North Bristol Trust, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB, UK
| | - Rouin Amirfeyz
- University Hospitals Bristol, Bristol Royal Infirmary, UK
| | - Ian G Winson
- Avon Orthopaedic Centre, North Bristol Trust, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB, UK
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Abstract
Interphalangeal (IP) joint pathology of the toes has gained little attention of the orthopedic surgeon. However, similar intra-articular pathologies e.g. osteoarthritis, synovitis, chondral lesion, arthrofibrosis and instability can occur as in other joints. Moreover, many corrective procedures of toe deformity involved excisional arthroplasty or arthrodesis of the IP joint although it is not the site of primary pathology. Classically, the operations of the IP joint were performed in an open manner. We described the technique of interphalangeal arthroscopy and its application to treat various pathologies of the interphalangeal joint was discussed. Among the various indications for interphalangeal arthroscopy, arthroscopic ganglionectomy of recurrent IP ganglion is the single most important one.
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Affiliation(s)
- T H Lui
- Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong Special Administrative Region.
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Lui TH, Chan KB. Arthroscopic management of late complications of calcaneal fractures. Knee Surg Sports Traumatol Arthrosc 2013; 21:1293-9. [PMID: 22692516 DOI: 10.1007/s00167-012-2086-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2011] [Accepted: 05/29/2012] [Indexed: 12/14/2022]
Abstract
PURPOSE To review retrospectively the results of arthroscopic management of late complications of calcaneal fractures. METHODS Fifty patients (32 males, 18 females) with late complications of calcaneal fractures were managed arthroscopically. The median age at the time of arthroscopic surgery was 45 (19-63) years old. Detailed history taking, physical examination, standing lateral radiograph of the foot and axial view of the calcaneus and computed tomogram study were performed in all of the patients in order to identify the sources of symptoms. The arthroscopic treatment was then planned accordingly. The patients were assessed according to the AOFAS ankle-hindfoot score and the standing radiographs of the foot and ankle, both preoperatively and at the latest follow-up consultation. RESULT A median of 1 arthroscopic procedure was performed for each patient (range, 1-4). The median follow-up after the latest arthroscopic surgery was 49 (range, 24-85 months) months. In all of the cases, the symptoms improved after the arthroscopic surgery and all the arthrodesis sites healed. The overall median preoperative AOFAS ankle-hindfoot score was 60.5 (27-75). The overall median AOFAS ankle-hindfoot score at the time of latest follow-up was 90 (73-100). CONCLUSIONS The arthroscopic approach focuses on the patient's symptoms. It is a feasible approach to alleviate patient's symptoms. Detailed history taking and clinical examination to determine the sources of the patient's symptoms are the keys to success.
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Affiliation(s)
- T H Lui
- Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong SAR, China.
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Jagodzinski NA, Hughes A, Davis NP, Butler M, Winson IG, Parsons SW. Arthroscopic resection of talocalcaneal coalitions--a bicentre case series of a new technique. Foot Ankle Surg 2013; 19:125-30. [PMID: 23548456 DOI: 10.1016/j.fas.2013.03.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 02/18/2013] [Accepted: 03/01/2013] [Indexed: 02/04/2023]
Abstract
BACKGROUND Symptomatic tarsal coalitions failing conservative treatment are traditionally managed by open resection. We describe an arthroscopic technique for excising talocalcaneal coalitions and present a retrospective two-surgeon case series of the first eight patients (nine feet). METHODS Outcome measures include restoration of subtalar movements, return to work and sports, visual analogue pain scales and Sports Athlete Foot and Ankle Scores (SAFAS). Follow-up ranges from 1 to 5.5 years. RESULTS Pain and SAFAS improved in 7 patients. Subtalar movements were improved in all feet. All patients achieved early good function but one relapsed requiring subsequent fusions. One posterior tibial nerve was damaged. CONCLUSIONS Minimal destruction of bone and soft tissues allows early mobilization and minimizes pain. Patient selection and preoperative planning are crucial to avoid relapse and complication. This series from two independent surgeons supports the feasibility and effectiveness of this technique.
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