Lateral endoscopy of the sinus tarsi: Anatomy, technique and current indications

Lopes, Ronny; Bauer, Thomas

doi:10.1016/j.otsr.2022.103383

Orthopaedics & Traumatology: Surgery & Research

2022

DOI: 10.1016/j.otsr.2022.103383

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Lateral endoscopy of the sinus tarsi: Anatomy, technique and current indications

Ronny Lopes

Thomas Bauer

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2024

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Cited by 3 publications

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Anterolateral and accessory anterolateral portals are safe to avoid subcutaneous nerve injury during subtalar arthroscopy—Definition of safe zones for standard lateral portals

Hirtler,

Bussek,

Kleinberger

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeInjury to the superficial peroneal nerve (SPN) or the sural nerve (SN) is a common complication in subtalar arthroscopy. The purpose of this anatomical study was to evaluate the distance to surrounding subcutaneous nerves in the vicinity of three standard arthroscopic portals for subtalar joint arthroscopy and through actual portal placement for arthroscopic procedures, in order to define anatomical safe zones.MethodsForty paired fresh‐frozen foot‐and‐ankle specimens were used. Subtalar arthroscopy using a three‐portal technique (anterolateral [AL], posterolateral [PL] and accessory anterolateral [AAL] portals) was performed. After completion of subtalar arthroscopy, the portals were marked, and all surrounding subcutaneous nerves, that is, the branches of the SPN and SN, were dissected. The distance of the nearest nerve at the level of the respective portal was measured and potential injury was recorded.ResultsThe nearest nerve at the level of the AL portal was the intermediate dorsal cutaneous nerve at a mean of 15.4 ± 5.1 mm medial to the portal. The nearest nerve at the level of the AAL portal was the lateral dorsal cutaneous nerve at a mean of 17.7 ± 4.8 mm, being lateral to the portal. The nearest nerve at the level of the PL portal was the SN at a mean of 6.7 ± 4.7 mm anterior to the portal. Based on the measurements, safe zones were defined.ConclusionsPlacement of the AL and AAL portals in subtalar arthroscopy is saved using standard anatomical landmarks and a thorough surgical technique. At the level of the PL portal, the SN is the most endangered structure in subtalar arthroscopy. Surgeons should be aware of the proximity of the SN to the PL portal and take the utmost care during portal placement and instrument insertion to avoid iatrogenic injury. The risk of nerve damage during portal placement may be reduced when positioning the portals in the defined safe zones.Level of EvidenceNot applicable.

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Anterolateral and accessory anterolateral portals are safe to avoid subcutaneous nerve injury during subtalar arthroscopy—Definition of safe zones for standard lateral portals

Hirtler,

Bussek,

Kleinberger

et al. 2024

Knee surg. sports traumatol. arthrosc.

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Beyond Osteochondral and Ligamentous Injuries of the Ankle: A New Focus on Other Overlooked Pathologies on CT Arthrography of the Ankle

Allam,

Esmaeel,

Ismail

et al. 2024

SN Compr. Clin. Med.

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Arthroscopic Subtalar Joint Arthrodesis: Topical Review

et al. 2021

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Background: Advances in foot and ankle arthroscopy over the last 2 decades have allowed for subtalar joint arthrodesis to be performed arthroscopically. The potential advantages of the arthroscopic technique include higher fusion rates, lower complications, reduced perioperative morbidity, and accelerated rehabilitation. Arthroscopic arthrodesis may, however, not be appropriate in the setting of complex deformity correction or the need for other open procedures. Methods: Surgical techniques of arthroscopic subtalar joint arthrodesis are described. Outcomes and complications associated with these procedures are presented, based on a comprehensive literature review. Thirteen Level IV studies of moderate quality were included. Results and Conclusion: Excellent arthrodesis union rates were achieved (average 96%, range 86%-100%), at a weighted average union time of 8.8 weeks (95% confidence interval 7.9-9.7). The overall complication rate was 21% (87/415 feet; range 10%-36.4%). Metal irritation was the most common complication (11.2%), followed by nerve injury (4.2%) and infection (0.9%). Similar fusion rates have been reported when comparing arthroscopic and open arthrodesis. Complication rates are also similar, excerpt for infection, which may be lower with arthroscopy. Three different approaches were used to access the subtalar joint with similar union and complication rates. There was no evidence that the use of bone graft or more than 1 screw improved outcomes. The superiority of arthroscopic subtalar fusion over open techniques cannot be demonstrated by the available studies. Level of Evidence: Level IV, case series.

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Lateral endoscopy of the sinus tarsi: Anatomy, technique and current indications

Cited by 3 publications

References 67 publications

Anterolateral and accessory anterolateral portals are safe to avoid subcutaneous nerve injury during subtalar arthroscopy—Definition of safe zones for standard lateral portals

Anterolateral and accessory anterolateral portals are safe to avoid subcutaneous nerve injury during subtalar arthroscopy—Definition of safe zones for standard lateral portals

Beyond Osteochondral and Ligamentous Injuries of the Ankle: A New Focus on Other Overlooked Pathologies on CT Arthrography of the Ankle

Arthroscopic Subtalar Joint Arthrodesis: Topical Review

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