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Inoue J, Yasui Y, Sasahara J, Takenaga T, Ha M, Miyamoto W, Kawano H, Murakami H, Yoshida M. Comparison of visibility in needle arthroscopy of the ankle according to surgical experience: A cadaveric study. Foot Ankle Surg 2024:S1268-7731(24)00109-7. [PMID: 38762338 DOI: 10.1016/j.fas.2024.05.005] [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: 12/11/2023] [Revised: 03/01/2024] [Accepted: 05/13/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Literature regarding the feasibility of inexperienced surgeons using needle arthroscopy is limited. The present study aimed to clarify the feasibility of performing ankle needle arthroscopy for inexperienced surgeons. METHODS Diagnostic needle arthroscopy was performed for 10 cadaveric ankles by two surgeons with different levels of experience in ankle arthroscopy (inexperienced and expert surgeons). The visibility of arthroscopy was assessed based on a 15-point checklist and compared between surgeons. In addition, iatrogenic articular cartilage injury created by the inexperienced surgeon was investigated. RESULTS The number of visible points was significantly larger for the expert surgeon than for the inexperienced surgeon (14.1 ± 1.0 vs. 13.7 ± 1.0, P = 0.035). The location of cartilage injury was greatest on the medial talar dome when viewing from the anteromedial portal at a rate of 30%. CONCLUSION Ankle needle arthroscopy may be an option for surgeons in the future, however, differences in surgeon experience may impact effective visualization.
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Affiliation(s)
- Jumpei Inoue
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Youichi Yasui
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan.
| | - Jun Sasahara
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Tetsuya Takenaga
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Myongsu Ha
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Wataru Miyamoto
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Hirotaka Kawano
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Hideki Murakami
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Masahito Yoshida
- Department of Musculosleletal Sports Medicine, Research and Innovation, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
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Stornebrink T, Walinga AB, Stufkens SA, Kerkhoffs GM. Wide-Awake Needle Arthroscopy of the Anterior Ankle: A Standardized Approach. Arthrosc Tech 2024; 13:102901. [PMID: 38690356 PMCID: PMC11056615 DOI: 10.1016/j.eats.2023.102901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 12/01/2023] [Indexed: 05/02/2024] Open
Abstract
Over the years, possibilities in ankle arthroscopy have evolved from diagnostic inspection to complex interventional procedures. Further innovation may come from needle arthroscopy, which has improved substantially in image quality in recent years and can now be used for interventional procedures as well. We here present a standardized approach to wide-awake needle arthroscopy of the anterior ankle under local anesthesia. As new needle arthroscopic procedures of the ankle arise, this approach serves to help ensure safe, uniform, and beneficial adoption of this emergent technique.
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Affiliation(s)
- Tobias Stornebrink
- Department of Orthopedic Surgery and Sports Medicine, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health & Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center Amsterdam UMC, Amsterdam, The Netherlands
| | - Alex B. Walinga
- Department of Orthopedic Surgery and Sports Medicine, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health & Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center Amsterdam UMC, Amsterdam, The Netherlands
| | - Sjoerd A.S. Stufkens
- Department of Orthopedic Surgery and Sports Medicine, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health & Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center Amsterdam UMC, Amsterdam, The Netherlands
| | - Gino M.M.J. Kerkhoffs
- Address correspondence to Gino M.M.J. Kerkhoffs, M.D., Ph.D., Amsterdam UMC, location AMC, department of Orthopedic Surgery, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands.
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3
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Stornebrink T, Walinga A, Dalmau-Pastor M, Bosman AW, Smit TH, Kerkhoffs GM. Implantation of a Cushioning Injectable Implant Using Needle Arthroscopy in the Foot and Ankle and First Carpometacarpal Joint. Arthrosc Tech 2023; 12:e2343-e2352. [PMID: 38196866 PMCID: PMC10773259 DOI: 10.1016/j.eats.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/07/2023] [Indexed: 01/11/2024] Open
Abstract
Injectable implants constitute a newly developed treatment class in the battle against osteoarthritis. They consist of water-formulated supramolecular polymer, coming from a new class of resorbable biomedical materials, and are implanted in encapsulated joints in a liquid form, where they solidify to form a tough, elastic, and cushioning layer between the joint surfaces. To resort any effect, intra-articular delivery should be guaranteed, and the implant should be distributed throughout the entire joint space. Traditional implantation techniques do not seem to suffice for this new implant class, being either imprecise (traditional injection) or overly invasive (open procedures and traditional arthroscopic surgery). We describe a needle arthroscopic implantation technique to reap the benefits of both worlds, ensuring precise implant delivery while avoiding unnecessarily invasive procedures. This study depicts our needle arthroscopic technique for implantation of injectable implants in the ankle, first metatarsophalangeal joint, and first carpometacarpal joint.
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Affiliation(s)
- Tobias Stornebrink
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Movement Sciences, Amsterdam, the Netherlands
- Amsterdam Collaboration for Health & Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center Amsterdam UMC, Amsterdam, the Netherlands
| | - Alex Walinga
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Movement Sciences, Amsterdam, the Netherlands
- Amsterdam Collaboration for Health & Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center Amsterdam UMC, Amsterdam, the Netherlands
| | - Miki Dalmau-Pastor
- Human Anatomy and Embryology Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- MIFAS by GRECMIP (Minimally Invasive Foot and Ankle Society), Merignac, France
| | | | - Theodoor H. Smit
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Movement Sciences, Amsterdam, the Netherlands
- Amsterdam Collaboration for Health & Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center Amsterdam UMC, Amsterdam, the Netherlands
| | - Gino M.M.J. Kerkhoffs
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Movement Sciences, Amsterdam, the Netherlands
- Amsterdam Collaboration for Health & Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center Amsterdam UMC, Amsterdam, the Netherlands
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4
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Dahmen J, Indino C, D’Ambrosi R, Usuelli FG. Needle Arthroscopic Subchondroplasty With Adipose-Derived Stem Cell Augmentation for the Treatment of Osteochondral Lesions of the Talus. Arthrosc Tech 2023; 12:e1649-e1656. [PMID: 37942119 PMCID: PMC10627869 DOI: 10.1016/j.eats.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 05/27/2023] [Indexed: 11/10/2023] Open
Abstract
Needle arthroscopy has enjoyed a tremendous growth concerning the quality of intraoperative images due to technical innovation, resulting in innovative possibilities concerning concomitant minimally invasive procedures and treatment of osteochondral lesions of the talus (OLT). These lesions have increasingly been receiving scientific attention in the orthopaedic (sports) medicine field, and, as such, the quality of evidence-based treatment for them has developed substantially. Treatment of OLTs-and specifically subchondroplasty. OLTs may also be suitable for needle arthroscopic interventions. The purpose of the present technical note is, therefore, to present an all-arthroscopic needle arthroscopic technique, including subchondroplasty with adipose-derived stem cells augmentation for osteochondral lesions of the talus.
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Affiliation(s)
- Jari Dahmen
- University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Sport, Amsterdam, The Netherlands
- Academic Center for Evidence-based Sports Medicine, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health & Safety in Sports, International Olympic Committee Research Center, Amsterdam, The Netherlands
| | - Cristian Indino
- Ortopedia della Caviglia e del Piede, Humanitas S. Pio X, Milano, Italia
| | - Riccardo D’Ambrosi
- Istituto di Ricovero e Cura a Carattere Scientifico, Ospedale Galeazzi–Sant’Ambrogio, Milano, Italia
- Università degli Studi di Milano, Dipartimento di Scienze Biomediche per la Salute, Milano, Italia
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Winter P, Najefi AA, Lambert L, Landgraeber S, Tschernig T, Wagener J. Endoscopically Assisted Percutaneous Harvesting of the Flexor Hallucis Tendon in Zone 2: An Anatomical Study. Foot Ankle Int 2023; 44:888-894. [PMID: 37296541 DOI: 10.1177/10711007231177250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Flexor hallucis longus (FHL) transfer is a well-established method for treating chronic Achilles tendon ruptures and tendinopathy. Harvesting of the FHL tendon in zone 2 results in greater length but is also associated with an increased risk of injury to the medial plantar nerve and requires an additional plantar incision. Because of the anatomic proximity of the FHL tendon to the tibial neurovascular bundle in zone 2, the purpose of this study was to investigate the risk of vascular or nerve injury with arthroscopic assisted percutaneous tenotomy in zone 2 of the FHL tendon. METHODS Endoscopically assisted percutaneous FHL transfer was performed on 10 right lower extremities from 10 cadaveric human specimens. The FHL tendon lengths and the relationship between FHL tendon and the tibial neurovascular bundle at zone 2 was analyzed. RESULTS We observed a complete transection of the medial plantar nerve in 1 case (10%). The mean length of the FHL tendon was 54.7 ± 9.5 mm and the mean distance from the distal stump of the FHL tendon to local neurovascular structures was 1.3 ± 0.7 mm. CONCLUSION There is a risk of neurovascular injury after endoscopic FHL tenotomy in zone 2. The tenotomy site is within 2 mm of the local neurovascular structures in the majority of cases. The additional length gained from this technique is unlikely to be required for the majority of FHL tendon transfer procedures. If additional length is needed, we would recommend the use of intraoperative ultrasonography or a mini-open approach to minimize injury risk. LEVEL OF EVIDENCE Level V, expert opinion.
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Affiliation(s)
- Philipp Winter
- Department of Orthopaedic Surgery, University of Saarland, Homburg, Germany
| | - Ali-Asgar Najefi
- Department of Trauma and Orthopaedic, London North West University Hospital NHS Trust, London, United Kingdom
| | - Laura Lambert
- Department of Orthopaedic Surgery, University of Saarland, Homburg, Germany
| | - Stefan Landgraeber
- Department of Orthopaedic Surgery, University of Saarland, Homburg, Germany
| | | | - Joe Wagener
- Department of Orthopaedic Surgery, University of Saarland, Homburg, Germany
- Department of Orthopaedic Surgery, Hôpital Kirchberg, Luxembourg
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6
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Weinraub GM, Vijayakumar A. Arthroscopy for Traumatic Ankle Injuries. Clin Podiatr Med Surg 2023; 40:529-537. [PMID: 37236689 DOI: 10.1016/j.cpm.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Using ankle arthroscopy in conjunction to open reduction internal fixation of traumatic ankle injuries can play an important role in the management of these injuries by way of treating intra-articular pathologies, leading to improved patient outcomes. While a majority of these injuries are not treated with concurrent arthroscopy, its addition may lead to more prognostic information to dictate the patient's course. This article has illustrated its use in managing malleolar fractures, syndesmotic injuries, pilon fractures and pediatric ankle fractures. While additional studies may be needed to further support AORIF, it may prove to play a vital role in the future.
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Affiliation(s)
- Glenn M Weinraub
- Department of Orthopaedic Surgery, Kaiser Permanente, San Leandro, CA, USA.
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7
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Theodoulou MH, Ravine M. Posterior Ankle Impingement. Clin Podiatr Med Surg 2023; 40:413-424. [PMID: 37236679 DOI: 10.1016/j.cpm.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
This article is devoted to managing posterior ankle impingement syndrome and its management using endoscopic to arthroscopic surgical instrumentation. The authors explore the critical anatomy, pathogenesis, and clinical examination. Operative techniques, including the approach, and instrumentation used, are outlined. The postoperative protocol is discussed. Finally, a literature review is provided, which also defines known complications.
