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Zhang J, Wang C, Li X, Fu S, Gu W, Shi Z. Application of mixed reality technology in talocalcaneal coalition resection. Front Surg 2023; 9:1084365. [PMID: 36684274 PMCID: PMC9852772 DOI: 10.3389/fsurg.2022.1084365] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 12/05/2022] [Indexed: 01/08/2023] Open
Abstract
Objectives With positive outcomes recorded, the mixed reality (MR) technology has lately become popular in orthopedic surgery. However, there are few studies that specifically address the utility of MR in talocalcaneal coalitions (TCC) resection. Our goal in this retrospective study is to assess certain data while examining the viability of using MR to treat TCC resection. Methods Six consecutive patients with TCC diagnosed by computed tomography (CT) for which nonoperative therapy had failed and MR system assisted TCC resection were included in this study from March 2021 to December 2021. The feasibility and accuracy of TCC resection were assessed by post-operation radiography. The American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score and visual analog scale (VAS) score were used to assess the recovery condition and pain level pre- and post-operation. Results The surgeon can accurately resect the TCC according to the preoperatively determined range by superimposing the holographic model with the actual anatomy of the TCC using an MR system. Additionally, no additional x-ray was necessary while operating. Mean follow-up was 10.3 months, with a minimum of 6 months. There is a significant difference between the preoperative AOFAS score of 53.4 ± 3.8 and the 6-month follow-up AOFAS score of 97.3 ± 2.2 (p < 0.05). There is also a significant difference between the preoperative VAS score of 8.1 ± 0.7 and the 6-month follow-up VAS score of 1.7 ± 0.4 (p < 0.05). All individuals had clinical subtalar mobility without stiffness following surgery. Conclusion While the TCC resection operation is being performed, the application of MR technology is practicable, effective, and radiation-free, giving surgeons satisfactory support.
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Affiliation(s)
- Jieyuan Zhang
- Department of Orthopedic Surgery, Shanghai Sixth People’s Hospital, Shanghai, China
| | - Cheng Wang
- Department of Orthopedic Surgery, Shanghai Sixth People’s Hospital, Shanghai, China
| | - Xueqian Li
- Department of Orthopedic Surgery, Shanghai Sixth People’s Hospital, Shanghai, China
| | - Shaoling Fu
- Department of Orthopedic Surgery, Shanghai Sixth People’s Hospital, Shanghai, China
| | - Wenqi Gu
- Department of Orthopedic Surgery, Shanghai Sixth People’s Hospital, Shanghai, China,Department of Orthopedic Surgery, Shanghai Sixth People’s Hospital East Campus, Shanghai, China,Correspondence: Zhongmin Shi Wenqi Gu
| | - Zhongmin Shi
- Department of Orthopedic Surgery, Shanghai Sixth People’s Hospital, Shanghai, China,Correspondence: Zhongmin Shi Wenqi Gu
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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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Wang A, Chen L, Pi Y, Zhao F, Xie X, Jiao C, Hu Y, Jiang D, Guo Q. Midterm Outcomes of Talocalcaneal Coalition Arthroscopic Resection in Adults. Foot Ankle Int 2022; 43:1062-1069. [PMID: 35619245 DOI: 10.1177/10711007221092756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Arthroscopic resection of the talocalcaneal coalition (TCC) has been reported to be associated with good short-term outcomes. However, the midterm outcomes of this approach remain uncertain. METHODS We performed a retrospective study of patients who underwent arthroscopic resection for symptomatic TCC. The patients were divided into 2 groups (group P, patients with isolated posterior facet coalition; and group MP, patients with both middle and posterior facet coalition). The preoperative and postoperative visual analog scale (VAS) scores for pain and American Orthopaedic Foot & Ankle Society (AOFAS) scale scores were calculated. The postoperative AOFAS and VAS scores between the 2 groups were analyzed. Patient satisfaction was also assessed. RESULTS Thirty-two patients were included in this study. The