An Anatomical Study Comparing Two Surgical Approaches for Isolated Talonavicular Arthrodesis

Higgs, Z.; Jamal, Bilal; Fogg, Quentin A.; Kumar, C. Senthil

doi:10.1177/1071100714540886

Cited by 11 publications

(6 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…They used a dorsal approach to prepare the TNJ, while we used a medial approach. An anatomical study showed that the total accessible talonavicular articular surface area for the medial and dorsal approaches was 71% and 92%, respectively [ 37 ]. Another study showed that 91% of the TNJ and STJ areas could be accessed through the medial approach [ 38 ].…”

Section: Discussionmentioning

confidence: 99%

“…Another study showed that 91% of the TNJ and STJ areas could be accessed through the medial approach [ 38 ]. It is important to note that all the anatomical specimens in both studies had no deformity [ 37 , 38 ]. In advanced AAFD, the hindfoot is in valgus, and the forefoot is abducted, allowing even superior access to these joints in comparison to normal feet when a medial approach is used [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Double versus triple arthrodesis for adult-acquired flatfoot deformity due to stage III posterior tibial tendon insufficiency: a prospective comparative study of two cohorts

Fadle

El-Adly

Attia

et al. 2021

International Orthopaedics (SICOT)

View full text Add to dashboard Cite

Purpose The study aims to prospectively compare double and triple arthrodesis in terms of functional outcomes and deformity correction. To the best of our knowledge, this is the first prospective comparative study in the literature to date. Methods This is a prospective comparative cohort study carried out between May 2017 and May 2019. The study was approved by the IRB at Assiut University and done according to the Helsinki declaration. Patients with AAFD stage III aged between 15 and 40 years old were assigned to double arthrodesis or triple arthrodesis. The groups were prospectively followed for one year. Primary outcomes were union rates, AOFAS scores, and radiological parameters of deformity correction on AP and lateral plain radiographs. Secondary outcomes were operative time, time to union, and complications. The double arthrodesis was done through the medial approach, while the triple arthrodesis was done through dual medial and lateral approaches. The post-operative protocol was standardized for both groups. Results A total of twenty-three patients matched the inclusion criteria and provided their consent to participate in the study. Thirteen (all males) patients underwent double arthrodesis, while ten (nine males and one female) patients underwent triple arthrodesis. The mean age for double and triple arthrodesis was 20.15 ± 5.63 and 25.10 ± 8.36 years, respectively, and the mean follow-up lengths were 12.46 and 12.9 months, respectively. There were no statistically significant differences between both groups in age, gender, laterality, or duration of follow-up. There were no statistically significant differences between both groups in AOFAS hindfoot scores or radiographic parameters. All patients were available for the final follow-up evaluation. All patients in both groups achieved union by four months post-operatively. The mean time to union in the double and triple arthrodesis groups was 3.39 ± 0.65 vs. 3.31 ± 0.6 months, respectively, with no statistically significant differences (p = 0.77). The mean operative time was significantly shorter in the double arthrodesis group than the triple arthrodesis group, 55.77 ± 15.18 vs. 91.6 ± 24.14 min (p < 0.001), respectively. Both double and triple arthrodesis groups had a statistically significant improvement of the mean AOFAS hindfoot score post-operatively (71.46 ± 7.77 vs. 88.38 ± 3.66, p < 0.001) and (66.9 ± 7.69 vs. 85 ± 5.83, p < 0.001), respectively. In the double arthrodesis group, the mean calcaneal pitch angle increased from 11.46° pre-operatively to 19.34° (MD = 8.45°, p < 0.001). The mean Meary’s angle improved from − 4.19 to 2.9° (MD = 7.32°, p < 0.001). Hibbs angle had a mean reduction of 6.45° post-operatively (p = 0.069). In the triple arthrodesis group, the mean calcaneal pitch angle improved from 10.06° pre-operatively to 17.49° post-operatively (MD = 7.12°, p < 0.001). The mean Meary’s angle improved from − 4.72 to 2.29° (MD = 7.09°, p < 0.001). The mean Hibbs angle decreased from 153.07 to 142.32° (MD = 10.54°, p < 0.001). The double vs. triple arthrodesis groups had no statistically significant differences in AOFAS hindfoot score improvement (16.92 vs. 19.1, p = 0.44), respectively. The two groups had no statistically significant differences in the magnitude of correction of all the radiographic parameters. Conclusion Double arthrodesis is an equally reliable surgical option for AAFD stage III for achieving union, improving the functional outcomes, and deformity correction as triple arthrodesis with a significantly shorter operative time in the former. The authors recommend double arthrodesis if the calcaneocuboid joint is unaffected.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Double versus triple arthrodesis for adult-acquired flatfoot deformity due to stage III posterior tibial tendon insufficiency: a prospective comparative study of two cohorts

