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Lescot T, Compagnon R, Accadbled F, Sales de Gauzy J, Mouliès D, Mihluedo L, Fourcade L, Ballouhey Q. Evaluation of surgical outcomes of calcaneonavicular coalition and too-long anterior process in children: A prospective study. Orthop Traumatol Surg Res 2024; 110:103620. [PMID: 37044243 DOI: 10.1016/j.otsr.2023.103620] [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] [Received: 06/29/2022] [Revised: 01/09/2023] [Accepted: 03/08/2023] [Indexed: 04/14/2023]
Abstract
INTRODUCTION Calcaneonavicular coalitions (CC) affect approximately 1% of the general population. CC or Too-long anterior process (TLAP) result in "repeated sprains" that can be associated with foot and/or ankle chronic pain. The main objective of this study was to analyze the effectiveness of surgery using the AOFAS score. HYPOTHESIS Functional results after surgical treatment of CC or TLAP are not as good as expected. MATERIALS AND METHODS A single-center prospective study was carried out at our University Hospital from 01/01/2019 to 06/01/2021. The patients included were operated on in the pediatric surgery department for CC or TLAP resection by direct approach after MRI confirmation and failure of non-operative treatment. A survey evaluating the AOFAS score as well as the number of ankle sprains and the intensity of pain was undertaken at the preoperative consultation and then at three and twelve months postoperatively. RESULTS A total of 17 feet in 16 patients (14 girls and 2 boys) comprising 12 TLAP and 5 CC were included. The AOFAS score was statistically significantly increased (58.6 vs. 82.9; p<0.001) postoperatively. No statistical difference was noted between the follow-up visits at three and twelve months. At the twelve-month follow-up, 9 out of 16 patients (56.2%) still reported activity restrictions; mainly linked to the persistence of chronic pain, and 10 out of 16 patients (62.5%) reported a feeling of instability. DISCUSSION CC and TLAP surgery rapidly improves function but it does not dramatically reduce foot pain and activity restrictions. A dedicated score would be useful to identify patients who will benefit the most from surgery. LEVEL OF EVIDENCE IV; prospective study.
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Affiliation(s)
- Timothé Lescot
- Service de chirurgie pédiatrique, hôpital des Enfants, CHU de Limoges, 8, avenue Dominique-Larrey, 87042 Limoges cedex, France
| | - Roxane Compagnon
- Service de chirurgie pédiatrique, hôpital des Enfants, CHU de Limoges, 8, avenue Dominique-Larrey, 87042 Limoges cedex, France
| | - Franck Accadbled
- Service de chirurgie orthopédique pédiatrique, hôpital des Enfants, 330, avenue de Grande Bretagne, 31300 Toulouse cedex, France
| | - Jérôme Sales de Gauzy
- Service de chirurgie orthopédique pédiatrique, hôpital des Enfants, 330, avenue de Grande Bretagne, 31300 Toulouse cedex, France
| | - Dominique Mouliès
- Service de chirurgie pédiatrique, hôpital des Enfants, CHU de Limoges, 8, avenue Dominique-Larrey, 87042 Limoges cedex, France
| | - Louis Mihluedo
- Service de chirurgie pédiatrique, hôpital des Enfants, CHU de Limoges, 8, avenue Dominique-Larrey, 87042 Limoges cedex, France
| | - Laurent Fourcade
- Service de chirurgie pédiatrique, hôpital des Enfants, CHU de Limoges, 8, avenue Dominique-Larrey, 87042 Limoges cedex, France
| | - Quentin Ballouhey
- Service de chirurgie pédiatrique, hôpital des Enfants, CHU de Limoges, 8, avenue Dominique-Larrey, 87042 Limoges cedex, France.
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Leung K, Lui TH. Arthroscopic Management of Sinus Tarsi Syndrome. Arthrosc Tech 2024; 13:103003. [PMID: 39233794 PMCID: PMC11369934 DOI: 10.1016/j.eats.2024.103003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 03/13/2024] [Indexed: 09/06/2024] Open
Abstract
Sinus tarsi syndrome (STS) is a clinical entity characterized by pain of the lateral hindfoot and a sense of instability especially on uneven surfaces due to chronic inflammation characterized by fibrotic tissue remnants and synovitis of the sinus tarsi, associated with both traumatic and nontraumatic causes. Arthroscopic debridement of the subtalar joint is an effective and safe alternative in the treatment of STS refractory to conservative treatment. The purpose of this Technical Note is to report the details of arthroscopic management of STS.
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Affiliation(s)
- Kit Leung
- Department of Orthopaedics and Traumatology, Tseung Kwan O Hospital, Tseung Kwan O, Hong Kong
| | - Tun Hing Lui
- Department of Orthopaedics and Traumatology, North District Hospital, Sheung Shui, Hong Kong
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Lucchesi G, Bonnel F, Wartelle J, Boutry N, Orlando N, Dimeglio A, Beltrami G, Canavese F. Anatomical characterization of the too-long anterior process of the calcaneum: a computed tomography scan analysis of 69 feet. J Pediatr Orthop B 2023; 32:47-53. [PMID: 35258029 DOI: 10.1097/bpb.0000000000000969] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Our work aims to identify and measure the morpho-anatomical characteristics of too-long anterior calcaneal process based on computed tomography scans done in patients with a history of pain and who have experienced repeated ankle sprains. The computed tomography scans of 69 feet were reviewed. These scans were used to calculate (1) the calcaneo-navicular distance; (2) the height, length, and width of the too-long anterior calcaneal process; (3) the length of the calcaneum; (4) the angle of the too-long anterior calcaneal process in the sagittal (anterior-superior angle), axial (anterior-medial angle), and frontal plane. Out of 69 feet, forty-nine were pathological (71%) with abnormalities of the too-long anterior calcaneal process, while the rest (29%) had no morphological abnormalities. The calcaneo-navicular distance was found to be <5 mm (mean: 2.8 ± 1.2 mm) in all pathological feet, which also had significantly reduced calcaneo-navicular distance ( P < 0.001) and longer bone portion distal to the calcaneocuboid tangent ( P < 0.001) in comparison to normal feet. In pathological feet, the mean too-long anterior calcaneal process length was 10.7 ± 1.9 mm; the mean anterior-superior angle was 29.6 ° ± 11.6, the mean angle anterior-medial angle was 40.7 ° ± 8.3, the mean angle frontal plane was 74.2 ° ± 14.1. Similar to a cone or a parallelepiped, the too-long anterior calcaneal process has a complex three-dimensional anatomy, with a superior, medial, and anterior direction. Using the measurements obtained, four different too-long anterior calcaneal process morphotypes could be identified: absence of TLACP, triangular shape, rectangular shape, and coalition (level of evidence III).