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Affiliation(s)
- Michael H Theodoulou
- Podiatric Surgery, Cambridge Health Alliance, Cambridge, MA, USA; Harvard Medical School, 1439 Cambridge Street, Cambridge, MA 02139, USA.
| | - Madison Ravine
- Cambridge Health Alliance Podiatric Medicine & Surgery Residency Program, 1439 Cambridge Street, Cambridge, MA 02139, USA
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8
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Inoue J, Yasui Y, Sasahara J, Takenaga T, Wakabayashi K, Nozaki M, Kobayashi M, Ha M, Fukushima H, Kato J, Miyamoto W, Kawano H, Murakami H, Yoshida M. Comparison of Visibility and Risk of Neurovascular Tissue Injury Between Portals in Needle Arthroscopy of the Anterior Ankle Joint: A Cadaveric Study. Orthop J Sports Med 2023; 11:23259671231174477. [PMID: 37332532 PMCID: PMC10273784 DOI: 10.1177/23259671231174477] [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: 01/12/2023] [Accepted: 02/22/2023] [Indexed: 06/20/2023] Open
Abstract
Background For needle arthroscopy with 0° viewing, the visible range of intra-articular structures and the difference between portals remain unknown, as do the risks for neurovascular tissue at each portal. Purpose To clarify the visibility and safety of needle arthroscopy. Study Design Descriptive laboratory study. Methods Ten cadaveric ankle specimens were used. A needle arthroscope with a 1.9-mm diameter was inserted from 4 portals (anteromedial [AM], anterolateral [AL], medial midline [MM], and anterocentral [AC]). Visibility was assessed using a 15-point ankle arthroscopy checklist. In addition, the ankles were dissected to measure the distance between each portal and neurovascular tissues. The visibility of the ankle joint was compared between portals. Results The success rate of visibility in the deltoid ligament and the tip of the medial malleolus was 100% from the AM, MM, and AC portals and 10% from the AL portal, with significant differences between the portals (P < .01). The visibility success rates in the origin of the anterior talofibular ligament and the tip of the lateral malleolus were 20% for the AM portal, 90% for the MM and AC portals, and 100% for the AL portal, with significant differences between the portals (P < .01). All other points of the ankle joint were visualized from all the portals with a 100% success rate. The AC portal was in contact with the anterior neurovascular bundle in 4 of the 10 specimens. Conclusion When needle arthroscopy was performed from the AM or AL portal, the site opposite to the portal in the ankle joint was difficult to visualize. Conversely, most points of the ankle joint could be visualized from the MM and AC portals. Care should be taken when creating an AC portal because of its proximity to the anterior neurovascular bundle. Clinical Relevance The present study provides information regarding which portal should be selected to perform needle arthroscopy in the ankle joint, which will be beneficial for management of ankle injuries.
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Affiliation(s)
- Jumpei Inoue
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Youichi Yasui
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Jun Sasahara
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Tetsuya Takenaga
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Kenjiro Wakabayashi
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Masahiro Nozaki
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Makoto Kobayashi
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Myongsu Ha
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Hiroaki Fukushima
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Jiro Kato
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Wataru Miyamoto
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Hirotaka Kawano
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Hideki Murakami
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Masahito Yoshida
- Department of Musculoskeletal Sports Medicine, Research and Innovation, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
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Presurgical Perspective and Postsurgical Evaluation of Instability and Microinstability Secondary to Ankle Ligaments Injury. Semin Musculoskelet Radiol 2022; 26:644-655. [PMID: 36791734 DOI: 10.1055/s-0042-1760245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Injuries of the ankle ligaments complexes are very common, and ∼ 20 to 40% of patients can develop chronic ankle instability (CAI). Current concepts in CAI allow a better understanding of the ankle biomechanics needed to repair it. The surgical treatment of CAI has evolved in the last decade, and ankle arthroscopy has become an essential tool in the treatment of instability with promising results. We review the different surgical techniques to treat CAI, both those frequently used and the new approaches, as well as the normal postsurgical appearance of ankle ligaments repair and the most common complications.
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10
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Does Demineralized Bone Matrix Affect the Nonunion Rate in Arthroscopic Ankle Arthrodesis? J Clin Med 2022; 11:jcm11133893. [PMID: 35807177 PMCID: PMC9267684 DOI: 10.3390/jcm11133893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/13/2022] [Accepted: 07/01/2022] [Indexed: 11/16/2022] Open
Abstract
Demineralized bone matrix (DBM) has been shown to have positive effects on union rates in many orthopedic subspecialties; however, minimal evidence exists about bone graft substitutes in foot and ankle surgery. The purpose of this study is to compare nonunion rates in arthroscopic ankle arthrodesis in patients receiving DBM with those without. We hypothesized DBM to be associated with a decreased risk of nonunion. This retrospective review includes 516 consecutive ankle arthrodesis cases from March 2002 to May 2016. Of these, 58 ankles (56 patients) that underwent primary arthroscopic ankle arthrodesis met the inclusion criteria, and 31 of these ankles received DBM, while 27 did not. Nonunion was assessed by clinical examination and routine postoperative radiographs. If nonunion was suspected, a computed tomography (CT) scan was performed. The primary outcome measure was nonunion rate. Secondary outcome measures included wound complications, return to operating room (OR), and rate of postoperative deep vein thrombosis (DVT) or pulmonary embolism (PE). From the study cases, 58 were available for final follow-up. The average age was 55.9 years (±17.4), and mean follow-up was 43.0 months (range 6.3–119.4). There was no difference in nonunion rate in patients who received DBM (4/31, 12.9%) versus those who did not (4/27, 14.8%) (p = 0.83). Similarly, when comparing the two groups, there were no statistically significant differences in superficial wound complications (6.5% vs. 3.7%, p = 1.0) or rate of return to OR (29% or 0.037/person-years vs. 37% or 0.099/person-years; p = 0.20). No major complications including deep wound infections, DVTs, or PEs occurred. This is the largest study to directly compare nonunion rates and complications for patients receiving DBM versus those who did not in primary arthroscopic ankle arthrodesis. No significant association was found between DBM usage and risk of nonunion, wound complications, return to OR, or postoperative DVT or PE development.
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Abstract
Ankle distraction arthroplasty (DA) is a joint-preserving option for the treatment of ankle osteoarthritis. The ideal patient is a young, active person who is compliant with follow-up and understands that clinical improvements may not be fully evident until 1 year after surgery. The procedure promotes cartilage healing and regeneration by removing mechanical stress at the joint surface through the application of a joint-spanning external fixator. There is an array of adjuvant procedures commonly performed to optimize healing potential-including microfracture, osteophyte removal, osteotomies, and soft tissue balancing procedures. Short- and intermediate-term studies have been promising, though there is a wide variance in reported failure and complication rates.
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Affiliation(s)
- Alirio J deMeireles
- Department of Orthopedic Surgery, Columbia University Irving Medical Center/New York-Presbyterian Hospital, 622 West 168th Street, PH 11 - 1102, New York, NY 10032-3720, USA
| | - Ettore Vulcano
- Department of Orthopedic Surgery, Columbia University Orthopedics at Mount Sinai Medical Center, 4302 Alton Road, Suite 220, Miami Beach, FL 33140, USA.
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12
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Batista JP, Abdelatif NMN, Del Vecchio JJ, Diniz P, Pereira H. Endoscopic Flexor Hallucis Longus Transfer for the Management of Acute Achilles Tendon Ruptures: A Prospective Case Series Report With a Minimum of 18 Months' Follow-Up. J Foot Ankle Surg 2021; 59:927-937. [PMID: 32527698 DOI: 10.1053/j.jfas.2019.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 12/18/2019] [Accepted: 12/22/2019] [Indexed: 02/03/2023]
Abstract
Acute Achilles tendon rupture can be treated either surgically or nonsurgically. The flexor hallucis longus (FHL) has been used successfully in patients with large chronic Achilles tendon defects. The aim of this study was to describe the clinical outcomes of isolated endoscopic FHL transfer in patients with acute Achilles tendon ruptures at a minimum follow-up of 18 months. Fifty-six male patients with an average age of 36.3 years who underwent endoscopic FHL transfer as a treatment for acute Achilles tendon ruptures were included. Follow-up was for a mean (± standard deviation) of 27.5 ± 7.29 months. At 18 months postoperatively, the Achilles tendon total rupture score mean was 95 ± 4.26, and the American Orthopaedic Foot and Ankle Society score was a mean of 96.4 ± 4.31. The median value for FHL tendon dynamometry on the surgical side was 95.72 (range 70.1 to 142), and 100.7 (range 68 to 161) for the nonoperated side. Mean ankle plantarflexion strength at 18 months was 19.19 ± 2.55 kg • m compared with the uninjured side of 19.27 ± 2.16 kg • m. Relative Achilles tendon resting angle showed a mean of -0.25° ± 2.43°. Magnetic resonance imaging performed at a minimum of 18 months postoperatively showed a homogeneous continuous Achilles tendon signal for 43 patients and heterogeneous signal intensity in 13 patients (23.21%). No patients reported any great toe complaints or symptomatic deficits of flexion strength. No neurovascular or skin complications were encountered. The current study demonstrated satisfactory and comparable results with minimal complications when using the endoscopic FHL tendon transfer in surgical management of acute Achilles tendon ruptures, compared with the currently used methods.