mean age at the time of surgery was 26.0±8.5 years, and the mean follow-up period was 56.9±18.0 months. Thirteen (41%) patients were in group P, whereas 19 (59%) patients were in group MP. Postoperative VAS and AOFAS scores improved more significantly than preoperative scores. At the final follow-up, excellent and good subjective outcomes were attained in 26 patients (81%), fair and poor outcomes in 6 patients (19%). There were no statistical differences in the postoperative AOFAS (91.0±7.0 vs 85.8±10.8, P = .532) and VAS score (2.1±1.7 vs 4.0±2.6, P = .537) between patients with the ratio of coalition/posterior facet more than or less than 50%. There were no statistical differences in postoperative VAS score (1.8±1.3 vs 2.6±2.2, P = .236) and AOFAS score (92.5±5.6 vs 89.2±8.7, P = .297) between group P (n=13) and group MP (n=19), either. Three patients (9.4%) had complications, including these notable findings: 1 patient complained of restricted dorsal flexion, 1 with computed tomography-proven coalition recurrence, and 1 with partial tibial nerve injury. CONCLUSION We found that TCC arthroscopic resection was generally associated with reasonable outcomes at midterm follow-up. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Anhong Wang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Linxin Chen
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Yanbin Pi
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Feng Zhao
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Xing Xie
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Chen Jiao
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Yuelin Hu
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Dong Jiang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Qinwei Guo
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
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Lateral Arthroscopic Subtalar Arthrodesis for Talocalcaneal Coalition: Surgical Technique. Arthrosc Tech 2022; 11:e1403-e1407. [PMID: 36061464 PMCID: PMC9437468 DOI: 10.1016/j.eats.2022.03.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 03/13/2022] [Indexed: 02/03/2023] Open
Abstract
Resection of symptomatic talocalcaneal coalitions (TCCs) has been performed for patients with normal tarsal joints and <50% involvement of the subtalar joint. For those with TCCs >50% of subtalar articulation or/and subtalar arthritis, a subtalar arthrodesis is done. The purpose of this Technical Note is to describe the arthroscopic resection of TCC and talocalcaneal arthrodesis during the same procedure by using a 2 lateral portal technique. With the patient in lateral decubitus under general or locoregional anaesthesia, the foot and ankle are extended beyond the edge of the surgical table. A lateral portal is created 1 cm anterior to the tip of the lateral malleolus in which the arthroscope is introduced. The anterolateral portal is created 1 cm inferior and 2 cm anterior to the tip of the lateral malleolus. The posterior subtalar surface is prepared progressively. The TCC resection is completed. The fixation is obtained with 2 cannulated screws. The arthroscopic resection of TCC and subtalar arthrodesis during the same procedure by using 2 lateral portals can be done for correctly selected patients.
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Surgical Treatment of Calcaneonavicular and Talocalcaneal Coalitions. Foot Ankle Clin 2021; 26:873-901. [PMID: 34752242 DOI: 10.1016/j.fcl.2021.07.011] [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
Tarsal coalition is determined by an absence of segmentation between one or more foot bones. The main symptom is activity-related foot pain, usually dorsolateral for calcaneonavicular coalitions and medial for talocalcaneal ones. At presentation, a symptomatic tarsal coalition must be treated conservatively for at least 6 months. If the conservative treatment fails and the foot is still painful, resection is the treatment of choice. Advantage of surgery is to restore mobility and reduce the risk of subsequent degenerative arthritis. Common pitfalls of surgery include failure to recognize associated coalitions, inadequate or extensive resection, and injury of adjoining bones.