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Affiliation(s)
- Giovanni Lucchesi
- Orthopaedic Clinic, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - François Bonnel
- University of Montpellier, Faculty of Medicine, 2 Rue de l'École de Médecine, Montpellier
| | | | - Nathalie Boutry
- Department of Pediatric Imaging, Hôpital Jeanne de Flandre, CHU Lille, Lille, France
| | | | - Alain Dimeglio
- Faculty of Medicine, University of Montpellier, Montpellier, France
| | - Giovanni Beltrami
- Department of Pediatric Orthopedic and Pediatric Orthopedic Oncology, Meyer Children Hospital, Florence, Italy
| | - Federico Canavese
- Department of Pediatric Orthopedic Surgery, Jeanne de Flandre Hospital, Lille University Centre, Lille, France
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Lopes R, Bauer T. Lateral endoscopy of the sinus tarsi: Anatomy, technique and current indications. Orthop Traumatol Surg Res 2022; 108:103383. [PMID: 35926723 DOI: 10.1016/j.otsr.2022.103383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 06/06/2022] [Accepted: 06/22/2022] [Indexed: 02/03/2023]
Abstract
Numerous pathologies are reported in the lateral mid- and hind-foot. Access to the sinus tarsi is difficult, making lateral endoscopy the preferred approach. The present technical note describes the anatomy, technique and current indications for lateral endoscopy of the sinus tarsi.
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Affiliation(s)
- Ronny Lopes
- Clinique Brétéché, 3, Rue de la Béraudière, 44000 Nantes, France; Polyclinique de l'Atlantique, avenue Claude-Bernard, 44800 Saint-Herblain, France.
| | - Thomas Bauer
- Service de chirurgie orthopédique, hôpital Ambroise-Paré, hôpitaux Universitaires Paris Île-de-France Ouest, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
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Duffaydar H, Elmajee M, Dermanis AA, Hussain S, Pillai A. Post-interventional Outcomes in the Management of Adult Calcaneonavicular Coalitions: A Systematic Review. Cureus 2022; 14:e31253. [DOI: 10.7759/cureus.31253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2022] [Indexed: 11/09/2022] Open
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Hollander JJ, Dusoswa QF, Dahmen J, Sullivan N, Kerkhoffs GMMJ, Stufkens SAS. 8 out of 10 patients do well after surgery for tarsal coalitions: A systematic review on 1284 coalitions. Foot Ankle Surg 2022; 28:1110-1119. [PMID: 35397990 DOI: 10.1016/j.fas.2022.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 03/03/2022] [Accepted: 03/21/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND The primary aim was to determine the clinical success rate after treatment for talocalcaneal (TCC) and calcaneonavicular coalitions (CNC). The secondary aim was to evaluate the complication, recurrence and revision rate. METHODS A search was carried out in MEDLINE, EMBASE and Cochrane Library. Methodological quality was assessed using the Methodological Index for Non-Randomised Studies (MINORS) criteria. The primary outcome was the clinical success rate and was pooled per type of coalition and treatment modality. 95% Confidence Intervals (CI) of the success rates were calculated. Secondary outcomes included complication rates, coalition recurrence rates, revision rates and pain improvement using the Visual Analogue Scale (VAS). A sub-analysis on interposition material was performed. RESULTS 43 articles comprising of 1284 coalitions were included, with a pooled mean follow-up of 51 months. Methodological quality was fair. The overall pooled success rate for TCCs was 79% (95% CI, 75%-83%). Conservative treatment, open resection and arthroscopic resection of TCCs resulted in success rates of 58% (95% CI, 42%-73%), 80% (95% CI, 76%-84%) and 86% (95% CI, 71%-94%), respectively. CNCs have an overall success rate of 81% (95% CI, 75%-85%), with 100% (95% CI, 34%-100%), 80% (95% CI, 74%-85%) and 100% (95% CI, 65%-100%) for conservative treatment, open resection and arthroscopic resection, respectively. Pooled complication rates of 4% (95% CI, 3%-7%) for TCCs and 6% (95% CI, 4%-11%) for CNCs were found. The success rates of resection with and without interposition material for TCCs were 83% (95% CI, 78%-87%) and 79% (95% CI, 65%-88%), and for CNCs 81% (95% CI, 76%-86%) and 69% (95% CI, 44%-85%), respectively. CONCLUSION Treatment of tarsal coalitions can be considered good to excellent as well as safe, with an overall clinical success rate of 79% for TCCs and 81% for CNCs. Arthroscopic resection of the coalition appears to be non-inferior to open resection of TCCs and CNCs. LEVEL OF EVIDENCE Level IV, Systematic Review.
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Affiliation(s)
- Julian J Hollander
- Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; Academic 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
| | - Quinten F Dusoswa
- Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; Academic 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
| | - Jari Dahmen
- Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; Academic 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
| | - Nicholas Sullivan
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
| | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; Academic 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
| | - Sjoerd A S Stufkens
- Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; Academic 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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Corin B, Laumonerie P, Zrounba V, Langlais T, De Gauzy JS, Accadbled F. Resection of calcaneonavicular coalition: Arthroscopic or open approach? J Child Orthop 2022; 16:136-140. [PMID: 35620128 PMCID: PMC9127878 DOI: 10.1177/18632521221087170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 02/25/2022] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Calcaneonavicular coalition accounts for more than half of all tarsal coalitions. Resection of calcaneonavicular coalition by an open approach is the standard treatment. Treatment of calcaneonavicular coalition by an arthroscopic approach appears promising. The objective of our study was to compare the clinical outcomes of calcaneonavicular coalition resection by open approach versus arthroscopic approach. METHODS A retrospective cohort study was conducted to evaluate 127 patients who underwent a resection of calcaneonavicular coalition from 2009 to 2017. Patients were divided into two groups according to whether an arthroscopic approach or an open approach was used. Demographics, operative parameters, and clinical outcomes (foot and ankle ability measure score, subjective score, and global ankle estimation) were assessed. RESULTS Arthroscopic approach was used for 81 patients and open approach for 46 patients. Treatment with arthroscopic approach resulted in a shorter hospital stay (2.6 ± 0.6 days vs 3.0 ± 0.7; p = 0.02) and a longer operative time (24.5 ± 8.1 min vs 20.5 ± 4.2; p < 0.01) than with open approach. The foot and ankle ability measure sports subscale scored significantly higher in the arthroscopic approach group (90.9 vs 77.3; p = 0.003). Revision rate was significantly higher in the arthroscopic approach group (12 (15%)) versus the open approach group (1 (2%)) (p = 0.024). Persistent symptoms (n = 12) were the main reason for revision. CONCLUSIONS Arthroscopic treatment of calcaneonavicular coalition is associated with a higher revision rate than the open approach. LEVEL OF EVIDENCE Level III-retrospective comparative study.