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Affiliation(s)
- Jorge Pablo Batista
- Head, Ankle and Knee Section, Orthopaedics Department, Centro Artroscópico Jorge Batista SA, Buenos Aires, Argentina; Head, Soccer Medical Department, Department of Sport Medicine, Club Atlético Boca Juniors, Buenos Aires, Argentina
| | | | - Jorge Javier Del Vecchio
- Head, Foot and Ankle Section, Orthopaedics Department, Fundación Favaloro. Hospital Universitario, Buenos Aires, Argentina; Professor, Department of Kinesiology and Physiatry, Universidad Favaloro, Buenos Aires, Argentina
| | - Pedro Diniz
- Orthopaedic Surgeon, Hospital de Sant'Ana, Parede, Portugal; PhD Student, Institute for Bioengineering and Biosciences, Instituto Superior Técnico, Universidade de Lisboa, Portugal
| | - Helder Pereira
- Orthopedic Surgeon, Orthopedic Department of Póvoa de Varzim, Ripoll y De Prado Sports Clinic, Murcia-Madrid, Spain; Orthopedic Surgeon, FIFA Medical Centre of Excellence; ICVS/3B's, PT Government Associate Laboratory, Porto, Portugal; Orthopedic Surgeon, ICVS/3B's, PT Government Associate Laboratory - Minho University, Braga, Portugal
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13
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Hirtler L, Rath C, Kügler P, Reissig L, Willegger M. Maximum Ankle Plantarflexion and Dorsiflexion Allow for Optimal Arthroscopic Access to the Talar Dome: An Anatomic 3-Dimensional Radiography Study. Arthroscopy 2021; 37:1245-1257. [PMID: 33359819 DOI: 10.1016/j.arthro.2020.12.207] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 12/09/2020] [Accepted: 12/14/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE (1) to improve the comprehension of the topographical position of the talar dome beneath the inferior articular surface of the tibia and, (2) to illustrate the changes of possible access to the articular surface of the talar dome during arthroscopic treatment of talar osteochondral defects in an anatomical model. METHODS Twenty matched pairs (n = 40) of anatomical ankle specimen were used. All specimens were mounted in a standardized fashion, 3-dimensional radiography was performed in 4 defined positions (maximum dorsiflexion, neutral position, noninvasive distraction, and maximum plantarflexion). All radiographs were analyzed and statistically compared. RESULTS Anterior accessibility was highest in maximum plantarflexion (medial: 49.20 ± 9.86%, lateral: 48.19 ± 8.85%), followed by non-invasive distraction (medial: 33.60 ± 7.96%, lateral: 31.98 ± 8.30%). Neutral position (medial: 19.34 ± 6.90%, lateral: 17.54 ± 6.63%) and dorsiflexion (medial: 15.36 ± 5.03%, lateral: 13.88 ± 4.33%) were not able to significantly increase accessibility. Posterior accessibility was greatest in maximum dorsiflexion (medial: 56.69 ± 9.65%, lateral: 46.82 ± 8.36%), followed by neutral position of the ankle joint (medial: 40.95 ± 8.28%, lateral: 31.06 ± 6.92%). Noninvasive distraction (medial: 31.41 ± 8.18%, lateral: 22.99 ± 7.63%) was still significantly better than plantarflexion (medial: 14.54 ± 5.10%, lateral: 13.89 ± 3.14%) and slightly increased accessibility to the talar dome. Medially, a central area of 5.89 ± 9.76% was accessible by maximum plantarflexion and maximum dorsiflexion from anterior and posterior, respectively, laterally a central blind spot of 4.99 ± 8.61% was detected. CONCLUSIONS From an anatomical point of view, maximum joint positions of the ankle (i.e., plantarflexion and dorsiflexion) allow for better access to the talar dome in anterior and posterior ankle arthroscopy. Noninvasive distraction may increase accessibility in anterior approaches, but has no benefit from posterior. CLINICAL RELEVANCE This study provides insight into the morphology of the ankle joint in a standardized laboratory setup and illustrates the influence of different surgically relevant ankle joint positions. The presented data allow for better preoperative planning for the arthroscopic treatment of talar osteochondral defects.
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Affiliation(s)
- Lena Hirtler
- Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria.
| | - Claus Rath
- Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - Paul Kügler
- Department of Plastic, Aesthetic and Reconstructive Surgery, Klagenfurt Clinic, Klagenfurt, Austria
| | - Lukas Reissig
- Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - Madeleine Willegger
- Division of Orthopedics, Department of Orthopedics and Trauma-Surgery, Medical University of Vienna, Vienna, Austria
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14
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Ferkel RD, Kwong C, Farac R, Pinto M, Fahimi N, Rahhal S, Marumoto J. Arthroscopic Posterior Ankle Ligament Anatomy. FOOT & ANKLE ORTHOPAEDICS 2021; 6:24730114211000624. [PMID: 35097439 PMCID: PMC8564934 DOI: 10.1177/24730114211000624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: The purpose of this article is to document the normal arthroscopic appearance of the posterior ankle capsular and ligamentous structures, and variations in their anatomical relationships. Methods: 102 ankle arthroscopy videotapes were evaluated retrospectively for the configuration of the posterior capsuloligamentous structures. Based on these observations, the variations in the appearance and position of the posterior tibiofibular ligament (PTFL) and transverse (tibiofibular) ligament (TTFL) were documented. In addition, differences in the appearance of the flexor hallucis longus (FHL) were also noted. Results: All patients had evidence of both a PTFL and TTFL, which formed a labrum or meniscus-like addition to the posterior distal tibia. No patients demonstrated disruption of the PTFL; 3 had tears of the TTFL. We noted 4 distinct patterns of the PTFL and the TTFL. Thirty-four patients (33%) had a gap of ≥2 mm between the 2 ligamentous structures. Thirty-three (32.4%) had a gap <2 mm between the PTFL and TTFL. Twenty-six (25.5%) had a confluence of the 2 ligaments without a gap. Nine (9%) demonstrated a sizable gap between the 2 ligaments, and the TTFL appeared as a “cord-like” structure. Conclusion: To our knowledge, this is the first article to describe the variations in the arthroscopic normal posterior capsuloligamentous structures and FHL of the ankle. Level of Evidence: Level IV, case series.
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Affiliation(s)
| | - Cory Kwong
- Southern California Orthopedic Institute, Van Nuys, CA, USA
| | | | - Mark Pinto
- Chelsea Orthopedic Specialists, Chelsea, MI, USA
| | - Nader Fahimi
- Elite Orthopaedics & Sports Medicine, Clifton, NJ, USA
| | - Scott Rahhal
- Advanced Orthopedics of Oklahoma, Tulsa, OK, USA
| | - Jay Marumoto
- Orthopedic Associates of Hawaii, Honolulu, HI, USA
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15
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De Leeuw PAJ, Vega J, Karlsson J, Dalmau-Pastor M. The posterior fibulotalocalcaneal ligament complex: a forgotten ligament. Knee Surg Sports Traumatol Arthrosc 2021; 29:1627-1634. [PMID: 33486559 PMCID: PMC8038989 DOI: 10.1007/s00167-020-06431-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 12/23/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE The purpose of the present anatomical study was to define the exact morphology of the posterior fibulotalocalcaneal ligament complex (PFTCLC), both for a better orientation and understanding of the anatomy, especially during hindfoot endoscopy. METHODS Twenty-three fresh frozen specimens were dissected in order to clarify the morphology of the PFTCLC. RESULTS In all specimens, the ligament originated from the posteromedial border of the lateral malleolus between the posterior tibiofibular ligament (superior border) and the calcaneofibular ligament (CFL), (inferior border). This origin functions as the floor for the peroneal tendon sheath. The origin of the PFTCLC can be subdivided into two parts, a superior and inferior part. The superior part forms an aponeurosis with the superior peroneal retinaculum and the lateral septum of the Achilles tendon. From this structure, two independent laminae can be identified. The inferior part of the origin has no role in the aponeurosis and ligamentous fibres run obliquely to insert in the lateral surface of the calcaneus, in the same orientation as the CFL, but slightly more posterior, which was a consistent finding in all examined specimens. The PFTCLC is maximally tensed with ankle dorsiflexion and is located within the fascia of the deep posterior compartment of the leg. CONCLUSIONS The PFTCLC is part of the normal anatomy of the hindfoot and therefore should be routinely recognized and partly released to achieve access to the posterior ankle anatomical pathology, relevant for hindfoot endoscopy. The origin of the ligament complex forms the floor for the peroneal tendon sheath. The superior part of the origin plays a role in the formation of an aponeurosis with the superior peroneal retinaculum and the lateral septum of the Achilles tendon.
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Affiliation(s)
- Peter A. J. De Leeuw
- Department of Orthopaedic Surgery, Flevoziekenhuis, Hospitaalweg 1, 1315 RA Almere, The Netherlands
- Department of Orthopaedic Surgery, Amsterdam UMC, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, The Netherlands
- Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands
- Amsterdam UMC IOC Research Center, Amsterdam Collaboration On Health and Safety in Sports, Amsterdam, The Netherlands
| | - Jordi Vega
- Human Anatomy and Embryology Unit, Department of Pathology and Experimental Therapeutics, University of Barcelona, Barcelona, Spain
- Foot and Ankle Unit, iMove -Tres Torres, and Hospital Quirón Barcelona, Barcelona, Spain
- GRECMIP (Groupe de Recherche et d’Etude en Chirurgie Mini-Invasive du Pied) Soon MIFAS (Minimally Invasive Foot and Ankle Society), Merignac, France
| | - Jon Karlsson
- Department of Orthopaedics, Sahlgrenska University Hospital, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Miki Dalmau-Pastor
- Human Anatomy and Embryology Unit, Department of Pathology and Experimental Therapeutics, University of Barcelona, Barcelona, Spain
- GRECMIP (Groupe de Recherche et d’Etude en Chirurgie Mini-Invasive du Pied) Soon MIFAS (Minimally Invasive Foot and Ankle Society), Merignac, France
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16
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Abstract
Chronic ankle instability can result from untreated or badly managed acute lateral ankle ligament injuries. Conservative management is the modality of choice for acute lateral ankle ligament injuries, and operative treatment is reserved for special cases. Failure after strict rehabilitation may be an indication for surgery. Several operative options are available, including anatomic repair, anatomic reconstruction, and tenodesis procedures. Anatomic repair can be performed when the quality of the damaged ligaments permits. Anatomic reconstruction with an autograft or allograft should be considered when the torn ligaments are not adequate. Ankle arthroscopy is a useful adjunct to ligamentous procedures, performed at the time of repair to identify and treat intra-articular conditions that may be associated with chronic ankle instability. Tenodesis techniques are not recommended because of their suboptimal long-term results related to the modification of ankle and hindfoot biomechanics.Level of Evidence: Level V, expert opinion.
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Affiliation(s)
- Rocco Aicale
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Baronissi, Italy.,Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Baronissi, Italy.,Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy.,Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital London, United Kingdom.,Keele University, Faculty of Medicine, School of Pharmacy and Bioengineering, Guy Hilton Research Centre, Thornburrow Drive, Hartshill, Stoke-on-Trent, United Kingdom
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17
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Abstract
BACKGROUND The anterocentral portal is not a standard portal in anterior ankle arthroscopy due to its proximity to the anterior neurovascular bundle. However, it provides certain advantages, including a wide field of vision, and portal changes become redundant. The purpose of this study was to evaluate the neurovascular complications after anterior ankle arthroscopy using the anterocentral portal. METHODS We retrospectively identified patients who had undergone anterior ankle arthroscopy with an anterocentral portal at our institution from 2013 to 2018. Medical record data were reviewed and patients were invited for clinical follow-up, where a clinical examination, quantitative sensory testing for the deep peroneal nerve, and ultrasonography of the structures at risk were performed. A total of 101 patients (105 arthroscopies) were identified and evaluated at a mean follow-up of 31.5 ± 17.7 months. RESULTS Leading indications to surgery were heterogeneous and included anterior impingement (48.6%), osteochondral lesions of the talus (24.8%), chronic ankle instability (14.3%), and fractures (8.6%). The overall complication rate was 7.6%, and no major complications were observed. In 1.9% (2/105) of the cases, the complications were associated with the anterocentral portal and included injury to the medial branch of the superficial nerve (1/105) and to the deep peroneal nerve (1/105). Injury to the deep peroneal nerve was associated with a loss of detection and nociception. There were no injuries to the anterior tibial artery. In 41.9% (44/105) of the cases, only 1 working portal was used in addition to the anterocentral portal, and in 19% (20/105) the anterolateral portal could be avoided. Ultrasonography confirmed the integrity of the deep peroneal nerve, the medial branch of the superficial peroneal nerve, and the anterior tibial artery in all patients. Patients with nerve injuries associated with the anterocentral portal showed no signs of neuroma or pseudoaneurysm. CONCLUSION Using a standardized technique, the anterocentral portal in ankle arthroscopy is safe with a low number of neurovascular injuries and can be recommended as a standard portal. The anterolateral portal remains associated with a high number of injuries to the superficial peroneal nerve. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Christoph Stotter
- Department of Orthopedics and
Traumatology, LK Baden-Mödling, Baden, Austria,Faculty of Health and Medicine,
Department for Health Sciences, Medicine and Research, Center for Regenerative
Medicine, Danube University Krems, Krems, Austria,Christoph Stotter, MD, PhD, Faculty of
Health and Medicine, Department for Health Sciences, Medicine and Research,
Center for Regenerative Medicine, Danube University Krems, Dr. Karl-Dorrek-Str.
