Naviculocuneiform Arthroscopy

Biomechanical evaluation of naviculocuneiform fixation with lag screw and locking plates

BACKGROUND

There have been no biomechanical evaluations of naviculocuneiform (NC) joint fixation. This study compared biomechanically 3 different fixation constructs for NC-1-3 joint fixation.

METHODS

The present study compared the three fixation constructs lag screw with locking plate for each NC joint, two crossed lag screws for each NC joint and a separate lag screw for each NC joint with bridging locking plates. NC-1-3 fixation was performed stepwise, and rotation of each joint was evaluated after the application of each lag screw or locking plate and their removal.

RESULTS

All examined fixation techniques led to a significant reduced rotation of the NC joints. For NC-1 rotation decreased from 2.8° (Range 1.2-6.6°) to 0.6° (0.2-3.0°) for lag screw and locking plate (p = 0.002) and from 5.0° (1.7-9.8°) to 1.0° (0.1-3.6°) for crossed lag screws (p = 0.002). For NC-2, locking plate constructs were better with 0.2° (0.1-0.5°) compared to crossed lag screw osteosynthesis with 0.9° (0.2-1.6°) (p = 0.011).

CONCLUSION

Each evaluated fixation technique led to a reduced NC joint rotation. The fixation of any NC joint had no relevant effect on the adjacent NC joints. The results might support surgeons treating NC joint disorders.

Tendoscopic Synovectomy of Tibialis Anterior Tendon of the Ankle

Tenosynovitis of the tibialis anterior tendon may occur as an overuse injury due to repetitive foot dorsiflexion. Most cases respond to conservative treatment with rest, shoe modification, anti-inflammatory agents, and physical therapy. Surgery may be required for chronic cases recalcitrant to conservative treatment. Other causes of tibialis anterior tenosynovitis include rheumatologic and infectious conditions. Classically, an operation on the tibialis anterior tendon is performed with open approach requiring dissection of the extensor retinacula. The purpose of this Technical Note is to describe the technical details of a tendoscopic approach to synovectomy of the tibialis anterior tendon. This can preserve the integrity of the extensor retinacula.