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Affiliation(s)
- Boris Corin
- Department of Orthopaedics, Hôpital des Enfants, CHU de Toulouse, France
| | - Pierre Laumonerie
- Department of Orthopaedics, Hôpital des Enfants, CHU de Toulouse, France,Department of Orthopaedics, Hôpital Pellegrin, Bordeaux, France
| | - Victor Zrounba
- Department of Orthopaedics, Hôpital des Enfants, CHU de Toulouse, France
| | - Tristan Langlais
- Department of Orthopaedics, Hôpital des Enfants, CHU de Toulouse, France
| | | | - Franck Accadbled
- Department of Orthopaedics, Hôpital des Enfants, CHU de Toulouse, France,Franck Accadbled, Orthopédie Traumatologie, Hôpital des Enfants, 330 avenue de Grande Bretagne, 31059 Toulouse cedex 9, France.
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Angelis S, Myrgiotis D, Apostolopoulos AP, Mandragos E, Statyris NC, Filippou DK, Michelarakis JΝ. Surgical Removal of Bone Bridge and Interposition of the Extensor Digitorum Brevis in the Treatment of the Calcaneonavicular Coalition in Pediatric Patients. A Case Series, Sh. J Long Term Eff Med Implants 2022; 32:27-37. [DOI: 10.1615/jlongtermeffmedimplants.2022042255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Addar A, Marwan Y, Algarni N, Algarni N, Berry GK, Benaroch T. Tarsal coalition: Systematic review of arthroscopic management. Foot (Edinb) 2021; 49:101864. [PMID: 34597922 DOI: 10.1016/j.foot.2021.101864] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 07/08/2021] [Accepted: 09/19/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The standard of care in the treatment of symptomatic tarsal coalitions is open surgery. However, certain limitations exist with open surgery, which include limited visualization leading to an incomplete resection and possible recurrence of the tarsal coalition. Arthroscopic tarsal coalition resection (TCR) is an alternative that is gaining traction, primarily as the safety profile of posterior ankle and subtalar arthroscopy is more well understood. This study provides a systematic review of the outcomes of arthroscopic TCR. METHODS PubMed and Embase were searched independently by 2 reviewers for relevant articles based on predetermined criteria. The subject heading "tarsal coalition" and its related key terms were used. RESULTS A total of 416 studies were revealed by the initial search, out of which only 6 met our predetermined inclusion criteria. A total of 42 patients (average age: 17.6 years) were treated with arthroscopic TCR. Thirty-three (78.6%) and 9 (21.4%) patients had talocalcaneal and calcaneonavicular coalitions, respectively. The follow-up period ranged from 6 to 60 months (mean: 26 months), and no recurrence of the tarsal coalition was detected (0.0%). Complications occurred in two (4.8%) patients only, with one developing complex regional pain syndrome (CRPS), and another patient developing hyperesthesia on the medial aspect of the calcaneus. CONCLUSION Arthroscopic TCR is a feasible and effective surgery for both CNC and TCC with minimal complications and no disease recurrence at an average of 26 months follow-up. Future high-level of evidence studies are needed to compare the outcomes of open versus arthroscopic TCR.
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Affiliation(s)
- Abdullah Addar
- Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Yousef Marwan
- Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Quebec, Canada.
| | - Nizar Algarni
- Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Nabil Algarni
- Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Gregory K Berry
- Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Thierry Benaroch
- Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Quebec, Canada
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Surgical Treatment of Calcaneonavicular and Talocalcaneal Coalitions. Foot Ankle Clin 2021; 26:873-901. [PMID: 34752242 DOI: 10.1016/j.fcl.2021.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Tarsal coalition is determined by an absence of segmentation between one or more foot bones. The main symptom is activity-related foot pain, usually dorsolateral for calcaneonavicular coalitions and medial for talocalcaneal ones. At presentation, a symptomatic tarsal coalition must be treated conservatively for at least 6 months. If the conservative treatment fails and the foot is still painful, resection is the treatment of choice. Advantage of surgery is to restore mobility and reduce the risk of subsequent degenerative arthritis. Common pitfalls of surgery include failure to recognize associated coalitions, inadequate or extensive resection, and injury of adjoining bones.
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Lui TH, Pan X, Chan CK. Arthroscopic Resection of Too-Long Anterior Process (TLAP) of the Calcaneus, Anterior Subtalar Synovectomy, Debridement of the Sinus Tarsi, and Posterior Subtalar Adhesiolysis Via Anterolateral Subtalar and Dorsolateral Midtarsal Portals. Arthrosc Tech 2021; 10:e2259-e2264. [PMID: 34754732 PMCID: PMC8556585 DOI: 10.1016/j.eats.2021.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 06/22/2021] [Indexed: 02/03/2023] Open
Abstract
Lateral heel pain can have numerous causes and many of them are intra-articular pathologies of the anterior and posterior subtalar joint. Frequently, there is not a single pathology that account for the lateral heel pain and combination of different pathologies can occur. Symptomatic too-long anterior process of the calcaneus, sinus tarsi syndrome, and subtalar arthrofibrosis can be precipitated by repeated sprain. Cases recalcitrant to conservative treatment are indicated for surgery. The purpose of this Technical Note is to report a 2-portal arthroscopic approach to address these pathologies.
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Affiliation(s)
- Tun Hing Lui
- Department of Orthopaedics and Traumatology, North District Hospital, Sheung Shui, NT, Hong Kong SAR, China,Shenzhen University, Shenzhen, China,Address correspondence to Dr. T. H. Lui, North District Hospital, 9 Po Kin Rd., Sheung Shui, NT, Hong Kong SAR, China.
| | - Xiaohua Pan
- Department of Trauma and Orthopedics, Second Affiliated Hospital of Shenzhen University & Affiliated Baoan Hospital of Shenzhen, Southern Medical University, The 8th People’s Hospital of Shenzhen, Shenzhen, Guangdong, China,Guangdong Provincial Engineering Research Center of Wound Repair and Regenerative Medicine, Guangdong Provincial Academician Workstation of Wound Repair and Regenerative Medicine, China
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Knörr J, Diaz-Gallardo P, Soldado F, Domenech P, Torres-Perez A, Sales de Gauzy J, Bergua-Domingo JM. Arthroscopic Calcaneonavicular Coalition and Too-long Anterior Process of the Calcaneus Resection in Children. J Foot Ankle Surg 2021; 60:228-232. [PMID: 33461922 DOI: 10.1053/j.jfas.2019.03.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Revised: 01/23/2019] [Accepted: 03/31/2019] [Indexed: 02/03/2023]
Abstract
Persistent symptomatic calcaneonavicular coalition (CNC) and too-long anterior process of the calcaneus (TLAP) are congenital disorders that can benefit from surgical treatment. The arthroscopic technique for CNC and TLAP resection has previously been described. The aim of this prospective study was to describe outcomes following arthroscopic resection of 12 (38.71%) CNC and 19 (61.29%) TLAP cases in 30 consecutive pediatric patients treated between July 2009 and March 2013. There mean age was 12.4 (range 10 to 15) years, and the mean follow-up was 55.2 (range 24 to 79) months. Radiographs, American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scores, AOFAS pain scores, and patient satisfaction were assessed. All final postoperative imaging scans revealed complete synostosis resection without recurrence. The mean overall AOFAS Ankle-Hindfoot Score increased from 78.87 (95% confidence interval [CI] 76.74 to 81.01) to 93.06 (95% CI 91.10 to 95.03) (p < .001). All patients showed pain reduction after surgery; even 1 patient (3.23%) who initially developed complex regional pain syndrome eventually had a successful outcome. The mean AOFAS pain score increased from 23.87 (95% CI 22.05 to 25.69) to 34.84 (95% CI 32.97 to 36.70) (p < .001). All patients were either satisfied (n = 9 [30%]) or very satisfied (n = 21 [70%]) with the intervention at the final follow-up. Although both arthroscopic CNC and TLAP resection are demanding techniques, they allow for precise coalition resection through a less invasive approach, which may ultimately lead to faster recovery and improved outcomes.