30, Krems, A-3500 Austria.
| | - Thomas Klestil
- Department of Orthopedics and
Traumatology, LK Baden-Mödling, Baden, Austria,Faculty of Health and Medicine,
Department for Health Sciences, Medicine and Research, Center for Regenerative
Medicine, Danube University Krems, Krems, Austria
| | | | - Vahid Naderi
- Department of Radiology, LK
Baden-Mödling, Baden, Austria
| | - Stefan Nehrer
- Faculty of Health and Medicine,
Department for Health Sciences, Medicine and Research, Center for Regenerative
Medicine, Danube University Krems, Krems, Austria
| | - Philippe Reuter
- Department of Orthopedics and
Traumatology, LK Baden-Mödling, Baden, Austria
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18
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Stornebrink T, Altink JN, Appelt D, Wijdicks CA, Stufkens SAS, Kerkhoffs GMMJ. Two-millimetre diameter operative arthroscopy of the ankle is safe and effective. Knee Surg Sports Traumatol Arthrosc 2020; 28:3080-3086. [PMID: 32065244 PMCID: PMC7511271 DOI: 10.1007/s00167-020-05889-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 01/29/2020] [Indexed: 12/26/2022]
Abstract
PURPOSE Technical innovation now offers the possibility of 2-mm diameter operative arthroscopy: an alternative to conventional arthroscopy that no longer uses inner rod-lenses. The purpose of this study was to assess whether all significant structures in the ankle could be visualized and surgically reached during 2-mm diameter operative arthroscopy, without inflicting iatrogenic damage. METHODS A novel, 2-mm diameter arthroscopic system was used to perform a protocolled arthroscopic procedure in 10 fresh-frozen, human donor ankles. Standard anteromedial and anterolateral portals were utilized. Visualization and reach with tailored arthroscopic instruments of a protocolled list of articular structures were recorded and documented. A line was etched on the most posterior border of the talar and tibial cartilage that was safely reachable. The specimens were dissected and distances between portal tracts and neurovascular structures were measured. The articular surfaces of talus and tibia were photographed and inspected for iatrogenic damage. The reachable area on the articular surface was calculated and analysed. RESULTS All significant structures were successfully visualized and reached in all specimens. The anteromedial portal was not in contact with neurovascular structures in any specimen. The anterolateral portal collided with a branch of the superficial peroneal nerve in one case but did not cause macroscopically apparent harm. On average, 96% and 85% of the talar and tibial surfaces was reachable respectively, without causing iatrogenic damage. CONCLUSION 2-mm diameter operative arthroscopy provides safe and effective visualization and surgical reach of the anterior ankle joint. It may hold the potential to make ankle arthroscopy less invasive and more accessible.
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Affiliation(s)
- Tobias Stornebrink
- grid.7177.60000000084992262Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,grid.491090.5Academic Center for Evidence-based Sports medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands ,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - J. Nienke Altink
- grid.7177.60000000084992262Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,grid.491090.5Academic Center for Evidence-based Sports medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands ,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Daniel Appelt
- grid.467155.40000 0004 4687 0378Department of Orthopedic Research, Arthrex GmbH, Munich, Germany
| | - Coen A. Wijdicks
- grid.467155.40000 0004 4687 0378Department of Orthopedic Research, Arthrex GmbH, Munich, Germany
| | - Sjoerd A. S. Stufkens
- grid.7177.60000000084992262Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,grid.491090.5Academic Center for Evidence-based Sports medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands ,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Gino M. M. J. Kerkhoffs
- grid.7177.60000000084992262Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,grid.491090.5Academic Center for Evidence-based Sports medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands ,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
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19
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Malagelada F, Vega J, Guelfi M, Kerkhoffs G, Karlsson J, Dalmau-Pastor M. Anatomic lectures on structures at risk prior to cadaveric courses reduce injury to the superficial peroneal nerve, the commonest complication in ankle arthroscopy. Knee Surg Sports Traumatol Arthrosc 2020; 28:79-85. [PMID: 30729253 DOI: 10.1007/s00167-019-05373-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 01/24/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE To assess the effectiveness of cadaveric ankle arthroscopy courses in reducing iatrogenic injuries. METHODS A total of 60 novice surgeons enrolled in a basic cadaveric ankle arthroscopy course were divided into two groups. Group A (n = 32) was lectured on portal placement and use of the arthroscope, whereas group B (n = 28) was in addition lectured on specific portal-related complications. Following the performance of anterior ankle arthroscopy and hindfoot endoscopy, the specimens were dissected and carefully assessed for detection of any iatrogenic injuries. RESULTS The rate of injury to the superficial peroneal nerve (SPN) was reduced from 25 to 3.6%, in group A compared with B (p = 0.033). Injuries to the peroneus tertius or extensor digitorum longus, the flexor hallucis longus and the tibial nerve or the Achilles tendon were also reduced in group B. Overall, the number of uninjured specimens was 50% (n = 30) and higher in group B (57%) than group A (44%). Lesions to the plantaris tendon, the sural nerve or the posterior tibial artery were more common in group B, however, without reaching statistical significance. Overall, 25 (13.9%) anatomic structures were injured in anterior arthroscopy compared to 18 (5%) in hindfoot endoscopy, out of a potential total of 180 and 360, respectively (p = 0.001). CONCLUSION Dedicated lectures on portal-related complications have proven useful in reducing the risk of injury to the SPN, the commonest iatrogenic injury encountered in ankle arthroscopy. Hindfoot endoscopy is significantly safer than anterior ankle arthroscopy in terms of injury to anatomical structures.
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Affiliation(s)
- F Malagelada
- Human Anatomy and Embryology Unit, Department of Pathology and Experimental Therapeutics, University of Barcelona, Barcelona, Spain. .,Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London, UK.
| | - J Vega
- Human Anatomy and Embryology Unit, Department of Pathology and Experimental Therapeutics, University of Barcelona, Barcelona, Spain.,GRECMIP (Groupe de Recherche et d'Etude en Chirurgie Mini-Invasive du Pied), Merignac, France.,Foot and Ankle Unit, Hospital Quirón and Clinica Tres Torres, Barcelona, Spain
| | - M Guelfi
- Foot and Ankle Unit, Clinica Montallegro, Genoa, Italy.,Human Anatomy and Embryology Unit, Department of Morphological Sciences, Universitad Autònoma de Barcelona, Barcelona, Spain
| | - G Kerkhoffs
- Department of Orthopedic Surgery, Amsterdam University Medical Centers, Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Academic Center for Evidence-Based Sports medicine (ACES), Academic Medical Center, Amsterdam, The Netherlands.,Amsterdam Collaboration on Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
| | - J Karlsson
- Department of Orthopaedics, Sahlgrenska University Hospital, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - M Dalmau-Pastor
- Human Anatomy and Embryology Unit, Department of Pathology and Experimental Therapeutics, University of Barcelona, Barcelona, Spain.,GRECMIP (Groupe de Recherche et d'Etude en Chirurgie Mini-Invasive du Pied), Merignac, France
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20
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Vega J, Malagelada F, Karlsson J, Kerkhoffs GM, Guelfi M, Dalmau-Pastor M. A step-by-step arthroscopic examination of the anterior ankle compartment. Knee Surg Sports Traumatol Arthrosc 2020; 28:24-33. [PMID: 31667570 DOI: 10.1007/s00167-019-05756-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 10/07/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Despite the increased use of ankle dorsiflexion without distraction, no reports have specifically addressed the arthroscopic anatomy of the ankle in this position. The purpose of this study was to describe the normal arthroscopic anatomy of the ankle joint, when using the ankle dorsiflexion and the dynamic distraction technique, and to propose an arthroscopic examination system for the anterior ankle compartment. METHODS Ankle arthroscopy was performed in 20 fresh frozen specimens. Arthroscopic examination was performed with the arthroscope introduced through the anteromedial portal. The anterior compartment was examined in ankle dorsiflexion without distraction. The compartment was examined in four steps: (1) lateral area including the lateral gutter; (2) the central area of the anterior tibial rim; (3) the medial area including the medial gutter; (4) the talar neck. Next, distraction was applied to visualise the anterior compartment again and to examine the central and posterior ankle compartments. RESULTS Anatomic intra-articular structures were visualised in all specimens. Four intra-articular fat pads, one anteromedial, two syndesmotic and another posteromedial, were constantly observed. A description of the normal arthroscopic anatomy of the ankle using the ankle dorsiflexion and the dynamic distraction technique is detailed for the anterior, central and posterior compartments. CONCLUSION The ankle arthroscopic procedure without distraction allows constant visualisation of the ATFL's superior fascicle on the floor of the lateral gutter, the ATiFL's distal fascicle laterally and the most anterior margin of the deltoid ligament in the medial gutter (anterior tibiotalar ligament). However, ankle distraction is required to observe the central and posterior compartments, but it does not provide optimal visualisation of the anterior ankle compartment structures. LEVEL OF EVIDENCE V.
