SLIDE 1
GO ANTERIOR! Anterior vs. Posterior Hindfoot Arthroscopy: Go - - PowerPoint PPT Presentation
GO ANTERIOR! Anterior vs. Posterior Hindfoot Arthroscopy: Go - - PowerPoint PPT Presentation
Anterior vs. Posterior Hindfoot Arthroscopy: GO ANTERIOR! Anterior vs. Posterior Hindfoot Arthroscopy: Go Anterior! The following relations exists Royalties and stock options Smith and Nephew, Wolters Kluwer Consulting income
SLIDE 2
SLIDE 3
Anterior vs. Posterior Hindfoot Arthroscopy: Go Anterior!
The following relations exists
Royalties and stock options – Smith and Nephew, Wolters Kluwer Consulting income – Smith and Nephew, Geistlich, Ossur, Cannuflow Research and educational support – Mitek, Smith & Nephew & Arthrex
SLIDE 4
Which Method is Best to Do Hindfoot Arthroscopy? What Do You Do When There is Pathology in the Front & Back of Ankle? How Do You See the Whole Joint?
Controversy!
SLIDE 5
Allows You to See Entire Joint Using Anterior and Posterior Portals Ankle and Subtalar Arthroscopy Can BOTH Be Done in Same Position Simultaneously I Do Not Have to Turn the Patient and Re-prep and Drape
Answer Scope Supine!
SLIDE 6
Answer Scope Supine!
I Cannot Operate Upside Down!
SLIDE 7
Arthroscopic Portals Anterolateral Anterocentral Anteromedial
SLIDE 8
Arthroscopic Portals
Posterolateral Transachilles Posteromedial
SLIDE 9
Accessory Posteromedial Portal
Posteromedial Portal Posterior to Posterior Tibial Tendon in “Soft Spot” Behind Medial Malleolus
SLIDE 10
Can We Access Posterior OLTs From Anterior Approach? Answer: YES!
SLIDE 11
Excision of P-M OLT
Scope Thru P-L Portal Inflow Thru A-L Portal Instruments Through A-M Portal Via Notch of Harty
SLIDE 12
SLIDE 13
Microfracture OLT
P-L View
90 degrees 65 degrees 45 degrees
SLIDE 14
Treatment of P-L OLT
Angle P-L Portal Towards Lesion Portal Made Through Capsule B/N PITFL and Transverse Ligament Alternate Portals Expand Opening in P-L Capsule Often Its Necessary to Instrument through P-L Portal
SLIDE 15
P-L OLT Lesion
MW A-L VIEW
SLIDE 16
SUBTALAR ARTHROSCOPY Supine – Lateral Approach
SLIDE 17
Subtalar Portals
Anterolateral Central (Middle) Posterolateral Accessory AL & PL Medial - ? Post.medial -?
SLIDE 18
Posterior Ankle Anatomy
Intact P-L Talar Process is Called Trigonal Process
- r Stieda Process
Ludwig Stieda was German Anatomist Terminology Can Be Very Confusing
SLIDE 19
Os Trigonuim
Occurs Due to: Congenital That Doesn't Fuse Fusion Doesn't Occur Due to Microtrauma Acquired Secondary to Fracture of Stieda Process
SLIDE 20
Posterolateral View Of Ankle And Subtalar Joints
SLIDE 21
Talar Compression Syndrome
Pain – PL Ankle Worse With Relevé, Jumping
- r Kicking
Most Common in Dancers (esp. ballet) PE – (+) Plantar Flexion Sign Possible FHL Pain
SLIDE 22
Diagnostic Workup
X-rays – AP, True Lateral, Mortise, Full Plantar Flexion Bone Scan – Look For Uptake in Posterior Talus Diagnostic /Therapeutic Injection
SLIDE 23
Diagnostic Workup
CT – Look for Multiple or Loose Fragments MRI – Most Useful and Test of Choice – Look For Fluid and Edema in Posterior Talar Region
SLIDE 24
Os Trigonum Supine Excision
Supine Approach is a Capsular & Ligament Preservation Technique No Need To Breakdown The Walls of the House to Get Inside Shell Out Os Trigonum With Little Disturbance to Surrounding Tissue This Technique is Easy & Better Than Prone!
SLIDE 25
Excision of Os Trigonum
Right Subtalar Joint
SLIDE 26
SLIDE 27
SLIDE 28
SLIDE 29
SLIDE 30
Results – Ferkel (1997)
Done Arthroscopically 11 Pts; F/U 35 Months AOFAS 45 → 86 All Pts Reached Maximum Recovery Within 3 Months Currently Over 300 Pts With Similar Results
FAI 18;777, 1997
SLIDE 31