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Affiliation(s)
- Jorge Knörr
- Surgeon, Orthopaedic Surgery Department, Vall Hebron Barcelona Hospital Campus, Universistat Autonoma de Barcelona, Barcelona, Spain.
| | - Paula Diaz-Gallardo
- Surgeon, Orthopaedic Surgery Department, Vall Hebron Barcelona Hospital Campus, Universistat Autonoma de Barcelona, Barcelona, Spain
| | - Francisco Soldado
- Surgeon, Orthopaedic Surgery Department, Vall Hebron Barcelona Hospital Campus, Universistat Autonoma de Barcelona, Barcelona, Spain; Surgeon, Pediatric Hand Surgery and Microsurgery Department, Vall Hebron Barcelona Hospital Campus, Universistat Autonoma de Barcelona, Barcelona, Spain
| | - Pedro Domenech
- Surgeon, Orthopaedic Surgery Department, Vall Hebron Barcelona Hospital Campus, Universistat Autonoma de Barcelona, Barcelona, Spain
| | - Ana Torres-Perez
- Surgeon, Hospital Universitario Santa Lucia de Cartagena, Cartagena, Spain
| | - Jérôme Sales de Gauzy
- Surgeon, Pediatric Orthopedic Surgery Department, Hôpital des Enfants, CHU Toulouse, France
| | - Josep Maria Bergua-Domingo
- Surgeon, Orthopaedic Surgery Department, Vall Hebron Barcelona Hospital Campus, Universistat Autonoma de Barcelona, Barcelona, Spain
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Faubel Navarrete E, Sánchez-González M, Vicent V, Puchol E. Endoscopic resection of the calcaneonavicular coalition. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020. [DOI: 10.1016/j.recote.2020.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Malik-Tabassum K, Wahed K, To C, Maling L, Rose B. Post-operative outcomes of arthroscopic tarsal coalition resection: A systematic review. J Orthop 2020; 21:537-543. [PMID: 33029041 DOI: 10.1016/j.jor.2020.09.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/21/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Arthroscopic resection of tarsal coalitions is a relatively new technique. This systematic review aimed to investigate the post-operative complications and functional outcomes in arthroscopic resection of tarsal coalitions. METHODS PubMed, Medline, Embase and Cochrane library were searched for studies that reported outcomes in arthroscopic resection of tarsal coalitions. RESULTS 8 studies met the inclusion criteria. Post-operative outcomes were reported in 103 cases. The overall complication rate was 13.6%. Tibial nerve injury was reported in 1 patient. All included studies demonstrated post-operative improvement in functional outcomes. CONCLUSION Arthroscopic resection is a feasible and effective treatment method for symptomatic tarsal coalitions.
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Affiliation(s)
- Khalid Malik-Tabassum
- Specialty Registrar, Trauma & Orthopaedics, Conquest Hospital, East Sussex Healthcare NHS Trust, Hastings, United Kingdom
| | - Karim Wahed
- Specialty Registrar, Trauma & Orthopaedics, Eastbourne District General Hospital, East Sussex Healthcare NHS Trust, Eastbourne, United Kingdom
| | - Christopher To
- Specialty Registrar, Trauma & Orthopaedics, Conquest Hospital, East Sussex Healthcare NHS Trust, Hastings, United Kingdom
| | - Lucy Maling
- Specialty Registrar, Trauma & Orthopaedics, Conquest Hospital, East Sussex Healthcare NHS Trust, Hastings, United Kingdom
| | - Barry Rose
- Consultant Trauma & Orthopaedic Surgeon, Eastbourne District General Hospital, East Sussex Healthcare NHS Trust, Eastbourne, United Kingdom
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15
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Abstract
Endoscopic resection of tarsal coalitions is technically feasible for both talocalcaneal and calcaneonavicular coalitions. Careful consideration of each individual patient is necessary before proceeding with endoscopic resection. Endoscopic resection of these coalitions may offer benefits in terms of faster recovery and less wound problems, but this has not been proven. Several case reports and case series appear in the literature and are reviewed here along with the different techniques reported. Better-quality evidence is required to assess the clinically relevant benefits and the recurrence rate for endoscopic resection in comparison with open resection.
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Affiliation(s)
- Andrew King
- Trauma and Orthopaedics Department, Royal Cornwall Hospitals NHS Trust, Royal Cornwall Hospital, Treliske, Truro TR1 3LQ, UK.
| | - Stephen Parsons
- Trauma and Orthopaedics Department, Royal Cornwall Hospitals NHS Trust, Royal Cornwall Hospital, Treliske, Truro TR1 3LQ, UK
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16
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Faubel Navarrete E, Sánchez-González M, Vicent V, Puchol E. Endoscopic resection of the calcaneonavicular coalition. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020; 64:375-379. [PMID: 32792286 DOI: 10.1016/j.recot.2020.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 04/15/2020] [Accepted: 06/11/2020] [Indexed: 10/23/2022] Open
Abstract
Tarsal coalition has an incidence between 2-5% of the general population, and calcaneonavicular is the most frequent (53%). When conservative treatment fails, surgical resection must be indicated. Endoscopic resection is a less invasive technique and can be considered an alternative with better functional recovery. MATERIAL AND METHODS We performed a retrospective study of the patients with calcaneonavicular coalition operated in our hospital between 2015 and 2018. We performed an endoscopic resection. We used AOFAS scale score for the results. RESULTS We reviewed seven cases for a minimum of 12 months. AOFAS score improved from 42 before surgery to 92. There were no major complications from surgery. We had a patient with dysesthesias in the forefoot that improved at 3 months and a case of local swelling that solved with ice and rest. CONCLUSIONS Endoscopic resection has advantages over open surgery. Offers a great vision and good control of the coalition resection, provides an early rehabilitation, decrease hospital stay, improves cosmetic results and the probability of neuroma is minimum with an adequate control of the technique.
