Arthroscopic Excision of a Symptomatic Os Trigonum in a Lateral Decubitus Position

Abstract

Level IV, retrospective case series.

Disorders of the Flexor Hallucis Longus and Os Trigonum

“…Average time to return to sports or activities was 5.9 weeks to 5.8 months. 23,[60][61][62][63]65,66,[70][71][72] Open excision of the os trigonum through PM or PL approaches were effective and safe in the patients with os trigonum syndrome. 29,73 Previous studies reported significant improvement of AOFAS scores, and average AOFAS scores were 87.6 to 100.0 points at the final postoperative visit.…”

“…29 In posterior arthroscopic debridement using the supine position, a potential hazard is injury to the calcaneofibular ligament or peroneal tendons while making the centrolateral portal. 66 Superficial wound infection was reported in 3.3% to 6.7% 29,62 and deep wound infection in 3.3% from the arthroscopic approach, 62 whereas only superficial wound infection was reported in 2.4% from the open approach. Ankle stiffness was reported in 6.7% and triggering of the hallux in 3.7% from the arthroscopic approach; there are no such reports in series involving the open approach.…”

“…23 Arthroscopic os trigonum excision can be performed from either a lateral or a posterior approach. 23,[60][61][62][63][64][65][66][67] The authors prefer prone over lateral decubitus position because it provides a more direct approach to the os trigonum, decreases the risk of instrument skiving off toward the neurovascular bundles, and simultaneously allows performance of the procedure for FHL pathology.…”

Posterior talar process as a suitable cell source for treatment of cartilage and osteochondral defects of the talus

“…The posterior process of the talus, also known as Stieda's process, can be associated with the syndrome of posterior impingement of the talus, especially in athletes and ballet dancers (Bizarro, ; Russell et al , ). Its clinical management requires arthroscopic surgery, in which Stieda's process is removed (Park et al , ). Also described in the literature is the existence of an accessory bone, the os trigonum, which is associated with the posterior process of the talus and has no defined function.…”

“…Nevertheless, it has been frequently associated with chronic complaints related to plantar flexion mechanisms (Bizarro, ). In the symptomatic posterior ankle impingement syndrome, the removal of these structures has been described and proposed for pain management (Park et al , ; Russell et al , ). The orthopaedic community assumes that the arthroscopic excision of these structures is not associated with significant morbidity (Chao, ).…”