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Affiliation(s)
- J Vega
- Human Anatomy and Embryology Unit, Department of Pathology and Experimental Therapeutics, University of Barcelona, Barcelona, Spain. .,Foot and Ankle Unit, Orthopedic Department, iMove Tres Torres Barcelona 76, Dr Roux st, Barcelona, Spain. .,GRECMIP-MIFAS (Groupe de Recherche et d'Etude en Chirurgie Mini-Invasive du Pied-Minimally Invasive Foot and Ankle Society), Merignac, France.
| | - F Malagelada
- Human Anatomy and Embryology Unit, Department of Pathology and Experimental Therapeutics, University of Barcelona, Barcelona, Spain.,Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - J Karlsson
- Department of Orthopaedics, Sahlgrenska University Hospital, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - G M Kerkhoffs
- Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam University Medical Centers, Amsterdam, The Netherlands.,Academic Center for Evidence-Based Sports Medicine (ACES), Academic Medical Center, Amsterdam, The Netherlands.,Amsterdam Collaboration On Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
| | - M Guelfi
- Foot and Ankle Unit, Clinica Montallegro, Genoa, Italy.,Human Anatomy and Embryology Unit, Department of Morphological Sciences, Universitad Autònoma de Barcelona, Barcelona, Spain
| | - M Dalmau-Pastor
- Human Anatomy and Embryology Unit, Department of Pathology and Experimental Therapeutics, University of Barcelona, Barcelona, Spain.,GRECMIP-MIFAS (Groupe de Recherche et d'Etude en Chirurgie Mini-Invasive du Pied-Minimally Invasive Foot and Ankle Society), Merignac, France
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21
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Hirtler L, Schellander K, Schuh R. Accessibility to Talar Dome in Neutral Position, Dorsiflexion, or Noninvasive Distraction in Posterior Ankle Arthroscopy. Foot Ankle Int 2019; 40:978-986. [PMID: 31081369 PMCID: PMC6669825 DOI: 10.1177/1071100719847134] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Osteochondral lesions of the talus are frequent pathologies of the ankle joint. Especially through arthroscopy, the treatment is kept as minimally invasive as possible. However, there are some drawbacks as to the reachability because of the high congruency of the ankle joint. Here, either noninvasive distraction or maximal dorsiflexion may be an option for better access to the lesion. The purpose of this study was to evaluate maximal dorsiflexion compared to neutral position or noninvasive distraction of the ankle joint in the arthroscopic reachability of the talar dome. The hypothesis of this study was that maximal dorsiflexion would allow for greater accessibility of the talar dome compared to neutral position or noninvasive distraction of the joint. METHODS Twenty matched pairs (n=40) of anatomical ankle specimens were used. The effects of neutral position, maximal dorsiflexion, and noninvasive distraction of the ankle joint on arthroscopic accessibility of the ankle joint were tested. After disarticulation of the talus, reach was measured and compared between the 3 positions. RESULTS In neutral position, 13.7±1.2 mm of the talar dome was reached laterally and 14.0±1.0 mm medially. In maximal dorsiflexion, the distance was 19.0±1.1mm laterally and 19.8±1.4 mm medially, and in noninvasive distraction it was 16.1±1.5 mm laterally and 15.7±1.0 mm medially. The statistical comparison showed a significantly better reach in dorsiflexion laterally (P = .003) and medially (P = .026). CONCLUSION Accessibility of the talar dome in maximal dorsiflexion was superior to that in neutral position or noninvasive distraction. CLINICAL RELEVANCE Results of this study may allow for better planning in arthroscopic treatment of osteochondral lesions of the talus.
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Affiliation(s)
- Lena Hirtler
- Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria,Lena Hirtler, MA, MD, PhD, Medical University of Vienna, Center for Anatomy and Cell Biology, Division of Anatomy, Währinger Straße 13, Vienna, 1090, Austria.
| | - Katarina Schellander
- Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - Reinhard Schuh
- Department of Pediatric Orthopedics and Foot Surgery, Orthopedic Hospital Vienna–Speising, Vienna, Austria
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22
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Barg A, Saltzman CL. Joint-Preserving Procedures in Patients with Varus Deformity: Role of Supramalleolar Osteotomies. Foot Ankle Clin 2019; 24:239-264. [PMID: 31036267 DOI: 10.1016/j.fcl.2019.02.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The most common cause for end-stage ankle osteoarthritis is posttraumatic, sometimes resulting from concomitant supramalleolar deformity. Aims of the supramalleolar osteotomy include restoring the lower-leg axis to improve intraarticular load distribution and retarding degeneration of the tibiotalar joint. Preoperative planning is based on conventional weight-bearing radiographs. Often advanced imaging, including computed tomography and/or MRI, is needed for a better understanding of the underlying problem. Postoperative complications are not uncommon, including progression of tibiotalar osteoarthritis in up to 25% within 5 years of all patients who have supramalleolar osteotomies.
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Affiliation(s)
- Alexej Barg
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA.
| | - Charles L Saltzman
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA.
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23
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Baumbach SF, Braunstein M, Herterich V, Böcker W, Waizy H, Polzer H. [Arthroscopic repair of chronic lateral ankle instability]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2019; 31:201-210. [PMID: 30918997 DOI: 10.1007/s00064-019-0595-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 10/03/2018] [Accepted: 10/06/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Repair of the lateral ligament complex of the ankle joint; identification and treatment of intra-articular pathologies. INDICATIONS Symptomatic chronic lateral ankle instability. Treatment of osteochondral lesions associated with lateral ankle instability. CONTRAINDICATIONS Osteoarthritis of the ankle joint, risk factors such as peripheral occlusive disease, diabetic foot syndrome, complex regional pain syndrome. SURGICAL TECHNIQUE Diagnostic arthroscopy of the ankle joint utilizing anterolateral and -medial portals; identification and treatment of intra-articular pathologies; identification and preparation of the distal fibula; insertion of two suture anchors; the sutures are passed inside-out through the joint capsule, the scarred lateral ligaments, the extensor retinaculum using a suture lasso; by tying down the sutures the tissue grasped is then pulled against the distal fibula; this will stabilize the lateral ligament complex. POSTOPERATIVE MANAGEMENT Partial weight-bearing and short leg cast for 2 weeks, then 4 weeks ankle brace and range of motion exercises, thereafter functional physical therapy, ankle brace only during exercises; no sports for at least 3 months. RESULTS Currently, one randomized controlled trial is available comparing open to arthroscopic lateral ankle ligament repair. Open repair was always combined with arthroscopy to treat intra-articular pathologies. In all patients, surgery led to a significant increase of the American Orthopaedic Foot and Ankle Score (AOFAS), Karlsson Score and visual analog score (VAS), but no significant differences between the open and arthroscopic procedure after one year with similar complications (arthroscopy group: 3 temporary nerve irritations and 2 patients with pain over the knot; open treated group: 2 temporary nerve irritations and one abscess). Intra-articular pathologies were treated in 68% of the arthroscopically treated patients and 70% of the patients treated by open surgery. One out of two retrospective comparative studies reported a significantly shorter operation time and time to return to daily activity and significantly lower VAS three days postoperatively for arthroscopically treated patients, while the other parameters assessed were comparable.
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Affiliation(s)
- S F Baumbach
- Sektion für Fuß- und Sprunggelenkchirurgie, Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, LMU München, Ludwig-Maximilians-Universität, Nußbaumstraße 20, 80336, München, Deutschland
| | - M Braunstein
- Sektion für Fuß- und Sprunggelenkchirurgie, Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, LMU München, Ludwig-Maximilians-Universität, Nußbaumstraße 20, 80336, München, Deutschland
| | - V Herterich
- Sektion für Fuß- und Sprunggelenkchirurgie, Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, LMU München, Ludwig-Maximilians-Universität, Nußbaumstraße 20, 80336, München, Deutschland
| | - W Böcker
- Sektion für Fuß- und Sprunggelenkchirurgie, Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, LMU München, Ludwig-Maximilians-Universität, Nußbaumstraße 20, 80336, München, Deutschland
| | - H Waizy
- Sektion für Fuß- und Sprunggelenkchirurgie, Donau-Ries Klinik Donauwörth, Neudegger Allee 6, 86609, Donauwörth, Deutschland
| | - H Polzer
- Sektion für Fuß- und Sprunggelenkchirurgie, Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, LMU München, Ludwig-Maximilians-Universität, Nußbaumstraße 20, 80336, München, Deutschland.
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[Supramalleolar osteotomy in asymmetric ankle osteoarthritis : Short-term clinical and radiographic results]. DER ORTHOPADE 2018; 46:761-775. [PMID: 28405708 DOI: 10.1007/s00132-017-3416-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The main indication for the supramalleolar osteotomy is asymmetric ankle osteoarthritis with concomitant supramalleolar valgus or varus deformity. The aim of this prospective study was to analyze short-term clinical and radiographic outcomes in patients with asymmetric ankle osteoarthritis. METHODS A total of 16 patients with asymmetric ankle osteoarthritis and concomitant supramalleolar deformity - 7 patients with valgus deformity, 9 patients with varus deformity - were treated. Intraoperative and postoperative complications were recorded and analyzed. The clinical and radiographic outcomes were assessed after a mean follow-up of 3.6 ± 1.1 years. RESULTS In 10 of 16 patients, removal of hardware was performed. The AOFAS hindfoot score increased significantly after surgery. All categories of the SF-36 score showed significant improvement. The average range of motion also increased significantly. Radiographic assessment showed neutral hindfoot alignment at the latest follow-up. The postoperative clinical outcomes were comparable in both patient groups. The time until complete osseous union was significantly longer in patients with opening wedge osteotomy. CONCLUSION This prospective study demonstrated encouraging short-term results in patients with asymmetric ankle osteoarthritis who underwent supramalleolar osteotomy. In progressive ankle osteoarthritis, joint-nonpreserving treatment options including total ankle replacement or ankle arthrodesis should be discussed.
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Walcher MG, Seefried L, Konrads C, Plumhoff P, Hoberg M, Rudert M, Fraissler L. Arthroskopisch gestützte Arthrodese des oberen Sprunggelenks. ARTHROSKOPIE 2018. [DOI: 10.1007/s00142-018-0201-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Dalmau-Pastor M, Vega J, Malagelada F, Peña F, Manzanares-Céspedes MC. An Anatomical Study of Nerves at Risk During Minimally Invasive Hallux Valgus Surgery. J Vis Exp 2018:56232. [PMID: 29553550 PMCID: PMC5931310 DOI: 10.3791/56232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
The growing popularity of minimally invasive surgical (MIS) procedures makes it necessary that new anatomical references arise, to aid in tridimensional orientation and localization of structures that are not directly visible to the surgeon. This is especially critical for structures at risk like nerves or blood vessels. Optimization of the handling of cadaveric material and the combination of multiple techniques compensate for the limited availability of adequate specimens. The described protocol combines anatomical plane-by-plane dissection and sectional anatomy of fresh-frozen specimens to help localize relevant structures, such as nerves, arteries, veins and to correctly position the portals during MIS procedures. Depiction of these structures in anatomy textbooks can differ from what is encountered in the surgical field; and for this reason, new anatomical studies with a surgical orientation are needed. However, this is a complex, time-consuming technique requiring specific training. The anatomical references described with the so-called 'clock method' provide the surgeon with an easy and reproducible system to locate the path of the nerves at risk in Hallux Valgus MIS procedures. This model can be extrapolated to many other minimally invasive surgical procedures.
