Posterior Hindfoot Arthroscopy

Abstract

In recent years, minimally invasive surgery has developed and progressed the standard of care in orthopaedics and sports medicine. In particular, the use of posterior hindfoot arthroscopy in the treatment of posterior ankle and hindfoot injury is increasing rapidly as a means of reducing pain, infection rates, and blood loss postoperatively compared with traditional open procedures. In athletes, hindfoot arthroscopy has been used effectively in expediting rehabilitation and ultimately in minimizing the time lost from competition at previous levels. Van Dijk et al were the first to describe the original 2-portal technique, which remains the most commonly used by surgeons today and forms the basis for this review. The current evidence in the literature supports the use of 2-portal hindfoot arthroscopy as a safe, primary treatment strategy for symptoms of posterior ankle impingement, including resection of os trigonum, treatment of flexor hallucis longus and peroneal tendon injury, treatment of osteochondral lesions of the ankle, and the resection of subtalar coalitions. In this review, we present where possible an evidence-based literature review on the arthroscopic treatment of posterior ankle and hindfoot abnormalities. Causes, diagnosis, surgical technique, outcomes, and complications are each discussed in turn.

Arthroscopic Excision of a Symptomatic Os Trigonum

“…[2][3][4][5] This frequency underscores the need for a careful inspection of the entire FHL length including following the FHL into the fibrous-osseous tunnel distally in the inferomedial quadrant. In this series FHL pathology requiring tenolysis and debridement was present in 14 of 24 cases (58%).…”

“…Due to their anatomic proximity, os trigonum impingement is often associated with FHL pathology. [2][3][4][5] The literature reports the prevalence of an os trigonum to vary. 5,6 It has been estimated to be present in 7% to 14% of adults and occur bilaterally in 1.4%.…”

“…1,2,8,10,11 Outpatient arthroscopic excision is less invasive, providing improved visualization with less morbidity. 3,[12][13][14][15] Concerns exist about the proximity of the posteromedial portal to the posterior tibial nerve and artery. However, peritendinous portals placed adjacent to the Achilles tendon in the prone patient are safe.…”

Football injuries of the ankle: A review of injury mechanisms, diagnosis and management

“…While arthroscopic procedures can permit earlier rehabilitation than traditional open procedures there is concern regarding the potential risk of neurovascular injury. Several studies have shown that the rate of nerve injury in patients treated with posterior ankle arthroscopy is lower than that found in anterior arthroscopy as long as care is taken to avoid structures medial to the FHL tendon [97][98][99] . Following posterior ankle arthroscopy players remain non-weightbearing in a compression bandage for 24-28 h. Weight bearing is subsequently increased as tolerated until full-weight bearing by one week [95,100] .…”

“…A recent current concepts review illustrates the technique for posterior ankle arthroscopy and management of posterior impingement and co-existing pathologies [98] . As for anterior impingement syndromes, arthroscopic treatment is very effective at restoring an athlete's ability to return to competitive sport with a very low incidence of postoperative complications [95,96,99,100] .…”