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Malik-Tabassum K, Wahed K, To C, Maling L, Rose B. Post-operative outcomes of arthroscopic tarsal coalition resection: A systematic review. J Orthop 2020; 21:537-543. [PMID: 33029041 DOI: 10.1016/j.jor.2020.09.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/21/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Arthroscopic resection of tarsal coalitions is a relatively new technique. This systematic review aimed to investigate the post-operative complications and functional outcomes in arthroscopic resection of tarsal coalitions. METHODS PubMed, Medline, Embase and Cochrane library were searched for studies that reported outcomes in arthroscopic resection of tarsal coalitions. RESULTS 8 studies met the inclusion criteria. Post-operative outcomes were reported in 103 cases. The overall complication rate was 13.6%. Tibial nerve injury was reported in 1 patient. All included studies demonstrated post-operative improvement in functional outcomes. CONCLUSION Arthroscopic resection is a feasible and effective treatment method for symptomatic tarsal coalitions.
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Affiliation(s)
- Khalid Malik-Tabassum
- Specialty Registrar, Trauma & Orthopaedics, Conquest Hospital, East Sussex Healthcare NHS Trust, Hastings, United Kingdom
| | - Karim Wahed
- Specialty Registrar, Trauma & Orthopaedics, Eastbourne District General Hospital, East Sussex Healthcare NHS Trust, Eastbourne, United Kingdom
| | - Christopher To
- Specialty Registrar, Trauma & Orthopaedics, Conquest Hospital, East Sussex Healthcare NHS Trust, Hastings, United Kingdom
| | - Lucy Maling
- Specialty Registrar, Trauma & Orthopaedics, Conquest Hospital, East Sussex Healthcare NHS Trust, Hastings, United Kingdom
| | - Barry Rose
- Consultant Trauma & Orthopaedic Surgeon, Eastbourne District General Hospital, East Sussex Healthcare NHS Trust, Eastbourne, United Kingdom
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Abstract
Endoscopic resection of tarsal coalitions is technically feasible for both talocalcaneal and calcaneonavicular coalitions. Careful consideration of each individual patient is necessary before proceeding with endoscopic resection. Endoscopic resection of these coalitions may offer benefits in terms of faster recovery and less wound problems, but this has not been proven. Several case reports and case series appear in the literature and are reviewed here along with the different techniques reported. Better-quality evidence is required to assess the clinically relevant benefits and the recurrence rate for endoscopic resection in comparison with open resection.
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Affiliation(s)
- Andrew King
- Trauma and Orthopaedics Department, Royal Cornwall Hospitals NHS Trust, Royal Cornwall Hospital, Treliske, Truro TR1 3LQ, UK.
| | - Stephen Parsons
- Trauma and Orthopaedics Department, Royal Cornwall Hospitals NHS Trust, Royal Cornwall Hospital, Treliske, Truro TR1 3LQ, UK
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Di Gennaro GL, Stallone S, Olivotto E, Zarantonello P, Magnani M, Tavernini T, Stilli S, Trisolino G. Operative versus nonoperative treatment in children with painful rigid flatfoot and talocalcaneal coalition. BMC Musculoskelet Disord 2020; 21:185. [PMID: 32209079 PMCID: PMC7093982 DOI: 10.1186/s12891-020-03213-5] [Citation(s) in RCA: 4] [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: 11/05/2019] [Accepted: 03/13/2020] [Indexed: 11/23/2022] Open
Abstract
Background The management of painful rigid flatfoot (RFF) with talocalcaneal coalition (TCC) is controversial. We aimed to compare operative and nonoperative treatment in children with RFF and TCC. Methods We retrospectively reviewed medical records and radiographs of children with RFF and TTC treated between 2005 and 2015. The nonoperative treatment consisted of manipulation under anesthesia, cast immobilization and shoe insert after cast removal. The operative treatment consisted of combined TCC resection, graft interposition and subtalar arthroereisis. Results Thirty-four children (47 ft) in the nonoperative group and twenty-one children (34 ft) in the operative group were included. No differences were found between groups, concerning baseline characteristics. The mean age at treatment was 11.8 years (9–17): 11.6 (9–17) for the nonoperative group, 12.2 (10–15) for the operative group. The mean follow-up averaged 6.6 (3–12) years and was significantly longer in the nonoperative group (7.8 versus 4.7 years; p < 0.0005), since the operative procedure was increasingly practiced in the latest years. There were no complications in either groups, but 6 patients (7 ft) in the nonoperative group were unsatisfied and required surgery. At the latest follow-up, the AOFAS-AHS improved in both groups, although the operative group showed significantly better improvement. The operative group reported also significantly better FADI score, after adjustment for follow-up and baseline variables. Conclusion The operative treatment showed better results compared to the nonoperative treatment. Symptomatic RFF with TCC in children can be effectively treated in one step with resection, graft interposition and subtalar arthroereisis. Further prospective randomized studies are needed to confirm our findings and to identify the best operative strategy in this condition.
