Accessibility to Talar Dome in Neutral Position, Dorsiflexion, or Noninvasive Distraction in Posterior Ankle Arthroscopy

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.

Maximum Plantarflexion Lateral Ankle Radiograph for Preoperative Planning for the Arthroscopic Treatment of Osteochondral Lesions of the Talus

“…This includes focus on the use of noninvasive distraction vs maximal position in both dorsiflexion and plantarflexion to improve access of the talar dome articular surface during anterior ankle arthroscopy as well as posterior ankle arthroscopy. 3 - 5 …”

“…This includes focus on the use of noninvasive distraction vs maximal position in both dorsiflexion and plantarflexion to improve access of the talar dome articular surface during anterior ankle arthroscopy as well as posterior ankle arthroscopy. [3][4][5] In the management of OLTs, the limits of anterior arthroscopy have been pushed with time, because of the added complexity and possible added morbidity associated with other techniques. Joint range of motion, ligamentous laxity, scar tissue, and other patient characteristics can all have an impact on the intra-articular access using anterior arthroscopy of the tibiotalar joint, with the posterior talus being the most challenging site to access.…”

Posterior arthroscopic treatment of ankle osteochondral lesions: technical note

“…We excluded patients with previous ankle surgery, ankle instability, rheumatoid arthritis, joint impingement and/or ankle osteoarthritis 10. All patients were studied with preoperative and postoperative X-rays, CT scan and MRI.…”

“…The results were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) clinical rating system for the ankle-hindfoot,10 Foot and Ankle Ability Measure (FAAM) and FAAM sports 12 13. Visual Analogue Scale (VAS) was complementarily used with these measures to evaluate the clinical behaviour of patients.…”

“…The aim of this study is to describe a technically straightforward and reproducible procedure such as posterior ankle arthroscopy10 11 for treatment of posterior talar OCL. The clinical results of a consecutive case series are also described.…”