Arthroscopic Posterior Subtalar Arthrodesis: Surgical Technique

Abstract

Surgical fusion of the subtalar joint is a procedure indicated to alleviate pain of subtalar origin, such as in post-traumatic osteoarthritis, adult-acquired flatfoot deformity, and other disorders. Open subtalar arthrodesis has been performed with predictable results, but concerns exist regarding injury to proprioception and local vascularity due to wide surgical dissection. Minimally invasive techniques try to improve results by avoiding these issues but have a reputation for being technically demanding. We describe the surgical technique for arthroscopic subtalar arthrodesis, which has proved to be a safe and reliable technique in our experience, with consistent improvements in American Orthopaedic Foot & Ankle Society scores.

Arthroscopic subtalar arthrodesis through the sinus tarsi portal approach: A series of 77 cases

“…We report an overall rate of successful union of 97.4%, which is comparable to previously published results for both arthroscopic [5,12,[14][15][16][17][18][19][20][21][22][23][24][25] and open [1][2][3][4][5]11] subtalar arthrodesis. The low incidence of surgical site infection and nerve injury in our series are favourable to rates reported for open arthrodesis [1][2][3], and comparable to those previously seen in arthroscopic subtalar arthrodesis.…”

“…Indeed, a number of small series' of arthroscopic subtalar arthrodesis have now been reported [5,[11][12][13][14][15][16][17][18][19][20][21][22][23][24][25], all demonstrating encouraging early results in terms of rates of successful union and incidence of complications. In these studies, procedures were performed through either a posterior (posteromedial and posterolateral portals) or lateral (anterolateral and posterolateral portals) approach.…”

Anterolateral Arthroscopic Posterior Subtalar Arthrodesis: The Surgical Technique

“…In the current literature, open subtalar arthrodesis is usually performed through a medial, lateral, or posterior approach 15 , 16 ; conversely, arthroscopic fusion is usually described from posterior. 14 , 17 , 18 , 19 In the latter, to avoid iatrogenic damage to the tibial nerve, caution is mandatory when using motorized instruments around the medial area. 18 , 20 In addition, posteriorly approached ASA (with the patient in the ventral decubitus position) is not adequate in case of the necessity for a surgical procedure on the midfoot or forefoot.…”

Regarding “Arthroscopic Posterior Subtalar Arthrodesis: Surgical Technique”

“…arthrodesis of Sanders type IV calcaneal fractures is widely accepted 4,5 ; arthroscopic arthrodesis is associated with less soft-tissue damage, respecting the vascularization, which could promote fusion. 1,2 We perform the operation 7 to 10 days after the fracture. The surgical procedure consists of arthroscopic subtalar arthrodesis using posterior endoscopic portals following a similar technique to that originally described by van Dijk et al 6 ; the joint is debrided from posterolateral to posteromedial and from anterolateral to anteromedial, until subchondral bone is visible on both aspects of the complete subtalar joint surface as described by Vilá y Rico et al 1 At this moment (after preparation of the joint surfaces and before the arthrodesis stabilization), the first modification is achieved: A Steinmann pin is introduced percutaneously from the medial to lateral side of the posterior tuberosity of the calcaneus.…”

“…The Steinmann pin is maneuvered as a joystick to re-establish the length and height of the calcaneus and to reduce its varus/valgus. Once the calcaneus is in the right position, the arthrodesis is stabilized with two 7-mm cannulated screws at the most anterior aspect of the joint, from the calcaneus to the talus, similar to the description of Vilá y Rico et al 1 The second modification consists of the use of fully threaded cannulated screws. Less compression is achieved by using these kinds of screws, and their use avoids decreasing the height and length of the calcaneus, which is a possible consequence if too much compression occurs in this type of comminuted fracture.…”