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Affiliation(s)
| | - Stefano Stallone
- Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Eleonora Olivotto
- RAMSES Laboratory, RIT Department, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Paola Zarantonello
- Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marina Magnani
- Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Tullia Tavernini
- Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Stilli
- Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giovanni Trisolino
- Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
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Wu G, Wang W, Chen S, Lin S. [Effectiveness of a modified posterior approach for arthroscopic resection on painful talocalcaneal coalition in adults]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:46-52. [PMID: 31939234 DOI: 10.7507/1002-1892.201905087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the effectiveness of arthroscopic talocalcaneal coalition resection in painful adults via a modified posterior approach. Methods Between January 2015 and December 2017, 9 patients with painful talocalcaneal coalition accepted arthroscopic resection via the posterior malleolus high lateral observation approach combined with the lower medial operation approach. Of them, 6 were male and 3 were female, aged from 19 to 30 years (mean, 24 years). Among them, 2 cases had no definite local trauma and 7 cases had a history of sprain of foot and ankle. The disease duration ranged from 6 to 30 months, with a median of 12 months. Rozansky classification of talocalcaneal coalition for the 9 patients: 5 cases (5 feet) were type Ⅰ, 2 cases (2 feet) type Ⅱ, and 2 cases (2 feet) type Ⅲ. The patients had no sequelae of limb dysfunction and no limb joint surgery in the past. All the patients received anteroposterior and lateral X-ray films and CT scans of the ankle joint during follow-up. The visual analogue scale (VAS) score and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hind foot score were used to evaluate the effectiveness. Results The operation time was 60-90 minutes (mean, 76 minutes). All patients were followed up 12-24 months (mean, 18 months). All the incisions healed by first intention, without infection, skin necrosis, lower extremity deep vein thrombosis, vascular nerve and tendon injury, bone bridge recurrence, and other complications. The ankle function recovered well and the pain was relieved obviously after operation, and the patients returned to work at 3-5 months after operation, with an average of 3.9 months. At last follow-up, the VAS score was 0.7±0.5, which was significantly improved ( t=20.239, P=0.000) when compared with preoperative score (4.2±0.5); the AOFAS ankle-hind foot score was 94±4, which was significantly improved ( t=-27.424, P=0.000) when compared with preoperative score (62±2). According to AOFAS ankle-hindfoot scoring system, the results were excellent in 7 cases and good in 2 cases at last follow-up. Conclusion It is more intuitive, more space, and more flexibility for operation via the modified posterior malleolus high lateral observation approach combined with the lower medial operation approach in talocalcaneal coalition. It is feasible to remove talocalcaneal coalition programmatically according to the specific anatomic signs during the operation.