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Affiliation(s)
| | | | - V Vicent
- Hospital Universitario y Politécnico La Fe, Valencia, España
| | - E Puchol
- Hospital Universitario y Politécnico La Fe, Valencia, España
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17
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Abstract
A tarsal coalition is an abnormal connection between two or more tarsal bones caused by failure of mesenchymal segmentation. The two most common tarsal coalitions are calcaneonavicular coalition (CNC) and talocalcaneal coalition (TCC). Both CNC and TCC can be associated with significant foot and ankle pain and impaired quality of life; there may also be concomitant foot and ankle deformity. Initial, non-operative management for symptomatic tarsal coalition commonly fails, leaving surgical intervention as the only recourse. The focus of this article is to critically describe the variety of methods used to surgically manage CNC and TCC. In review of the pertinent literature we highlight the ongoing treatment controversies in this field and discuss new innovations. The evidence-based algorithmic approach used by the authors in the management of tarsal coalitions is illustrated alongside some clinical pearls that should help surgeons treating this common, and at times complex, condition.
Cite this article: EFORT Open Rev 2020;5:80-89. DOI: 10.1302/2058-5241.5.180106
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Affiliation(s)
- Alpesh Kothari
- Department of Paediatric Orthopaedics, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Javier Masquijo
- Department of Pediatric Orthopaedics, Sanatorio Allende, Córdoba, Argentina
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18
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Docquier PL, Maldaque P, Bouchard M. Tarsal coalition in paediatric patients. Orthop Traumatol Surg Res 2019; 105:S123-S131. [PMID: 29601967 DOI: 10.1016/j.otsr.2018.01.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 01/13/2018] [Accepted: 01/22/2018] [Indexed: 02/02/2023]
Abstract
Tarsal coalition is due to failure of segmentation between two or more foot bones during embryological development at a site where the joint cleft fails to develop. Depending on the nature of the tissue connecting the bones, the abnormality is a syndesmosis, synchondrosis, or synostosis. Although the coalition exists at birth, synostosis usually develops only late during growth. Talo-calcaneal and calcaneo-navicular coalitions account for over 90% of all cases of tarsal coalition. The joint at the site of the coalition is stiff. Pain during physical activity is the main symptom, although recurrent ankle sprain is another possible presenting manifestation. During the physical examination, range-of-motion limitation at the hindfoot or midfoot should be sought, as well as varus or valgus malalignment of the hindfoot. Either pes planus or pes cavus may be seen. Calcaneo-navicular coalition may be visible on the standard radiograph, whereas talo-calcaneal coalition is best visualised by computed tomography or magnetic resonance imaging. As growth proceeds, the coalition becomes ossified and range-of-motion diminishes. Onset of the pain is often in the second decade of life or later. In patients with symptomatic tarsal coalition, the initial management should always consist in non-operative treatment for at least 6 months. A consensus exists that surgery should be offered when non-operative treatment fails. Open resection of the coalition is the treatment of choice, although endoscopic resection is also an option. Sound evidence exists that resection of the coalition can produce favourable outcomes even in the long-term. Fusion should be reserved for failure of resection, extensive coalitions, multiple coalitions, and patients with advanced osteoarthritis.
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Affiliation(s)
- Pierre-Louis Docquier
- Orthopaedic surgery and traumatology department, Saint-Luc university hospital, 10, avenue Hippocrate, 1200 Brussels, Belgium.
| | - Pierre Maldaque
- Foot and Ankle Institute, avenue Ariane 5 E0, 1200 Brussels, Belgium
| | - Maryse Bouchard
- Paediatric orthopaedics department, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, Washington 98105, USA
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19
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Abstract
Tarsal coalitions are the result of impaired mesenchymal separation of the tarsal bones. The most common types include calcaneonavicular or talocalcaneal coalitions. Subtalar stiffness results in pathologic kinematics with increased risk of ankle sprains, planovalgus foot deformity, and progressive joint degeneration. Resection of the coalition yields good results. Tissue interposition may reduce the risk of reossification, and concomitant deformity should be addressed in the same surgical setting.
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Affiliation(s)
- Georg Klammer
- Foot and Ankle Surgery, FussInstitut Zurich, Kappelistrasse 7, Zurich 8002, Switzerland.
| | - Norman Espinosa
- Foot and Ankle Surgery, FussInstitut Zurich, Kappelistrasse 7, Zurich 8002, Switzerland
| | - Lukas Daniel Iselin
- Foot and Ankle Surgery, Department of Orthopaedic Surgery and Traumatology, Spitalstrasse 16, Kantonsspital Lucerne, Lucerne 6000, Switzerland
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20
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Bourlez J, Joly-Monrigal P, Alkar F, Laborde A, Cottalorda J, Louahem D, Delpont M. Does arthroscopic resection of a too-long anterior process improve static disorders of the foot in children and adolescents? INTERNATIONAL ORTHOPAEDICS 2018; 42:1307-1312. [PMID: 29313094 DOI: 10.1007/s00264-017-3740-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 12/14/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE A too-long anterior process of the calcaneus is a common cause of pain and hind-foot instability. Our goal was to evaluate the early results of arthroscopic resection in terms of static foot disorders in children and adolescents. METHODS We retrospectively studied 11 ft (10 patients). The inclusion criteria were treatment of TLAP by arthroscopic resection and a minimum follow-up period of six months. Surgery was indicated in cases with persistent symptomatic TLAP resistant to orthopaedic treatment. RESULTS The mean age at surgery was 11 (range, 7-15) years. The mean follow-up duration was 15 (range, 8-28) months. Pre-operatively, we diagnosed four flat feet, two cavus feet and five feet with normal footprints, but loss of physiological hind-foot valgus. All patients presented with subtalar joint stiffness. At the last follow-up, four feet with no hind-foot valgus were normal, two were unchanged and the other feet had improved. The mean AOFAS increased from 61.9 (range, 47-73) to 89.1 (range, 71-97; P = 0.009). The mean radiological angles were near normal, exhibiting significant improvements in the lateral talo-metatarsal and Djian-Annonier angles. CONCLUSIONS Arthroscopic resection of a TLAP is safe. In the short term, the restoration of subtalar mobility reduces pain, and improves instability and static disorders. Longer follow-up of a larger patient series is required.
