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 – Smith and Nephew, Geistlich, Ossur, Cannuflow Research and educational support – Mitek, Smith & Nephew & Arthrex

Controversy! 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?

Answer Scope Supine! 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! I Cannot Operate Upside Down!

Arthroscopic Portals Anterolateral Anterocentral Anteromedial

Arthroscopic Portals Posterolateral Transachilles Posteromedial

Accessory Posteromedial Portal Posteromedial Portal Posterior to Posterior Tibial Tendon in “Soft Spot” Behind Medial Malleolus

Can We Access Posterior OLTs From Anterior Approach? Answer: YES!

Excision of P-M OLT Scope Thru P-L Portal Inflow Thru A-L Portal Instruments Through A-M Portal Via Notch of Harty

Microfracture OLT P-L View 90 65 45 degrees degrees degrees

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

P-L OLT Lesion A-L VIEW MW

SUBTALAR ARTHROSCOPY Supine – Lateral Approach

Subtalar Portals Anterolateral Central (Middle) Posterolateral Accessory AL & PL Medial - ? Post.medial -?

Posterior Ankle Anatomy Intact P-L Talar Process is Called Trigonal Process or Stieda Process Ludwig Stieda was German Anatomist Terminology Can Be Very Confusing

Os Trigonuim Occurs Due to: Congenital That Doesn't Fuse Fusion Doesn't Occur Due to Microtrauma Acquired Secondary to Fracture of Stieda Process

Posterolateral View Of Ankle And Subtalar Joints

Talar Compression Syndrome Pain – PL Ankle Worse With Relevé, Jumping or Kicking Most Common in Dancers (esp. ballet) PE – (+) Plantar Flexion Sign Possible FHL Pain

Diagnostic Workup X-rays – AP, True Lateral, Mortise, Full Plantar Flexion Bone Scan – Look For Uptake in Posterior Talus Diagnostic /Therapeutic Injection

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

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!

Excision of Os Trigonum Right Subtalar Joint

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

Thank You