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Affiliation(s)
- Miki Dalmau-Pastor
- Laboratory of Arthroscopic and Surgical Anatomy. Department of Pathology and Experimental Therapeutics (Human Anatomy and Embryology Unit), University of Barcelona; Health Sciences Faculty of Manresa, University of Vic-Central University of Catalunya; Groupe de Recherche et d'Etude en Chirurgie Mini-Invasive du Pied, GRECMIP;
| | - Jordi Vega
- Laboratory of Arthroscopic and Surgical Anatomy. Department of Pathology and Experimental Therapeutics (Human Anatomy and Embryology Unit), University of Barcelona; Foot and Ankle Unit, Hospital Quirón Barcelona
| | - Francesc Malagelada
- Laboratory of Arthroscopic and Surgical Anatomy. Department of Pathology and Experimental Therapeutics (Human Anatomy and Embryology Unit), University of Barcelona; Foot and Ankle Unit, Orthopedic and Trauma Surgery, Royal London Hospital, Barts Health NHS Trust
| | - Fernando Peña
- Department of Orthopedic Surgery, Foot and Ankle Unit, University of Minnesota
| | - Maria Cristina Manzanares-Céspedes
- Laboratory of Arthroscopic and Surgical Anatomy. Department of Pathology and Experimental Therapeutics (Human Anatomy and Embryology Unit), University of Barcelona
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Hirtler L, Schuh R. Accessibility of the Talar Dome-Anatomic Comparison of Plantarflexion Versus Noninvasive Distraction in Arthroscopy. Arthroscopy 2018; 34:573-580. [PMID: 29079263 DOI: 10.1016/j.arthro.2017.07.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 07/28/2017] [Accepted: 07/28/2017] [Indexed: 02/06/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the difference in accessibility of the talar dome during ankle arthroscopy between noninvasive distraction and maximum plantar flexion without distraction. METHODS For this study, 20 matched pairs (n = 40) of anatomic ankle specimens were used. Two groups (distraction or maximum plantar flexion) were defined. Through the use of chondral picks, the accessibility of each technique was tested arthroscopically. Afterward, the ankle joint was dissected and the reach achieved was measured and compared between the 2 groups. RESULTS Through noninvasive distraction, 13.1 ± 4.4 mm of the talar dome was reached laterally and 16.7 ± 3.7 mm medially. Through plantar flexion, 18.1 ± 3.4 mm of the talar dome was reached laterally and 18.1 ± 3.4 mm medially. Statistical comparison revealed a significantly better reach in plantar flexion on the lateral side of the talar dome (P = .007). There was no significant difference medially. CONCLUSIONS Plantar flexion significantly improves reachability of the dome on the lateral side and it is equal to noninvasive distraction medially. Results of this study may allow for better access to the lesion of the talus. CLINICAL RELEVANCE Results of this study allow for a better planning of interventions in OCD of the talus.
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Affiliation(s)
- Lena Hirtler
- Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria.
| | - Reinhard Schuh
- Department of Pediatric Orthopedics and Foot Surgery, Orthopedic Hospital Vienna-Speising, Vienna, Austria
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Vega J, Dalmau-Pastor M, Malagelada F, Fargues-Polo B, Peña F. Ankle Arthroscopy: An Update. J Bone Joint Surg Am 2017; 99:1395-1407. [PMID: 28816902 DOI: 10.2106/jbjs.16.00046] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Jordi Vega
- 1Foot and Ankle Unit, Hospital Quirón Barcelona, Barcelona, Spain 2Human Anatomy and Embriology Unit, Department of Pathology and Experimental Therapeutics, University of Barcelona, Barcelona, Spain 3Manresa Health Science School, University of Vic-Central University of Catalonia, Barcelona, Spain 4Foot and Ankle Unit, Department of Orthopaedic Surgery, Heatherwood and Wexham Park Hospitals, Frimley Health NHS Trust, Ascot, Berkshire, United Kingdom 5Foot and Ankle Unit, Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota
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Van Dijk CN, Vuurberg G, Batista J, d’Hooghe P. Posterior ankle arthroscopy: current state of the art. J ISAKOS 2017. [DOI: 10.1136/jisakos-2016-000082] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Batista JP, Del Vecchio JJ, Patthauer L, Ocampo M. Arthroscopic Lateral Ligament Repair Through Two Portals in Chronic Ankle Instability. Open Orthop J 2017; 11:617-632. [PMID: 29081860 PMCID: PMC5633705 DOI: 10.2174/1874325001711010617] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 07/18/2016] [Accepted: 07/23/2016] [Indexed: 11/22/2022] Open
Abstract
Objectives: Injury to the lateral ligament complex of the ankle is one of the most common sports-related injury. Usually lateral ankle evolves with excellent clinical recovery with non surgical treatment, however, near about 30% develop a lateral chronic instability sequela. Several open and arthroscopic surgical techniques have been described to treat this medical condition. Material and Methods: Of the 22 patients who were treated; 18 males and 4 females, and aged from 17-42 years (mean 28 years). All patients presented a history of more than three ankle sprains in the last two years and presented positive anterior drawer and talar tilt test of the ankle in the physical examination. We perform an anterior arthroscopy of the ankle in order to treat asociated disease and then we performed “All inside¨ lateral ligament repair through two portals (anteromedial and anterolateral) using an anchor knotless suture. Results: Clinical outcome evaluations were performed at a mean follow up of 25 months. (R: 17-31). Overall results has been shown by means of the American Orthopaedic Foot and Ankle Society (AOFAS). Mean AOFAS scores improved from 63 points (range 52–77) preoperatively to 90 points (range 73–100) at final follow up. No recurrences of ankle instability were found in the cases presented. Conclusion: Several surgical procedures have been described during the last years in order to treat chronic ankle instability. ¨All inside¨ lateral ligament reconstruction presents lower local morbidity than open procedures with few complications. Moreover, it is a reproductible technique, with high clinical success rate, few complications and relatively quick return to sports activities. A high knowledge of the anatomic landmarks should be essential to avoid unwated injuries.
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Affiliation(s)
- Jorge Pablo Batista
- Centro Artroscópico Jorge Batista, 2446 Pueyrredón Avenue, 1st Floor, 1119 Buenos Aires, Argentina
| | | | - Luciano Patthauer
- Centro Artroscópico Jorge Batista, 2446 Pueyrredón Avenue, 1st Floor, 1119 Buenos Aires, Argentina
| | - Manuel Ocampo
- Centro Artroscópico Jorge Batista, 2446 Pueyrredón Avenue, 1st Floor, 1119 Buenos Aires, Argentina
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Anatomical variations of flexor hallucis longus tendon increase safety in hindfoot endoscopy. Knee Surg Sports Traumatol Arthrosc 2017; 25:1929-1935. [PMID: 28220191 DOI: 10.1007/s00167-017-4465-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 01/30/2017] [Indexed: 12/17/2022]
Abstract
PURPOSE The flexor hallucis longus (FHL) tendon is the main anatomical landmark during hindfoot endoscopy, and anatomical variations related to the FHL can pose a risk to the tibial nerve and posterior tibial vessels during hindfoot endoscopy. The aim of this study was to determine the distance between the FHL tendon and the tibial neurovascular bundle in the posterior ankle joint when an anatomical variant of the FHL is present. The hypothesis was that the shortest distance between the tibial neurovascular bundle and the FHL tendon in the working area of the hindfoot endoscopy is increased when an anatomical variant of the FHL is present. METHODS A retrospective review was performed using consecutive ankle magnetic resonance imaging (MRI) scans obtained during 1 year. All scans with anatomical variations related to the FHL were included in the study. A control group including scans without anatomical variations was obtained for comparison. The shortest distance between the FHL tendon and the neurovascular tibial bundle was measured in both groups. RESULTS Three-hundred and fifty-five ankle MRIs were reviewed. 35 scans with anatomical variants of the FHL (9.8%) were found and comprised the study group that was compared to 35 scans without variants (control group). The mean distance from FHL to the neurovascular tibial bundle in the control group was 0.9 mm. The study group consisted of 18 cases with distal muscle belly insertion (5.1%), and 17 cases with an accessory tendon corresponding to a flexor digitorum accessorius longus (4.5%). In these subgroups, the mean distance from FHL to the neurovascular tibial bundle was 1.1 and 1.5 mm respectively. Overall this distance was found to be higher in the group with anatomical variants (1.3 mm) when compared to the control group (0.9 mm) (p < 0.05). CONCLUSION During hindfoot endoscopy, the presence of an anatomical variant related to the FHL tendon has proven safer anatomically than in its absence, due to the increased distance between the FHL tendon and the tibial neurovascular bundle in the working area. However, the minimal difference observed in safety distances still poses a major risk of injury during hindfoot endoscopic procedures in all cases.
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Swaney PJ, York PA, Gilbert HB, Burgner-Kahrs J, Webster RJ. Design, Fabrication, and Testing of a Needle-Sized Wrist for Surgical Instruments. J Med Device 2016; 11:0145011-145019. [PMID: 28070228 DOI: 10.1115/1.4034575] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 08/26/2016] [Indexed: 11/08/2022] Open
Abstract
This paper presents a miniature wrist that can be integrated into needle-sized surgical instruments. The wrist consists of a nitinol tube with asymmetric cutouts that is actuated by a single tendon to provide high distal curvature. We derive and experimentally validate kinematic and static models for the wrist and describe several prototype wrists, illustrating the straightforward fabrication and scalability of the design. We experimentally investigate fatigue life, the concept of tip-first bending, and practical use of the wrist with a concentric tube robot in an endonasal surgical scenario.
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Affiliation(s)
- Philip J Swaney
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37212 e-mail:
| | - Peter A York
- Department of Mechanical Engineering, Harvard University, Cambridge, MA 02138
| | - Hunter B Gilbert
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37212
| | - Jessica Burgner-Kahrs
- Associate Professor Center of Mechatronics, Leibniz Universität Hannover, Hannover 30167, Germany
| | - Robert J Webster
- Associate Professor Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37212 e-mail:
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Barg A, Saltzman CL, Beals TC, Bachus KN, Blankenhorn BD, Nickisch F. Arthroscopic Talar Dome Access Using a Standard Versus Wire-Based Traction Method for Ankle Joint Distraction. Arthroscopy 2016; 32:1367-74. [PMID: 27050022 DOI: 10.1016/j.arthro.2016.01.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 11/20/2015] [Accepted: 01/13/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the accessibility of the talar dome through anterior and posterior portals for ankle arthroscopy with the standard noninvasive distraction versus wire-based longitudinal distraction using a tensioned wire placed transversely through the calcaneal tuberosity. METHODS Seven matched pairs of thigh-to-foot specimens underwent ankle arthroscopy with 1 of 2 methods of distraction: a standard noninvasive strapping technique or a calcaneal tuberosity wire-based technique. The order of the arthroscopic approach and use of a distraction method was randomly determined. The areas accessed from both 2-portal anterior and 2-portal posterior approaches were determined by using a molded translucent grid. RESULTS The mean talar surface accessible by anterior ankle arthroscopy was comparable with noninvasive versus calcaneal wire distraction with 57.8% ± 17.2% (range, 32.9% to 75.7%) versus 61.5% ± 15.2% (range, 38.5% to 79.1%) of the talar dome, respectively (P = .590). The use of calcaneal wire distraction significantly improved posterior talar dome accessibility compared with noninvasive distraction, with 56.4% ± 20.0% (range, 14.4% to 78.0%) versus 39.8% ± 14.9% (range, 20.0% to 57.6%) of the talar dome, respectively (P = .031). CONCLUSIONS Under the conditions studied, our cadaveric model showed equivalent talar dome access with 2-portal anterior arthroscopy of calcaneal wire-based distraction versus noninvasive strap distraction, but improved access for 2-portal posterior arthroscopy with calcaneal wire-based distraction versus noninvasive strap distraction. CLINICAL RELEVANCE The posterior 40% of the talar dome is difficult to access via anterior ankle arthroscopy. Posterior calcaneal tuberosity wire-based longitudinal distraction improved arthroscopic access to the centro-posterior talar dome with a posterior arthroscopic approach.
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Affiliation(s)
- Alexej Barg
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, U.S.A.; Orthopaedic Research Laboratory, Department of Orthopaedics, University of Utah, Salt Lake City, Utah, U.S.A
| | - Charles L Saltzman
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, U.S.A..
| | - Timothy C Beals
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, U.S.A
| | - Kent N Bachus
- Orthopaedic Research Laboratory, Department of Orthopaedics, University of Utah, Salt Lake City, Utah, U.S.A
| | - Brad D Blankenhorn
- Department of Orthopaedic Surgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, U.S.A
| | - Florian Nickisch
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, U.S.A..