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Affiliation(s)
- Julien Bourlez
- Service de Chirurgie Pédiatrique, Hôpital Lapeyronie, 191 avenue du Doyen Gaston Giraud, 34295, Montpellier Cedex 5, France
| | - Pauline Joly-Monrigal
- Service de Chirurgie Pédiatrique, Hôpital Lapeyronie, 191 avenue du Doyen Gaston Giraud, 34295, Montpellier Cedex 5, France
| | - Fanny Alkar
- Service de Chirurgie Pédiatrique, Hôpital Lapeyronie, 191 avenue du Doyen Gaston Giraud, 34295, Montpellier Cedex 5, France
| | - Alexandre Laborde
- Service de Chirurgie Pédiatrique, Hôpital Lapeyronie, 191 avenue du Doyen Gaston Giraud, 34295, Montpellier Cedex 5, France
| | - Jerôme Cottalorda
- Service de Chirurgie Pédiatrique, Hôpital Lapeyronie, 191 avenue du Doyen Gaston Giraud, 34295, Montpellier Cedex 5, France
| | - Djamel Louahem
- Service de Chirurgie Pédiatrique, Hôpital Lapeyronie, 191 avenue du Doyen Gaston Giraud, 34295, Montpellier Cedex 5, France
| | - Marion Delpont
- Service de Chirurgie Pédiatrique, Hôpital Lapeyronie, 191 avenue du Doyen Gaston Giraud, 34295, Montpellier Cedex 5, France.
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21
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Abstract
Computer-assisted orthopaedic surgery was born in the 1990s. Nowadays, computer-assisted orthopaedic surgery is used for transpedicular screw fixation and for total knee arthroplasty.Patient-specific instrumentation is one type of computer-assisted surgery based on volumetric images, such as computed tomography or magnetic resonance imaging.In this article, possible applications of patient-specific instruments in paediatric orthopaedics are described. The use of patient-specific instrumentation for the correction of cubitus varus is given as an example with complex osteotomy. Another application for tarsal coalition resection is shown.A last example of using patient-specific instrumentation for both tumour resection and allograft reconstruction is illustrated.Patient-specific instruments based on computed tomography of the bone can increase peri-operative accuracy and decrease operative time. They are very helpful for the surgeon. Other applications are possible and will be probably developed in the future. Cite this article: Docquier PL, Paul L, TranDuy V. Surgical navigation in paediatric orthopaedics. EFORT Open Rev 2016;1:152-159. DOI: 10.1302/2058-5241.1.000009.
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22
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Abstract
BACKGROUND Children with flatfeet are frequently referred to pediatric orthopaedic clinics. Most of these patients are asymptomatic and require no treatment. Care must be taken to differentiate patients with flexible flatfeet from those with rigid deformity that may have underlying pathology and have need of treatment. Rigid flatfeet in infants may be attributable to a congenital vertical talus (CVT); whereas those in older children and adolescents may be due to an underlying tarsal coalition. We performed a review of the recent literature regarding evaluation and management of pediatric flatfeet to discuss new findings and suggest areas where further research is needed. METHODS We searched the PubMed database for all papers related to the treatment of pediatric flatfoot, tarsal coalition, and CVT published from January 1, 2011 to December 31, 2014, yielding 85 English language papers. RESULTS A total of 18 papers contributed new or interesting findings. CONCLUSIONS The pediatric flexible flatfoot (FFF) remains poorly defined, making the understanding, study, and treatment of the condition extremely difficult.Pediatric FFF is often unnecessarily treated. There is very little evidence for the efficacy of nonsurgical intervention to affect the shape of the foot or to influence potential long-term disability for children with FFF. The treatment of tarsal coalition remains challenging, but short-term and intermediate-term outcome studies are satisfactory, whereas long-term outcome studies are lacking. Management of the associated flatfoot deformity may be as important as management of the coalition itself. The management of CVT is still evolving; however, early results of less invasive treatment methods seem promising. LEVEL OF EVIDENCE Level 4-literature review.
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23
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Lui TH. Arthroscopic Resection of Too-Long Anterior Process of the Calcaneus. Arthrosc Tech 2016; 5:e1179-e1183. [PMID: 28224074 PMCID: PMC5310192 DOI: 10.1016/j.eats.2016.07.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 07/05/2016] [Indexed: 02/03/2023] Open
Abstract
A too-long anterior process (TLAP) of the calcaneus is an elongated anteromedial process of the calcaneus impinging the navicular or the talar head. TLAP can cause recurrent ankle sprain, peroneal muscle spasm, or persistent tarsal pain in adolescents. Arthroscopic resection is indicated if the symptoms do not respond to conservative treatment. It has the advantage of assessment of completeness of bone resection and treatment of associated lesions of the adjacent joints. The purpose of this technical note is to report an arthroscopic approach of the resection of the TLAP with the lateral midtarsal portal as the viewing portal.
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Affiliation(s)
- Tun Hing Lui
- Address correspondence to Tun Hing Lui, M.B.B.S.(HK), F.R.C.S.(Edin), F.H.K.A.M., F.H.K.C.O.S., Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong SAR, China.Department of Orthopaedics and TraumatologyNorth District Hospital9 Po Kin RoadSheung Shui, NTHong Kong SARChina
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24
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Rosello O, Solla F, Oborocianu I, Chau E, Yagoubi F, Clément JL, Rampal V. Too-long calcaneal process: Results of surgical treatment and prognostic factors. Orthop Traumatol Surg Res 2016; 102:663-7. [PMID: 27132037 DOI: 10.1016/j.otsr.2016.01.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 01/07/2016] [Accepted: 01/22/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The too-long anterior process (TLAP) can be responsible for ankle pain or repeated sprains in children or adolescents. The objective of this study was to assess the results of TLAP surgical treatment and to analyze influencing factors in case of this surgery's failure. MATERIAL AND METHODS Retrospective single-center study conducted from 2009 to 2012 including all patients under 18 years of age for a TLAP with follow-up equal to or longer than 1 year. The results of surgical treatment were assessed using the AOFAS score. Failure was defined as no significant improvement in the AOFAS score at the last follow-up. HYPOTHESIS Predictive factors of the result of surgical treatment for TLAP can be identified. RESULTS At the mean follow-up of 2.5 years, 35 patients (43 feet) fulfilled the inclusion criteria. Thirteen feet (30%) presented surgical failure. According to the AOFAS score, the results were excellent in 30 feet (70%), good in four (9%), fair in five (12%), and poor in four (9%). Surgical failure was influenced by the patient's age at the onset of symptoms and at the time of surgery, the degree of functional limitation, the duration of symptoms before surgery, the number of sprains, and gender (P<0.05). CONCLUSION Firstly, in this pediatric population with its high functional demand, the overall rate of failure of TLAP surgery was 30%. Secondly, the factors associated with failure demonstrated made it possible to identify the ideal patient for this surgery: male, with symptom onset between 7 and 10 years of age, who had experienced fewer than 15 sprains, and undergone surgery in the 3 years following the beginning of symptoms. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- O Rosello
- Service d'orthopédie pédiatrique, Hôpitaux pédiatriques de Nice CHU-Lenval, 57, avenue de la Californie, 06000 Nice, France
| | - F Solla
- Service d'orthopédie pédiatrique, Hôpitaux pédiatriques de Nice CHU-Lenval, 57, avenue de la Californie, 06000 Nice, France
| | - I Oborocianu
- Service d'orthopédie pédiatrique, Hôpitaux pédiatriques de Nice CHU-Lenval, 57, avenue de la Californie, 06000 Nice, France
| | - E Chau
- Service d'orthopédie pédiatrique, Hôpitaux pédiatriques de Nice CHU-Lenval, 57, avenue de la Californie, 06000 Nice, France; Institut Monégasque de Médecine du Sport, 11, avenue d'Ostende, 98000 Monaco, France
| | - F Yagoubi
- Service d'orthopédie pédiatrique, Hôpitaux pédiatriques de Nice CHU-Lenval, 57, avenue de la Californie, 06000 Nice, France
| | - J-L Clément
- Service d'orthopédie pédiatrique, Hôpitaux pédiatriques de Nice CHU-Lenval, 57, avenue de la Californie, 06000 Nice, France
| | - V Rampal
- Service d'orthopédie pédiatrique, Hôpitaux pédiatriques de Nice CHU-Lenval, 57, avenue de la Californie, 06000 Nice, France.
