Posterior Arthroscopic Subtalar Arthrodesis: Clinical and Radiologic Review of 19 Cases

Abstract

Level of Clinical Evidence: 4Keywords: ankle arthroscopy posterior subtalar arthroscopy subtalar arthritis subtalar arthrodesis a b s t r a c t Arthroscopic subtalar arthrodesis has recently gained popularity in the treatment of primary subtalar or posttraumatic arthritis, coalition, or inflammatory diseases with subtalar arthritis. The present study reports the clinical and radiologic results of 19 patients (19 feet) who underwent posterior arthroscopic subtalar arthrodesis using 2 posterior portals. A total of 19 posterior arthroscopic subtalar arthrodeses (minimum follow-up of 24 months) performed without a bone graft and with 2 parallel screws were prospectively evaluated. The fusion rate was 94% (mean time to fusion 9.8 weeks). Modified American Orthopaedic Foot and Ankle Society anklehindfoot scale score (maximum 94 points) improved significantly from 43 to 80 points and the visual analog scale for pain score improved from 7.6 to 1.2. The 12-item short-form physical and mental scores at the last follow-up point were 52.5 and 56.4, respectively. One (5.3%) patient underwent open repeat fusion for nonunion, 2 (10.5%) patients required a second procedure for implant removal, and 1 (5.3%) experienced reversible neuropraxia. In conclusion, posterior arthroscopic subtalar arthrodesis is a safe technique with a good union rate and a small number of complications in patients with no or very little hindfoot deformity.

Do Patient Positioning and Portal Placement for Arthroscopic Subtalar Arthrodesis Matter?

“…All selected studies were identified using the literature search strategy, as the review of reference sections did not identify additional articles for inclusion. Overall, 8 studies 5 , 9 , 12 , 18 , 21 , 22 , 24 , 31 examined prone patients with 2 posterior portals (n = 111; 22.9%), 7 articles 4 , 11 , 13 , 16 , 27 , 30 , 35 evaluated lateral portals in the supine or lateral position (n = 182; 37.6%), and 5 studies 2 , 3 , 6 , 26 , 34 examined patients in the prone position with 3 portals (n = 191; 39.5%). The mean MCMS of included studies was found to be 38.4 (range, 10-63) ( Table 1 ).…”

“…Patient-reported outcome scores after arthroscopic subtalar arthrodesis have been consistently reported as excellent in the literature, regardless of patient positioning or portal placement. 2 , 4 , 11 , 13 , 18 , 21 , 34 Amendola et al 2 reported an improvement in the mean AOFAS score from 36 to 86 in a series of 11 arthroscopic subtalar fusion cases in the prone position with 2 posterior portals and a third accessory lateral portal. In a case series of 22 arthroscopic subtalar fusion procedures using lateral-based portals, Boack et al 4 reported an improvement in the AOFAS score from 38 to 81.…”

“…In a case series of 22 arthroscopic subtalar fusion procedures using lateral-based portals, Boack et al 4 reported an improvement in the AOFAS score from 38 to 81. Martin Oliva et al 21 examined 19 patients undergoing arthroscopic subtalar fusion in the prone position using 2 portals and found that the AOFAS score improved from 42.4 to 80.2. Of the 20 articles that met the inclusion criteria of our study, only 11 (55.0%) reported both preoperative and postoperative AOFAS scores.…”

“…30 The procedure was originally performed with the patient in the lateral decubitus or supine position using anterolateral and posterolateral portals based around the fibula with good results. 11 , 13 , 27 , 35 More recently, several authors 2 , 3 , 5 , 21 , 24 , 26 , 31 have advocated for prone positioning utilizing posteromedial and posterolateral portals, as first described by van Dijk et al 32 in 2000. Proponents of the prone position cite improved intra-articular visualization with a limited need for traction and more thorough preparation of the posterior facet for fusion.…”

How many screws are necessary for subtalar fusion? A retrospective study

“…However, as the mobility of the talonavicular joint has a major impact on hindfoot function, fusion of the subtalar joint alone may have less adverse effects [2,3]. Furthermore, the development of secondary osteoarthritis in adjacent joints may be less common [4].…”