Arthroscopic Evaluation of the Subtalar Joint: Does Sinus Tarsi Syndrome Exist?

Abstract

This is a retrospective review of 49 subtalar arthroscopies performed between 1989 and 1996. Patients were evaluated in the following areas: (1) preoperative diagnosis, (2) preoperative tests and clinical evaluation, (3) intraoperative findings, (4) postoperative diagnosis,(5) complications, and (6) clinical outcome. Particular attention was paid to the accuracy of the preoperative diagnosis, subtalar instability, intraoperative findings in sinus tarsi syndrome, and clinical outcome. Overall, this study demonstrated a success rate of 94% good and excellent results in the treatment of various types of subtalar pathologic conditions with arthroscopic techniques. The Workers' Compensation cases reported 90% good and excellent results. The complication rate was low, with five minor complications reported. The most common complication was a transient neuropraxia involving branches of the superficial peroneal nerve. Of the 14 feet that had a preoperative diagnosis of sinus tarsi syndrome, all the diagnoses were changed at the time of arthroscopy. The postoperative diagnoses included 10 interosseous ligament tears, two cases of arthrofibrosis, and two degenerative joints. Based on these findings, "sinus tarsi syndrome" seems to be an inaccurate term that should be replaced with a specific diagnosis. Arthroscopy is the tool that will allow the orthopaedic surgeon to make a more accurate diagnosis.

Subtalar instability: imaging features of subtalar ligaments on 3D isotropic ankle MRI

“…Moreover, some of these ligamentous structures might have been confused with each other due to their adjacent positions. The ITCL has been described with different morphologies, including a V shape, an inverted Y shape, a veil extending across the tarsal canal, an oblique band, and a two-layered structure [ 7 , 8 , 14 , 18 ]. A consensus on the description of the ITCL is lacking.…”

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

“…Although noninvasive distraction may improve accessibility in posterior arthroscopy 2,35 and even wire-based invasive distraction may have its place in specific cases, 2,32,57,58,63 one should nonetheless take all possible means to minimize complication rate, which has been shown to be higher in procedures using invasive or noninvasive distraction. 3,7,11,12,14,17,18,21,25,29,39,43,45,52,54,55,58 Though most talar OCDs may be addressed though anterior arthroscopy, there can arise situations in which the location of the specific OCD may warrant a posterior approach. As the majority of OCDs treated by arthroscopic approaches commonly do not exceed 1 cm 2 , 19,38,60 the authors feel certain that the results shown in this study are clinically significant as the information presented may affect preoperative planning and the arthroscopic treatment of some talar lesions.…”

Anatomy of the Tarsal Canal and Sinus in Relation to the Subtalar Joint Capsule

“…Previous papers have morphologically described the ITCL as a broad, flattened band 9,11,17,30 or a V-shaped ligament in the tarsal canal. 7 In terms of the layer of the ITCL, it has been described as part of the capsule of the talocalcaneonavicular joint 29 or to be located between the capsules of the posterior talocalcaneal and talocalcaneonavicular joints. 30 The medial root of the IER has been described as being separated into 2 or 3 components.…”

“…Anatomical knowledge of the subtalar joint remains controversial due to complexity in nomenclature, shape, and functions of the ligamentous structures, including the ITCL, cervical ligament (CL), and inferior extensor retinaculum (IER). 7,9,15,24,27,29,30,34 The tarsal canal and sinus are described as small funnel-shaped areas situated anterior to the posterior talocalcaneal joint and posterior to the talocalcaneonavicular joint, respectively. 4,9,30 The larger tarsal sinus opens laterally, whereas the stemlike tarsal canal extends medially, posterior to the sustentaculum tali.…”