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Affiliation(s)
- Guozhong Wu
- Department of Orthopedics, the Second Affiliated Hospital of Fujian Medical University, Quanzhou Fujian, 362000, P.R.China
| | - Wenhuai Wang
- Department of Orthopedics, the Second Affiliated Hospital of Fujian Medical University, Quanzhou Fujian, 362000,
| | - Shoubo Chen
- Department of Orthopedics, the Second Affiliated Hospital of Fujian Medical University, Quanzhou Fujian, 362000, P.R.China
| | - Sanfu Lin
- Department of Orthopedics, the Second Affiliated Hospital of Fujian Medical University, Quanzhou Fujian, 362000, P.R.China
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Walter RP, Walker RW, Butler M, Parsons S. Arthroscopic subtalar arthrodesis through the sinus tarsi portal approach: A series of 77 cases. Foot Ankle Surg 2018; 24:417-422. [PMID: 29409234 DOI: 10.1016/j.fas.2017.04.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Revised: 01/16/2017] [Accepted: 04/14/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Subtalar arthrodesis through an open approach carries significant risk of complications. An arthroscopic approach aims to minimise damage to the soft tissue envelope to improve recovery, union and complication rates. A two portal approach through the sinus tarsi was used. METHODS A retrospective review of all patients undergoing isolated arthroscopic arthrodesis was performed. RESULTS Seventy-seven procedures were performed. Successful arthrodesis was achieved in 75 (97.4%). Two patients underwent successful revision arthrodesis for aseptic nonunion. There was one (1.3%) superficial infection and one (1.3%) partial sural nerve injury. CONCLUSIONS Two-portal sinus tarsi arthroscopic subtalar arthrodesis is safe and effective. Advantages over other arthroscopic approaches are the access to all three facets of the joint, avoidance of a posterolateral portal in order to minimise risk to the sural nerve, and the ability to use the same approach to arthrodese the entire triple hindfoot joint complex. Technical tips and pitfalls are discussed.
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Affiliation(s)
- R P Walter
- Royal Cornwall Hospitals NHS Trust, Treliske, Cornwall, UK.
| | - R W Walker
- Royal Cornwall Hospitals NHS Trust, Treliske, Cornwall, UK
| | - M Butler
- Royal Cornwall Hospitals NHS Trust, Treliske, Cornwall, UK
| | - S Parsons
- Royal Cornwall Hospitals NHS Trust, Treliske, Cornwall, UK
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Aldahshan W, Hamed A, Elsherief F, Abdelaziz AM. Endoscopic Resection of Different Types of Talocalcaneal Coalition. Foot Ankle Int 2018; 39:1082-1088. [PMID: 29661082 DOI: 10.1177/1071100718770625] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to describe the technique of endoscopic resection of talocalcaneal coalition (TCC) by using 2 posterior portals and to report the outcomes of endoscopic resection of different types and sites of TCC. METHODS An interventional prospective study was conducted on 20 feet in 18 consecutive patients who were diagnosed by computed tomography to have TCC for which nonoperative treatment had failed and endoscopic resection was performed. The patients were divided into groups according to the site of the coalition (middle facet or posterior facet) and according to type (fibrous, cartilage, or bony). The mean follow-up period was 26 months (range, 6-36). RESULTS The average preoperative American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score was 57.7 (range, 40-65), and the average preoperative visual analog scale (VAS) score was 7.8 (range, 6-8). The average postoperative AOFAS hindfoot score was 92.4 (range, 85-98; P < .01). The average postoperative VAS score was 2.4 (range, 1-4). All patients showed no recurrence on postoperative lateral and Harris-Beath X-ray until the end of the study. CONCLUSIONS Endoscopic resection of TCC was an effective and useful method for the treatment of talocalcaneal coalition. It provided excellent outcomes with no recurrence in this short-term study. Resection of the fibrous type had a better outcome than resection of cartilage and bony types. Endoscopic resection of the posterior coalition had a better outcome than resection of the middle coalition. LEVEL OF EVIDENCE Level III, comparative study.