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25
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Knörr J, Soldado F, Menendez ME, Domenech P, Sanchez M, Sales de Gauzy J. Arthroscopic Talocalcaneal Coalition Resection in Children. Arthroscopy 2015; 31:2417-23. [PMID: 26315054 DOI: 10.1016/j.arthro.2015.06.022] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 06/07/2015] [Accepted: 06/18/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To present the technique and outcomes of arthroscopic talocalcaneal coalition (TCC) resection in pediatric patients. METHODS We performed a prospective study of 16 consecutive feet with persistent symptomatic TCCs in 15 children. The mean age was 11.8 years (range, 8 to 15 years), and the mean follow-up period was 28 months (range, 12 to 44 months). A posterior arthroscopic TCC resection was performed. The plantar footprint, subtalar motion, pain, and the American Orthopaedic Foot & Ankle Society Ankle-Hindfoot scale score were evaluated preoperatively and postoperatively. Preoperative computed tomography (CT) scans were used to classify the coalition according to the Rozansky classification, to measure the percentage of involvement of the surface area, and to determine the degree of hindfoot valgus. Postoperative CT scans at 1 year (n = 15) and 3 years (n = 5) were used to assess recurrences. Patient satisfaction was also evaluated. RESULTS The TCC distribution according to the Rozansky classification was type I in 7 cases, type II in 3, type III in 3, and type IV in 3. In all cases the arthroscopic approach enabled complete coalition resection. All patients increased by at least 1 stage in the footprint classification and showed clinical subtalar mobility after surgery. All patients showed a statistically significant improvement in pain after surgery except for 1 patient in whom complex regional pain syndrome developed (P < .001). The mean American Orthopaedic Foot & Ankle Society score was 56.8 (range, 45 to 62) preoperatively versus 90.9 (range, 36 to 100) postoperatively, showing a statistically significant increase (P < .001). Preoperative CT scans showed that all TCCs involved the medial subtalar joint facet, with mean involvement of 40.8% of the articular surface. All postoperative CT scans showed complete synostosis resections with no recurrences at final follow-up. At final follow-up, all patients were either satisfied (n = 4 [27%]) or extremely satisfied (n = 10 [67%]) with the outcome, except the 1 patient (7%) in whom complex regional pain syndrome developed. CONCLUSIONS Arthroscopic TCC resection provides good outcomes (symptom relief and restoration of subtalar motion), with no recurrence of the coalition. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Jorge Knörr
- Department of Pediatric Orthopedic Surgery and Microsurgery, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain; Orthopaedic Surgery Department, Universitat de Barcelona, Barcelona, Spain.
| | - Francisco Soldado
- Department of Pediatric Orthopedic Surgery and Microsurgery, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain; Orthopaedic Surgery Department, Universitat de Barcelona, Barcelona, Spain
| | - Mariano E Menendez
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | - Pedro Domenech
- Department of Pediatric Orthopedic Surgery and Microsurgery, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain; Orthopaedic Surgery Department, Universitat de Barcelona, Barcelona, Spain
| | - Mikel Sanchez
- Unidad Cirugía Artroscópica, Hospital Vhitas San José, Vitoria-Gasteiz, Spain
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26
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Nehme AH, Bou Monsef J, Bou Ghannam AG, Imad JP, Moucharafieh R, Wehbe J. Arthroscopic Resection of a Bilateral Calcaneonavicular Coalition in a Child. J Foot Ankle Surg 2015; 55:1079-82. [PMID: 26364235 DOI: 10.1053/j.jfas.2015.07.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Indexed: 02/03/2023]
Abstract
Calcaneonavicular coalition is a congenital anomaly characterized by a connection between the calcaneus and the navicular. It can manifest as lateral foot pain, peroneal spastic flatfoot, and repeated ankle sprains. Surgery is required in the case of chronic pain and after failure of conservative treatment. The aim of surgical intervention is pain relief and preventing recurrence. Arthroscopic resection is a minimally invasive alternative that has the advantages of quicker recovery and better aesthetic results. This technique has shown significant symptomatic improvement and no recurrence at early follow-up points in a small number of reported cases. The present report presents the case of a child with bilateral calcaneonavicular coalition. This is the first report to our knowledge that describes the outcome of simultaneous bilateral arthroscopic resection of calcaneonavicular coalition in a child with a 2-year follow-up period.
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Affiliation(s)
- Alexandre H Nehme
- Chairman, Department of Orthopedic Surgery and Traumatology, Saint George's University Medical Center, Balamand University, Beirut, Lebanon
| | - Jad Bou Monsef
- Resident, Orthopedic Surgery, University of Illinois at Chicago, Chicago, IL.
| | - Alaa G Bou Ghannam
- Resident, Department of Orthopedic Surgery and Traumatology, Saint George's University Medical Center, Balamand University, Beirut, Lebanon
| | - Joseph P Imad
- Resident, Department of Orthopedic Surgery and Traumatology, Saint George's University Medical Center, Balamand University, Beirut, Lebanon
| | - Ramzi Moucharafieh
- Professor, Department of Orthopedic Surgery and Traumatology, Saint George's University Medical Center, Balamand University, Beirut, Lebanon
| | - Joseph Wehbe
- Professor, Department of Orthopedic Surgery and Traumatology, Saint George's University Medical Center, Balamand University, Beirut, Lebanon
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27
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Abstract
Excision of symptomatic tarsal coalitions, after failure of attempted conservative treatment, is a widely accepted surgical procedure, when the surrounding joints are not degenerated. Historically, the literature has supported open resection. Recently, arthroscopic/endoscopic resection has been described for both calcaneonavicular (CNC) and talocalcaneal (TCC) coalitions. This article describes indications, preoperative planning, surgical techniques, and results of arthroscopic/endoscopic CNC and TCC resection.
