Arthroscopic treatment of calcaneonavicular coalition in children

Abstract

Calcaneonavicular coalition is a common source of pain and more or less severe flat and stiff foot in children. Classically, treatment consists in resecting the coalition using a dorsolateral approach. Good quality resection and interposition can prevent recurrence. The most common complications are infection, hematoma and neuroma. Arthroscopy offers a minimally invasive alternative, but the optimal approach remains undetermined. We describe a surgical technique with an approach based on the anterolateral process of the calcaneus, in three cases with 12 months' follow-up. Arthroscopic resection has certain advantages: recovery is quicker, and the esthetic result is better. For the instrumental portal, skin incision should be superficial, followed by blunt dissection of subcutaneous tissue to avoid superficial peroneal nerve injury. Although longer term follow-up is needed, arthroscopy seems to be an attractive minimally invasive technique in this kind of pathology.

Surgical navigation in paediatric orthopaedics

“…Fluoroscopy is often not useful for talocalcaneal coalition. Arthroscopic resection has also been reported, 24,25 but involves a long learning curve, 26 longer operating time, 27 , risk of posterior tibial pedicle neurovascular lesion 28 and difficulty in positioning. 29 …”

Endoscopic Resection of a Talocalcaneal Coalition Using a Posteromedial Approach

“…4,5 The first report about endoscopic resection of TCCs was published by Bonasia et al 6 in 2011, and they limited the indication to posterior-facet coalition. On the other hand, Jagodzinski et al 7 reported in 2013 that the lateral approach was useful for middle-facet coalition but had a risk of neurovascular damage for a posterior-facet coalition.…”

The Evaluation and Treatment of Pediatric Tarsal Coalitions

“…Andreasen reported that this technique was associated with satisfactory outcomes for twenty-two of thirty patients who were followed for as long as twenty-two years postoperatively 52 , Chambers et al noted a 100% rate of satisfactory results in a study of twenty-nine patients who were followed for three to fourteen years 55 , Cowell reported good or excellent outcomes for twenty-three (88%) of twenty-six patients 56 , and Gonzalez and Kumar reported good to excellent outcomes for fifty-eight (77%) of seventyfive patients who were followed for an average of three years following resection and interposition 54 . A minimally invasive method of performing a coalition resection with use of arthroscopy 57,58 recently has received attention, with good short-term results being observed in studies involving very small sample sizes 59 . The main concern regarding arthroscopic resection involves adequate identification of the deeper aspect of the osseous coalition bridge, which, if not adequately resected, can facilitate recurrence of coalition.…”