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Affiliation(s)
- Wael Aldahshan
- 1 Alzahraa University Hospital, Faculty of Medicine for Girls, Al-azhar University, Cairo, Egypt
| | - Adel Hamed
- 1 Alzahraa University Hospital, Faculty of Medicine for Girls, Al-azhar University, Cairo, Egypt
| | - Faisal Elsherief
- 1 Alzahraa University Hospital, Faculty of Medicine for Girls, Al-azhar University, Cairo, Egypt
| | - Ashraf Mohamed Abdelaziz
- 1 Alzahraa University Hospital, Faculty of Medicine for Girls, Al-azhar University, Cairo, Egypt
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Abstract
PURPOSE Describe the surgical technique of talocalcaneal coalition resection using live CT navigation. METHODS A ten-year-old female with left talocalcaneal coalition hindfoot pain refractory to conservative management underwent surgical coalition resection using live CT navigation. The procedure and discussion of this technique is described in detail. RESULTS With minimal radiation exposure to the patient, CT navigation for this complex talocalcaneal coalition was both helpful and potentially timesaving by allowing immediate localization and guided resection of the coalition. CONCLUSION In the case of a complex subtalar coalition resection, CT navigation poses minimal patient radiation exposure and allows immediate localization and guided resection of the coalition. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
- J. J. Stokman
- Dept. of Orthopedics and Rehabilitation, University of Wisconsin Hospital and Clinics, Madison, WI, USA,Correspondence should be sent to J. J. Stokman, Dept. of Orthopedics and Rehabilitation, University of Wisconsin Hospital and Clinics, Madison, WI, United States. E-mail:
| | - J. Mitchell
- Dept. of Orthopedics and Rehabilitation, University of Wisconsin Hospital and Clinics, Madison, WI, USA
| | - K. Noonan
- Dept. of Orthopedics and Rehabilitation, University of Wisconsin Hospital and Clinics, Madison, WI, USA
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Abstract
Computer-assisted orthopaedic surgery was born in the 1990s. Nowadays, computer-assisted orthopaedic surgery is used for transpedicular screw fixation and for total knee arthroplasty.Patient-specific instrumentation is one type of computer-assisted surgery based on volumetric images, such as computed tomography or magnetic resonance imaging.In this article, possible applications of patient-specific instruments in paediatric orthopaedics are described. The use of patient-specific instrumentation for the correction of cubitus varus is given as an example with complex osteotomy. Another application for tarsal coalition resection is shown.A last example of using patient-specific instrumentation for both tumour resection and allograft reconstruction is illustrated.Patient-specific instruments based on computed tomography of the bone can increase peri-operative accuracy and decrease operative time. They are very helpful for the surgeon. Other applications are possible and will be probably developed in the future. Cite this article: Docquier PL, Paul L, TranDuy V. Surgical navigation in paediatric orthopaedics. EFORT Open Rev 2016;1:152-159. DOI: 10.1302/2058-5241.1.000009.
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14
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Alaia EF, Rosenberg ZS, Bencardino JT, Ciavarra GA, Rossi I, Petchprapa CN. Tarsal tunnel disease and talocalcaneal coalition: MRI features. Skeletal Radiol 2016; 45:1507-14. [PMID: 27589967 DOI: 10.1007/s00256-016-2461-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 08/08/2016] [Accepted: 08/11/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess, utilizing MRI, tarsal tunnel disease in patients with talocalcaneal coalitions. To the best of our knowledge, this has only anecdotally been described before. MATERIALS AND METHODS Sixty-seven ankle MRIs with talocalcaneal coalition were retrospectively reviewed for disease of tendons and nerves of the tarsal tunnel. Interobserver variability in diagnosing tendon disease was performed in 30 of the 67 cases. Tarsal tunnel nerves were also evaluated in a control group of 20 consecutive ankle MRIs. RESULTS Entrapment of the flexor hallucis longus tendon (FHL) by osseous excrescences was seen in 14 of 67 cases (21 %). Attenuation, split tearing, tenosynovitis, or tendinosis of the FHL was present in 26 cases (39 %). Attenuation or tenosynovitis was seen in the flexor digitorum longus tendon (FDL) in 18 cases (27 %). Tenosynovitis or split tearing of the posterior tibial tendon (PT) was present in nine cases (13 %). Interobserver variability ranged from 100 % to slight depending on the tendon and type of disease. Intense increased signal and caliber of the medial plantar nerve (MPN), indicative of neuritis, was seen in 6 of the 67 cases (9 %). Mildly increased T2 signal of the MPN was seen in 15 (22 %) and in 14 (70 %) of the control group. CONCLUSIONS Talocalcaneal coalitions may be associated with tarsal tunnel soft tissue abnormalities affecting, in decreasing order, the FHL, FDL, and PT tendons, as well as the MPN. This information should be provided to the referring physician in order to guide treatment and improve post-surgical outcome.