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Blázquez Martín T, Iglesias Durán E, San Miguel Campos M. Complications after ankle and hindfoot arthroscopy. Rev Esp Cir Ortop Traumatol (Engl Ed) 2016; 60:387-393. [PMID: 27311555 DOI: 10.1016/j.recot.2016.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 04/24/2016] [Accepted: 04/25/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To evaluate the percentage of complications associated with ankle and hindfoot arthroscopy in our hospital and to compare the results with those reported in the literature. MATERIAL AND METHOD A retrospective descriptive review was conducted on the complications associated with ankle and hindfoot arthroscopy performed between May 2008 and April 2013. A total of 257 arthroscopy were performed, 23% on subtalar joint, and 77% of ankle joint. An anterior approach was used in 69%, with 26% by a posterior approach, and the remaining 5% by combined access. RESULTS A total of 31 complications (12.06%) were found. The most common complication was neurological damage (14 cases), with the most affected nerve being the superficial peroneal nerve (8 cases). Persistent drainage through the portals was found in 10 cases, with 4 cases of infection, and 3 cases of complex regional pain syndrome type 1. DISCUSSION There have been substantial advances in arthroscopy of ankle and hindfoot in recent years, expanding its indications, and also the potential risk of complications. The complication rate (12.06%) found in this study is consistent with that described in the literature (0-17%), with neurological injury being the most common complication. CONCLUSIONS Ankle and hindfoot arthroscopy is a safe procedure. It is important to make a careful preoperative planning, to use a meticulous technique, and to perform an appropriate post-operative care, in order to decrease the complication rates.
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Affiliation(s)
- T Blázquez Martín
- Unidad de Tobillo y Pie, Hospital Monográfico Asepeyo Coslada de Traumatología, Cirugía Ortopédica y Rehabilitación, Madrid, España.
| | - E Iglesias Durán
- Unidad de Tobillo y Pie, Hospital Monográfico Asepeyo Coslada de Traumatología, Cirugía Ortopédica y Rehabilitación, Madrid, España
| | - M San Miguel Campos
- Unidad de Tobillo y Pie, Hospital Monográfico Asepeyo Coslada de Traumatología, Cirugía Ortopédica y Rehabilitación, Madrid, España
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Chamseddin KH, Kirkwood ML. Anterior Tibial Artery Pseudoaneurysm following Ankle Arthroscopy in a Hemophiliac Patient. Ann Vasc Surg 2016; 34:269.e17-9. [PMID: 27174350 DOI: 10.1016/j.avsg.2015.12.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 11/14/2015] [Accepted: 12/12/2015] [Indexed: 11/25/2022]
Abstract
Arthroscopy of the foot and ankle is a common orthopedic procedure with low complication rates. Arterial injuries from these procedures are an even more rare subset of the complications. Hemophilia A is a genetic disorder of aberrant coagulation, which leads to increased risk of bleeding even after minor trauma. We present the second case of anterior tibial artery pseudoaneurysm formation secondary to ankle arthroscopy in a hemophiliac patient and suggest that these individuals are at higher risk for developing complications associated with arterial injury. Furthermore, potential risk factors include port placement, anatomic variation of the vessels, and nature of the arthroscopic procedure. We recommend steps to prevent complications in hemophiliac patients.
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Affiliation(s)
- Khalil H Chamseddin
- Division of Vascular Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, TX
| | - Melissa L Kirkwood
- Division of Vascular Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, TX.
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Iatrogenic articular cartilage injuries during ankle arthroscopy. Knee Surg Sports Traumatol Arthrosc 2016; 24:1304-10. [PMID: 25151362 DOI: 10.1007/s00167-014-3237-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Accepted: 08/11/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE The purpose of this study was to assess the incidence of iatrogenic articular cartilage injuries during ankle arthroscopy and to determine the factors that caused them. The hypothesis of this study was that the incidence of iatrogenic cartilage injuries produced during ankle arthroscopic procedures is high and directly related to the arthroscopic technique. METHODS All consecutive records from ankle arthroscopies performed between 2008 and 2010 were reviewed. Arthroscopic arthrodesis of the ankle was excluded from the study. Iatrogenic articular cartilage injury was defined as any cartilage injury that occurred during the arthroscopic procedure. RESULTS The final number of ankle arthroscopic procedures reviewed was 74. There were a total of 23 iatrogenic lesions of the cartilage, for an overall complication rate of 31%. The two most common injury locations were the anterolateral and central area of the talus. The cartilage lesion was superficial in 78.2% of injuries (24.3% of all patients), and deep in 21.8% of injuries (6.7% of all patients). Of the 23 injuries found, 65% of them were sustained during the therapeutic portion of the arthroscopic procedure and the remaining 35% occurred during the portal creation portion of the procedure. CONCLUSION The incidence of cartilage injury during ankle arthroscopy is high. However, severe damage was found in only 6.7% of ankle arthroscopies. LEVEL OF EVIDENCE Retrospective case series, Level IV.
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Vega J, Peña F, Golanó P. Minor or occult ankle instability as a cause of anterolateral pain after ankle sprain. Knee Surg Sports Traumatol Arthrosc 2016; 24:1116-23. [PMID: 25429765 DOI: 10.1007/s00167-014-3454-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 11/18/2014] [Indexed: 12/26/2022]
Abstract
PURPOSE The aim of this study was to determine which intra-articular injuries are associated with chronic anterolateral pain and functional instability after an ankle sprain. METHODS From 2008 to 2010, records of all patients who underwent ankle joint arthroscopy with anterolateral pain and functional instability after an ankle sprain were reviewed. A systematic arthroscopic examination of the intra-articular structures of the ankle joint was performed. Location and characteristics of the injuries were identified and recorded. RESULTS A total of 36 ankle arthroscopic procedures were reviewed. A soft-tissue occupying mass over the lateral recess was present in 18 patients (50%). A partial injury of the anterior talofibular ligament (ATFL) was observed in 24 patients (66.6%). Cartilage abrasion due to the distal fascicle of the anteroinferior tibiofibular ligament coming into contact with the talus was seen in 21 patients (58.3%), but no thickening of the ligament was observed. Injury to the intra-articular posterior structures, including the transverse ligament in 19 patients (52.7%) and the posterior surface of the distal tibia in 21 patients (58.3%), was observed. CONCLUSION Intra-articular pathological findings have been observed in patients affected by anterolateral pain after an ankle sprain. Despite no demonstrable abnormal lateral laxity, morphologic ATFL abnormality has been observed on arthroscopic evaluation. An injury of the ATFL is present in patients with chronic anterolateral pain and functional instability after an ankle sprain. A degree of microinstability due to a deficiency of the ATFL could explain the intra-articular pathological findings and the patients' complaints. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Jordi Vega
- Foot and Ankle Unit, Hospital Quirón Barcelona, Plaza Alfonso Comín 5, 08023, Barcelona, Spain.
| | - Fernando Peña
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Pau Golanó
- Laboratory of Arthroscopic and Surgical Anatomy, Department of Pathology and Experimental Therapeutics (Human Anatomy Unit), University of Barcelona, Barcelona, Spain.,Department of Orthopaedic Surgery, Medical School, University of Pittsburgh, Pisttsburgh, PA, USA
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Poggio D, Claret G, López AM, Medrano C, Tornero E, Asunción J. Correlation Between Visual Inspection and Ultrasonography to Identify the Distal Branches of the Superficial Peroneal Nerve: A Cadaveric Study. J Foot Ankle Surg 2016; 55:492-5. [PMID: 26878806 DOI: 10.1053/j.jfas.2016.01.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Indexed: 02/03/2023]
Abstract
The anatomy of the superficial peroneal nerve (SPN) and, more precisely, of the distal branches of the SPN at the ankle has attracted interest owing to the possibility of injury when performing ankle arthroscopy. The anterolateral portal is one of the most commonly used portals in ankle arthroscopy, and the intermediate dorsal cutaneous nerve can easily be injured during portal placement. The purpose of the present study was to assess whether visual inspection and palpation of the cutaneous nerves at the ankle differed from examination with ultrasonography and whether the 2 examination techniques correlated with the anatomic location of the SPN, which was verified by cadaver dissection. First, visual examination and palpation was performed to identify the SPN, after which 12 cadaver legs from separate specimens were examined with ultrasonography to mark the course of the SPN. We then measured the distance between the nerve as identified with gross visualization/palpation and ultrasound examination, and compared these with the precise location determined by anatomic dissection. The use of ultrasonography to determine the course of the SPN was good or excellent in 11 of the 12 legs (91.7%) studied. In contrast, gross visualization/palpation was good or excellent in 4 legs (33.3%). Excellent agreement was observed between the ultrasound markings and the anatomic dissection results. However, the visual examination poorly identified the course and the anatomic variations of the nerve branches evidenced in the anatomic dissection. From these findings in cadaver specimens, ultrasound identification of the SPN and its branches is likely preferable to gross visualization/palpation before placement of the anterolateral arthroscopic portal to the ankle.
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Affiliation(s)
- Daniel Poggio
- Professor, Department of Orthopedic Surgery, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Guillem Claret
- Orthopedist, Department of Orthopedic Surgery, Hospital Clinic of Barcelona, Barcelona, Spain.
| | - Ana Maria López
- Professor, Department of Anesthesiology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Cristina Medrano
- Orthopedist, Department of Orthopedic Surgery, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Eduard Tornero
- Orthopedist, Department of Orthopedic Surgery, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Jordi Asunción
- Professor, Department of Orthopedic Surgery, Hospital Clinic of Barcelona, Barcelona, Spain
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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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York PA, Swaney PJ, Gilbert HB, Webster RJ. A Wrist for Needle-Sized Surgical Robots. IEEE INTERNATIONAL CONFERENCE ON ROBOTICS AND AUTOMATION : ICRA : [PROCEEDINGS]. IEEE INTERNATIONAL CONFERENCE ON ROBOTICS AND AUTOMATION 2015; 2015:1776-1781. [PMID: 26405562 PMCID: PMC4578322 DOI: 10.1109/icra.2015.7139428] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The needle-sized surgical tools used in arthroscopy, otolaryngology, and other surgical fields could become even more valuable to surgeons if endowed with the ability to navigate around sharp corners to manipulate or visualize tissue. We present a needle-sized wrist design that grants this ability. It can be easily interfaced with manual tools or concentric tube robots and is straightforward and inexpensive to manufacture. The wrist consists of a nitinol tube with several asymmetric cutouts, actuated by a tendon. Perhaps counter-intuitively, within this seemingly simple design concept, design optimization is challenging due to the number of parameters available and nonlinearities in material properties. In this paper, we examine a subset of possible geometries and derive kinematic and static models. Experimental results with a 1.16 mm diameter prototype validate the models. Lastly, we provide a discussion summarizing the lessons learned in our early experience designing and fabricating wrists of this type.