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Affiliation(s)
- Davide Edoardo Bonasia
- Department of Orthopaedics and Traumatology, AO Città della Salute e della Scienza - Presidio CTO, University of Torino, Via Zuretti 29, Torino 10100, Italy.
| | - Phinit Phisitkul
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Annunziato Amendola
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA
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28
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Carli A, Leblanc E, Amitai A, Hamdy RC. The Evaluation and Treatment of Pediatric Tarsal Coalitions: A Critical Analysis Review. JBJS Rev 2014; 2:01874474-201408000-00002. [PMID: 27490073 DOI: 10.2106/jbjs.rvw.m.00112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Alberto Carli
- Division of Orthopaedics, Shriners Hospital for Children, Montreal Children's Hospital, McGill University, 1529 Cedar Avenue, Montreal, Quebec, Canada H3G 1A6
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29
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de Wouters S, Tran Duy K, Docquier PL. Patient-specific instruments for surgical resection of painful tarsal coalition in adolescents. Orthop Traumatol Surg Res 2014; 100:423-7. [PMID: 24793905 DOI: 10.1016/j.otsr.2014.02.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 02/03/2014] [Accepted: 02/11/2014] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Congenital tarsal coalition resection in adolescents may be hindered by the complex three-dimensional anatomy of the talocalcaneal joint. Peroperative fluoroscopy is not greatly contributive, especially for talocalcaneal coalition. HYPOTHESIS 3D planning and patient-specific instruments facilitate the procedure. MATERIALS AND METHODS A made-to-measure surgical guide (patient-specific instrument) was used in 9 consecutive patients for tarsal coalition resection (7 talocalcaneal and 2 calcaneonavicular coalitions). The guide was created by 3D modeling from the CT scan of the foot. Placed on the bone surface, it oriented the saw blade to resect the bone bridge at the appropriate depth. A fascia lata allograft was interposed. Complete resection and absence of recurrence were checked on postoperative CT in talocalcaneal and on radiography in calcaneonavicular coalitions. RESULTS Resection was complete in all cases, with no recurrence at last follow-up. DISCUSSION This technique makes tarsal coalition resection easier and more reliable and may be recommended to improve precision. LEVEL OF EVIDENCE Level IV, prospective study of a new surgical technique.
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Affiliation(s)
- S de Wouters
- Cliniques Universitaires Saint-Luc, Service de Chirurgie Orthopédique et Traumatologique, avenue Hippocrate 10, 1200 Brussels, Belgium; Computer Assisted and Robotic Surgery (CARS), Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, avenue Mounier 53, 1200 Brussels, Belgium
| | - K Tran Duy
- Centis Engineering, Université Catholique de Louvain (UCL), Institute of Mechanics, Materials and Civil Engineering (IMMC), SST/IMMC/MCTR, Louvain-la-Neuve, Belgium
| | - P-L Docquier
- Cliniques Universitaires Saint-Luc, Service de Chirurgie Orthopédique et Traumatologique, avenue Hippocrate 10, 1200 Brussels, Belgium; Computer Assisted and Robotic Surgery (CARS), Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, avenue Mounier 53, 1200 Brussels, Belgium.
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30
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Hayashi K, Kumai T, Tanaka Y. Endoscopic resection of a talocalcaneal coalition using a posteromedial approach. Arthrosc Tech 2013; 3:e39-43. [PMID: 24749021 PMCID: PMC3986476 DOI: 10.1016/j.eats.2013.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 08/14/2013] [Indexed: 02/03/2023] Open
Abstract
Resection is a standard surgical procedure for a talocalcaneal coalition (TCC). A posterior approach is the representative technique for hindfoot endoscopy, and there is only 1 report of endoscopic resection of TCC using this approach. Disadvantages of the posterior approach for TCC are as follows: (1) the indication is limited to posterior-facet coalition, (2) the flexor hallucis longus can be an obstacle in approaching the coalition, (3) the acute insertion angle between the endoscope and instrument reduces operability, and (4) a position change and additional skin incision are essential for conversion to an open procedure. In contrast, a posteromedial approach for TCC with established portals at the entrance and exit of the flexor retinaculum is a useful technique because (1) the indication is allow to middle- and posterior-facet coalitions, (2) increased perfusion pressure allows the creation of sufficient working space, (3) operating the instrument only at the coalition site decreases the risk of tendon injury and neurovascular damage, (4) the obtuse insertion angle between the endoscope and instrument improves operability, and (5) a position change and additional skin incision are unnecessary for conversion to an open procedure.
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Affiliation(s)
- Koji Hayashi
- Department of Orthopaedic Surgery and Rehabilitation, Otemae Hospital, Osaka, Japan,Address correspondence to Koji Hayashi, M.D., 1-5-34, Otemae, Chuo-ku, Osaka-shi, Osaka, 540-0008, Japan.
| | - Tsukasa Kumai
- Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
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Singh AK, Parsons SW. Arthroscopic resection of calcaneonavicular coalition/malunion via a modified sinus tarsi approach: an early case series. Foot Ankle Surg 2012; 18:266-9. [PMID: 23093122 DOI: 10.1016/j.fas.2012.04.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Revised: 04/09/2012] [Accepted: 04/17/2012] [Indexed: 02/04/2023]
Abstract
BACKGROUND Calcaneonavicular coalition represents abnormal coalescence between calcaneus and navicular bone. It is a congenital anomaly, sometimes becoming symptomatic in young adolescent. This is managed conservatively initially, failing which surgical excision, open or arthroscopic, is considered. We present our arthroscopic technique via a modified sinus tarsi approach, with early results in two adolescent and two young adult patients. METHOD The patient is placed in a 45° "saggy" lateral position, and entry points for portals are marked around sinus tarsi area. The adequacy of resection is checked with image intensifier at the end of procedure. Patients complete subjective scoring forms, Manchester-Oxford Foot Questionnaire and Visual Analogue Scale, pre operatively and at follow-ups. Paired t test was performed to assess statistical significance. RESULTS The results of early follow-up of these patients have confirmed complete excision, non-recurrence and symptomatic improvement. The mean difference in MOXFQ scores pre and post surgery is 39.33, with a two-tailed p value of 0.0187. Similarly, the mean difference in VAS score is 5.67 with a two-tailed p value of 0.0034. These are statistically significant and confirm symptomatic improvement at an early follow-up. CONCLUSION The arthroscopic technique provides better access allowing wide excision and causes minimal soft tissue trauma leading to early recovery and mobilisation.
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Affiliation(s)
- Ashok K Singh
- Department of Trauma & Orthopaedics, Royal Cornwall Hospital, Truro TR1 3LJ, United Kingdom.
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