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Affiliation(s)
| | | | | | - Gina A Ciavarra
- New York University Langone Medical Center, New York, NY, USA
| | - Ignacio Rossi
- New York University Langone Medical Center, New York, NY, USA.,Centro de Diagnóstico Dr. Enrique Rossi, Buenos Aires, Argentina
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Knörr J, Soldado F, Menendez ME, Domenech P, Sanchez M, Sales de Gauzy J. Arthroscopic Talocalcaneal Coalition Resection in Children. Arthroscopy 2015; 31:2417-23. [PMID: 26315054 DOI: 10.1016/j.arthro.2015.06.022] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 06/07/2015] [Accepted: 06/18/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To present the technique and outcomes of arthroscopic talocalcaneal coalition (TCC) resection in pediatric patients. METHODS We performed a prospective study of 16 consecutive feet with persistent symptomatic TCCs in 15 children. The mean age was 11.8 years (range, 8 to 15 years), and the mean follow-up period was 28 months (range, 12 to 44 months). A posterior arthroscopic TCC resection was performed. The plantar footprint, subtalar motion, pain, and the American Orthopaedic Foot & Ankle Society Ankle-Hindfoot scale score were evaluated preoperatively and postoperatively. Preoperative computed tomography (CT) scans were used to classify the coalition according to the Rozansky classification, to measure the percentage of involvement of the surface area, and to determine the degree of hindfoot valgus. Postoperative CT scans at 1 year (n = 15) and 3 years (n = 5) were used to assess recurrences. Patient satisfaction was also evaluated. RESULTS The TCC distribution according to the Rozansky classification was type I in 7 cases, type II in 3, type III in 3, and type IV in 3. In all cases the arthroscopic approach enabled complete coalition resection. All patients increased by at least 1 stage in the footprint classification and showed clinical subtalar mobility after surgery. All patients showed a statistically significant improvement in pain after surgery except for 1 patient in whom complex regional pain syndrome developed (P < .001). The mean American Orthopaedic Foot & Ankle Society score was 56.8 (range, 45 to 62) preoperatively versus 90.9 (range, 36 to 100) postoperatively, showing a statistically significant increase (P < .001). Preoperative CT scans showed that all TCCs involved the medial subtalar joint facet, with mean involvement of 40.8% of the articular surface. All postoperative CT scans showed complete synostosis resections with no recurrences at final follow-up. At final follow-up, all patients were either satisfied (n = 4 [27%]) or extremely satisfied (n = 10 [67%]) with the outcome, except the 1 patient (7%) in whom complex regional pain syndrome developed. CONCLUSIONS Arthroscopic TCC resection provides good outcomes (symptom relief and restoration of subtalar motion), with no recurrence of the coalition. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Jorge Knörr
- Department of Pediatric Orthopedic Surgery and Microsurgery, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain; Orthopaedic Surgery Department, Universitat de Barcelona, Barcelona, Spain.