Fadle

El-Adly

Attia

et al. 2021

International Orthopaedics (SICOT)

View full text Add to dashboard Cite

show abstract

“…Because of the concave-convex nature of the joint, a medial percutaneous approach has been advocated as preferred for ease of access. 5 However, some studies have found the dorsal approach to be more suitable for more adequately preparing the joint surface, an essential process for subsequent fusion. 1,15 Percutaneous approaches carry the potential advantages of causing decreased tissue trauma, incision size, surgical site inflammation, and less pain.…”

Section: Introductionmentioning

confidence: 99%

“…6 Alternative percutaneous methods have been suggested for talonavicular fusion. 1,5,6,12,18 Although there are benefits to an arthroscopic approach, it may take a longer time to set up an operating room, and instruments may not be available in all facilities.…”

Section: Introductionmentioning

confidence: 99%

Anatomical Structures at Risk in Percutaneous Preparation Talonavicular Fusion

Yeager,

Nihalani,

Rutz

et al. 2024

Foot Ankle Int.

View full text Add to dashboard Cite

Background: The stability of the hindfoot greatly relies on the integrity of the talonavicular joint. Pathologies affecting this joint often necessitate fusion. Our study explores the risks posed to neurovascular and tendon structures during simulated percutaneous talonavicular joint preparation for fusion. Methods: In 9 fresh cadaver specimens, the talonavicular joint was accessed through two portals. A 2-mm Shannon burr was employed for joint surface preparation with distraction provided by a pin-based distractor. Dissections were performed to assess potential damage to critical structures, including the dorsalis pedis artery, superficial and deep peroneal nerves, extensor hallucis longus (EHL), and tibialis anterior (TA) tendons. Results: The dorsal portal site was found to be significantly closer to important structures compared to the medial portal site. The Shannon burr made contact with various structures, with a single transection identified for both deep and superficial peroneal nerve branches. During the dorsal portal site approach, potential injury to the EHL tendon was identified as concern. Conclusion: This study sheds light on the potential risks associated with percutaneous dorsal and medial joint preparation approaches using a Shannon burr. Level of Evidence: Level V, mechanism-based reasoning..

show abstract

“…The talonavicular (TN) joint is a multiaxial, ball-and-socket joint that functions as the cornerstone of the medial joint complex of the hindfoot, allowing for controlled movements 20 and distributing forces among the peritalar joints during the gait cycle. 1,8,12,13,17 The TN joint can be associated with an array of musculoskeletal pathologies, including joint degeneration, inflammatory processes, and traumas. 2,5,17,21 TN fusion is a reliable intervention for degenerative, inflammatory, and traumatic TN joint pathology as well as many hindfoot deformities.…”

mentioning

confidence: 99%

Structures at Risk During Percutaneous Screw Fixation for Talonavicular Fusion

et al. 2018

View full text Add to dashboard Cite

show abstract

An Anatomical Study Comparing Two Surgical Approaches for Isolated Talonavicular Arthrodesis

Abstract: These data support for the use of the dorsal approach for talonavicular arthrodesis, particularly in cases where access to the lateral half of the joint is necessary.

Cited by 11 publications

References 25 publications

Double versus triple arthrodesis for adult-acquired flatfoot deformity due to stage III posterior tibial tendon insufficiency: a prospective comparative study of two cohorts

Double versus triple arthrodesis for adult-acquired flatfoot deformity due to stage III posterior tibial tendon insufficiency: a prospective comparative study of two cohorts

Anatomical Structures at Risk in Percutaneous Preparation Talonavicular Fusion

Structures at Risk During Percutaneous Screw Fixation for Talonavicular Fusion

Contact Info

Product

Resources

About