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Affiliation(s)
- Peter A. York
- Department of Engineering and Applied Sciences, Harvard University, Cambridge, MA USA
| | - Philip J. Swaney
- Webster III are with the Department of Mechanical Engineering, Vanderbilt University, Nashville, TN USA
| | - Hunter B. Gilbert
- Webster III are with the Department of Mechanical Engineering, Vanderbilt University, Nashville, TN USA
| | - Robert J. Webster
- Webster III are with the Department of Mechanical Engineering, Vanderbilt University, Nashville, TN USA
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Appy-Fedida B, Vernois J, Krief E, Gouron R, Mertl P, Havet E. Risk of sural nerve injury during lateral distal Achilles tendinoscopy: a cadaver study. Orthop Traumatol Surg Res 2015; 101:93-6. [PMID: 25595430 DOI: 10.1016/j.otsr.2014.10.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 09/30/2014] [Accepted: 10/22/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND The risk of damage to cutaneous sensory nerves located near portals has been evaluated for both conventional arthroscopy and extra-articular posterior ankle endoscopy. The objective of the anatomic study reported here was to assess the risk of injury to the sural nerve or lateral calcaneal nerve while using the distal lateral portal for the Achilles tendinoscopy procedure described by Vega et al. in 2008. MATERIALS AND METHODS We dissected the sural nerve and its branch, the lateral calcaneal nerve, of 13 human cadaver ankles in the prone position. We defined P as the point where the Achilles peritendon was opened during the distal lateral approach used for the study technique. P was adjacent to the lateral edge of the Achilles tendon, 2 cm proximal to the postero-superior edge of the calcaneal tuberosity. T was defined as the attachment site of the most lateral fibres of the Achilles tendon to the postero-superior edge of the calcaneal tuberosity. We evaluated the origin of the lateral calcaneal nerve relative to T and we measured the shortest distances separating P from the sural nerve and lateral calcaneal nerve. RESULTS A lateral calcaneal nerve was identified in 10 (77%) ankles and originated a mean of 39.1mm (range, 25.0-65.0mm) proximal to T. P was at a mean distance from the sural nerve of 12.3mm (range, 5.0-18.0mm) and from the lateral calcaneal nerve of 6.8mm (range, 4.0-9.0mm). The median difference between these two distances was statistically significant (P=0.002). DISCUSSION While using the distal lateral portal for Achilles tendinoscopy, the lateral calcaneal nerve is at greater risk for injury than is the sural nerve. LEVEL OF EVIDENCE Level IV. Anatomic Study.
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Affiliation(s)
- B Appy-Fedida
- Laboratoire d'anatomie, faculté de médecine, université Picardie Jules-Verne, centre hospitalier universitaire d'Amiens, 3, rue des Louvels, 80036 Amiens cedex 1, France
| | - J Vernois
- Laboratoire d'anatomie, faculté de médecine, université Picardie Jules-Verne, centre hospitalier universitaire d'Amiens, 3, rue des Louvels, 80036 Amiens cedex 1, France
| | - E Krief
- Laboratoire d'anatomie, faculté de médecine, université Picardie Jules-Verne, centre hospitalier universitaire d'Amiens, 3, rue des Louvels, 80036 Amiens cedex 1, France
| | - R Gouron
- Laboratoire d'anatomie, faculté de médecine, université Picardie Jules-Verne, centre hospitalier universitaire d'Amiens, 3, rue des Louvels, 80036 Amiens cedex 1, France
| | - P Mertl
- Laboratoire d'anatomie, faculté de médecine, université Picardie Jules-Verne, centre hospitalier universitaire d'Amiens, 3, rue des Louvels, 80036 Amiens cedex 1, France
| | - E Havet
- Laboratoire d'anatomie, faculté de médecine, université Picardie Jules-Verne, centre hospitalier universitaire d'Amiens, 3, rue des Louvels, 80036 Amiens cedex 1, France.
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Anatomical relations of anterior and posterior ankle arthroscopy portals: a cadaveric study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2014; 25:577-81. [DOI: 10.1007/s00590-014-1559-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 10/13/2014] [Indexed: 10/24/2022]
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Smyth NA, Zwiers R, Wiegerinck JI, Hannon CP, Murawski CD, van Dijk CN, Kennedy JG. Posterior hindfoot arthroscopy: a review. Am J Sports Med 2014; 42:225-34. [PMID: 23868522 DOI: 10.1177/0363546513491213] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
In recent years, minimally invasive surgery has developed and progressed the standard of care in orthopaedics and sports medicine. In particular, the use of posterior hindfoot arthroscopy in the treatment of posterior ankle and hindfoot injury is increasing rapidly as a means of reducing pain, infection rates, and blood loss postoperatively compared with traditional open procedures. In athletes, hindfoot arthroscopy has been used effectively in expediting rehabilitation and ultimately in minimizing the time lost from competition at previous levels. Van Dijk et al were the first to describe the original 2-portal technique, which remains the most commonly used by surgeons today and forms the basis for this review. The current evidence in the literature supports the use of 2-portal hindfoot arthroscopy as a safe, primary treatment strategy for symptoms of posterior ankle impingement, including resection of os trigonum, treatment of flexor hallucis longus and peroneal tendon injury, treatment of osteochondral lesions of the ankle, and the resection of subtalar coalitions. In this review, we present where possible an evidence-based literature review on the arthroscopic treatment of posterior ankle and hindfoot abnormalities. Causes, diagnosis, surgical technique, outcomes, and complications are each discussed in turn.
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Affiliation(s)
- Niall A Smyth
- Niall A. Smyth, Hospital for Special Surgery, 523 East 72nd Street, Ste 507, New York, NY 10021.
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Vega J, Golanó P, Pellegrino A, Rabat E, Peña F. All-inside arthroscopic lateral collateral ligament repair for ankle instability with a knotless suture anchor technique. Foot Ankle Int 2013; 34:1701-9. [PMID: 23978706 DOI: 10.1177/1071100713502322] [Citation(s) in RCA: 152] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Recently, arthroscopic-assisted techniques have been described to treat lateral ankle instability with excellent results. However, complications including neuritis of the superficial peroneal or sural nerve, and pain or discomfort due to a prominent anchor or suture knot have been reported. The aim of this study was to describe a novel technique, the "all-inside arthroscopic lateral collateral ankle ligament repair," and its results for treating patients with ankle instability. METHODS Sixteen patients (10 men and 6 women, mean age 29.3 years, 17-46) with lateral ankle instability were treated with an arthroscopic procedure. Using a suture passer and a knotless anchor, the ligaments were repaired with an all-inside technique. The right ankle was affected in 10 cases. Mean follow-up was 22.3 (12-35) months. RESULTS On arthroscopic examination, 13 patients had an isolated anterior talofibular ligament (ATFL) injury, and in 3 patients, both the ATFL and calcaneofibular ligament (CFL) were affected. All-inside arthroscopic anatomic repair of the lateral collateral ligament complex was performed in all cases. All patients reported subjective improvement of their ankle instability. The mean AOFAS score increased from 67 preoperatively to 97 at final follow-up. No major complications were reported. CONCLUSION The all-inside arthroscopic ligament repair was a safe, reliable, and reproducible technique that both provided an anatomic repair of the lateral collateral ligament complex and restored ankle stability while preserving all the advantages of an arthroscopic technique. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Valderrabano V, Paul J, Monika H, Pagenstert GI, Henninger HB, Barg A. Joint-preserving surgery of valgus ankle osteoarthritis. Foot Ankle Clin 2013; 18:481-502. [PMID: 24008214 DOI: 10.1016/j.fcl.2013.06.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Patients with posttraumatic ankle osteoarthritis (OA) typically present with asymmetric involvement of the tibiotalar joint, resulting in valgus or varus deformity of the ankle and hindfoot. Without appropriate treatment, patients with asymmetric ankle OA typically develop full end-stage ankle OA. Ankles with valgus deformities suffer from a lateral joint overload with subsequent lateral tibiotalar joint degeneration, which causes further lateral load shift. In these cases patients may benefit from joint-preserving realignment surgery to unload the degenerated lateral area and normalize joint biomechanics. This article describes the authors' algorithm for the treatment of patients with asymmetric valgus ankle OA.
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Affiliation(s)
- Victor Valderrabano
- Orthopaedic Department, Osteoarthritis Research Center Basel, University Hospital of Basel, University of Basel, Spitalstrasse 21, Basel 4031, Switzerland.
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Abstract
For select patients, distraction ankle arthroplasty may be a promising treatment approach for ankle osteoarthritis; however, there is still limited literature addressing its efficacy and clinical long-term results. In this article, the literature regarding the outcome after ankle distraction arthroscopy is reviewed, the indications and contraindication for this procedure are listed, our surgical technique is described, and our preliminary results with this procedure are presented.
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Affiliation(s)
- Alexej Barg
- Orthopaedic Department, University Hospital of Basel, University of Basel, Spitalstrasse 21, Basel CH-4031, Switzerland
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Zengerink M, van Dijk CN. Response to: comment on "complications in ankle arthroscopy": anatomy, an important factor to avoid complications related to ankle arthroscopy. Knee Surg Sports Traumatol Arthrosc 2013; 21:1710-1. [PMID: 23291789 DOI: 10.1007/s00167-012-2337-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 12/04/2012] [Indexed: 11/29/2022]
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Golanó P, Vega J. Comment on "Complications in ankle arthroscopy": anatomy, an important factor to avoid complications related to ankle arthroscopy. Knee Surg Sports Traumatol Arthrosc 2013; 21:1708-9. [PMID: 23263226 DOI: 10.1007/s00167-012-2344-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Vega J, Batista JP, Golanó P, Dalmau A, Viladot R. Tendoscopic groove deepening for chronic subluxation of the peroneal tendons. Foot Ankle Int 2013; 34:832-40. [PMID: 23513032 DOI: 10.1177/1071100713483098] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Recurrent subluxation of the peroneal tendons over the lateral malleolus is an uncommon disabling condition in young people involved in sports. Injury to the superior peroneal retinaculum, sometimes in association with a shallow fibular groove, can lead to this condition. There are several surgical treatments for recurrent peroneal tendon subluxation, but no tendoscopy technique has been reported to date. The aim of this study was to describe a tendoscopic groove-deepening technique and its results for treating patients with recurrent subluxation of the peroneal tendons. METHODS Seven patients (3 women and 4 men; mean age 26.4 [21-32] years) with chronic subluxation of the peroneal tendons were treated with a tendoscopic procedure. All patients experienced pain at the lateral retromalleolar area and recurrent subluxation of the peroneal tendons. The right ankle was affected in 4 patients. Mean follow-up was 15.4 (8-25) months. RESULTS On tendoscopic examination, all patients had a flat fibular groove, and the superior peroneal retinaculum was found to be detached in 4 cases. Three patients had a superficial injury of the peroneus brevis tendon which was debrided. Tendoscopic deepening of the peroneal groove without superior peroneal retinaculum repair was performed in all cases. None of the patients experienced recurrent subluxation during follow-up. The AOFAS score increased from 75 preoperatively to 93 at final follow-up. No complications were reported in any case. CONCLUSION Tendoscopic deepening of the fibular groove was a reproducible, minimally invasive technique that provided a favorable outcome for recurrent subluxation of the peroneal tendons in our limited number of patients. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Jordi Vega
- Etzelclinic, Foot and Ankle Surgery Unit, Pfäffikon, Schwyz, Switzerland.
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