| | - Francisco Soldado
- Department of Pediatric Orthopedic Surgery and Microsurgery, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain; Orthopaedic Surgery Department, Universitat de Barcelona, Barcelona, Spain
| | - Mariano E Menendez
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | - Pedro Domenech
- Department of Pediatric Orthopedic Surgery and Microsurgery, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain; Orthopaedic Surgery Department, Universitat de Barcelona, Barcelona, Spain
| | - Mikel Sanchez
- Unidad Cirugía Artroscópica, Hospital Vhitas San José, Vitoria-Gasteiz, Spain
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de Wouters S, Tran Duy K, Docquier PL. Patient-specific instruments for surgical resection of painful tarsal coalition in adolescents. Orthop Traumatol Surg Res 2014; 100:423-7. [PMID: 24793905 DOI: 10.1016/j.otsr.2014.02.009] [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: 11/01/2013] [Revised: 02/03/2014] [Accepted: 02/11/2014] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Congenital tarsal coalition resection in adolescents may be hindered by the complex three-dimensional anatomy of the talocalcaneal joint. Peroperative fluoroscopy is not greatly contributive, especially for talocalcaneal coalition. HYPOTHESIS 3D planning and patient-specific instruments facilitate the procedure. MATERIALS AND METHODS A made-to-measure surgical guide (patient-specific instrument) was used in 9 consecutive patients for tarsal coalition resection (7 talocalcaneal and 2 calcaneonavicular coalitions). The guide was created by 3D modeling from the CT scan of the foot. Placed on the bone surface, it oriented the saw blade to resect the bone bridge at the appropriate depth. A fascia lata allograft was interposed. Complete resection and absence of recurrence were checked on postoperative CT in talocalcaneal and on radiography in calcaneonavicular coalitions. RESULTS Resection was complete in all cases, with no recurrence at last follow-up. DISCUSSION This technique makes tarsal coalition resection easier and more reliable and may be recommended to improve precision. LEVEL OF EVIDENCE Level IV, prospective study of a new surgical technique.
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Affiliation(s)
- S de Wouters
- Cliniques Universitaires Saint-Luc, Service de Chirurgie Orthopédique et Traumatologique, avenue Hippocrate 10, 1200 Brussels, Belgium; Computer Assisted and Robotic Surgery (CARS), Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, avenue Mounier 53, 1200 Brussels, Belgium
| | - K Tran Duy
- Centis Engineering, Université Catholique de Louvain (UCL), Institute of Mechanics, Materials and Civil Engineering (IMMC), SST/IMMC/MCTR, Louvain-la-Neuve, Belgium
| | - P-L Docquier
- Cliniques Universitaires Saint-Luc, Service de Chirurgie Orthopédique et Traumatologique, avenue Hippocrate 10, 1200 Brussels, Belgium; Computer Assisted and Robotic Surgery (CARS), Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, avenue Mounier 53, 1200 Brussels, Belgium.
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Hayashi K, Kumai T, Tanaka Y. Endoscopic resection of a talocalcaneal coalition using a posteromedial approach. Arthrosc Tech 2013; 3:e39-43. [PMID: 24749021 PMCID: PMC3986476 DOI: 10.1016/j.eats.2013.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 08/14/2013] [Indexed: 02/03/2023] Open
Abstract
Resection is a standard surgical procedure for a talocalcaneal coalition (TCC). A posterior approach is the representative technique for hindfoot endoscopy, and there is only 1 report of endoscopic resection of TCC using this approach. Disadvantages of the posterior approach for TCC are as follows: (1) the indication is limited to posterior-facet coalition, (2) the flexor hallucis longus can be an obstacle in approaching the coalition, (3) the acute insertion angle between the endoscope and instrument reduces operability, and (4) a position change and additional skin incision are essential for conversion to an open procedure. In contrast, a posteromedial approach for TCC with established portals at the entrance and exit of the flexor retinaculum is a useful technique because (1) the indication is allow to middle- and posterior-facet coalitions, (2) increased perfusion pressure allows the creation of sufficient working space, (3) operating the instrument only at the coalition site decreases the risk of tendon injury and neurovascular damage, (4) the obtuse insertion angle between the endoscope and instrument improves operability, and (5) a position change and additional skin incision are unnecessary for conversion to an open procedure.
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Affiliation(s)
- Koji Hayashi
- Department of Orthopaedic Surgery and Rehabilitation, Otemae Hospital, Osaka, Japan,Address correspondence to Koji Hayashi, M.D., 1-5-34, Otemae, Chuo-ku, Osaka-shi, Osaka, 540-0008, Japan.
| | - Tsukasa Kumai
- Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
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