Arthroscopy of the Subtalar Joint

Abstract

The purpose of this study was to determine the position and relative safety of the anterior, posterior, and newly defined middle portals by measuring their distance from the neurovascular structures and tendons on the lateral side of the foot and ankle. Furthermore, this study demonstrates specific components of the posterior subtalar joint and arthroscopic access to each utilizing a technique that allows direct anatomic correlation. The 15 specimens were divided into three groups of five feet each, with one arthroscopic portal site and one instrumentation portal site per group. Group I used the anterior portal for the arthroscope and the posterior portal for the curette. Group II used the posterior portal for the arthroscope and the anterior portal for the curette. In group III, the arthroscope was inserted through the anterior portal and the curette through the middle portal. The sural nerve and small saphenous vein were at risk with posterior portal placement. The anterior portal presented a minor risk of injury to the dorsal intermediate cutaneous branch of the superficial peroneal nerve. The middle portal was without risk to surrounding structures. Group I provided the best access to the posterior facet of the subtalar joint. Group II provided excellent arthroscopic visualization of the posterior facet, but poor access for instrumentation via the anterior portal. Group III provided the best access to the sinus tarsi. No combination of portals allowed visualization or instrumentation of the middle or anterior facets.

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

“…In these studies, procedures were performed through either a posterior (posteromedial and posterolateral portals) or lateral (anterolateral and posterolateral portals) approach. One concern relating to these approaches is proximity of the posterolateral portal to the sural nerve, with a 10% incidence of nerve injury seen in cadaveric studies [26,27]. To avoid a posterolateral portal, and to access all three facets of the subtalar joint, we use a two-portal sinus tarsi approach that has previously been described in the literature [28][29][30][31] .…”

Subtalar arthroscopy - indications and surgical technique

“…The ALV portal is just posterior to the anterior calcaneal process. Using this access, the dorsal cutaneous branch of the su- [7] perficial peroneal nerve, the dorsal lateral cutaneous nerve at the end of the sural nerve as well as the tendon of the peroneal tertial muscle and branches of the small saphenous vein have to be avoided. This can be managed by a superficial retrograde skin incision and a subcutaneous preparation down to the joint capsule, which is performed by a haemostat.…”

“…Frey et al [7] showed in anatomic studies that from these two portals 90% of the posterior joint facet can be reached. Only a small medial part is not accessible, but this area can be reached from the ALD portal (Fig.…”

“…Knowledge about the arthroscopic options in the subtalar joint, however, is still limited [7,[24][25][26]. After reasonable caution in the beginning, the subtalar joint now seems to be available for arthroscopic procedures.…”

Arthroscopic Excision of a Symptomatic Os Trigonum

“…However, peritendinous portals placed adjacent to the Achilles tendon in the prone patient are safe. 4,12,[16][17][18][19][20] The purpose of the study was to report the clinical outcomes of arthroscopic excision for a symptomatic os trigonum initially viewing through the posteromedial ankle portal with the motorized instrument in the posterolateral portal. Our hypothesis was that this approach would be both safe and effective and would provide comparable outcomes, a comparable complication rate, and a comparable recovery to other arthroscopic techniques.…”