Quality of MIS vs Open Joint Preparations of the Foot and Ankle

Zhao, John; Kaiser, Philip; DeGruccio, Christina; Farina, Evan M; Miller, Christopher P.

doi:10.1177/10711007221081865

Cited by 9 publications

(8 citation statements)

References 23 publications

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“…The authors highlighted that if arthroscopic preparation is undertaken, accessory portals may be required to ensure adequate joint preparation. Other studies have found high fusion rates with minimally invasive 22 and arthroscopic 23,24 hindfoot joint preparation for TTC nailing, suggesting these approaches are an alternative when open joint preparation is less favorable.…”

Section: Discussionmentioning

confidence: 99%

Reaming for Tibiotalocalcaneal (TTC) Nailing Removes Only 10% of the Ankle and Subtalar Joints

Baker,

Schroeder,

Kimbler

et al. 2024

Journal of Orthopaedic Trauma

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OBJECTIVES: Tibiotalocalcaneal (TTC) nailing in the setting of acute ankle trauma has become increasingly popular. No consensus exists as to whether formal joint preparation is necessary, although there is some concern that residual motion at unprepared joints may lead to implant loosening and/or breakage. The objective of this study was to quantify the proportion of tibiotalar and subtalar articular surface destruction that occurs during reaming for TTC nail fixation. METHODS: Twelve cadaver lower extremities were procured. The specimens were pinned into neutral ankle and hindfoot alignment. A guide wire was inserted under fluoroscopy, followed by a 12 millimeter opening reamer. The specimens were then dissected, exposing the tibial plafond, talar dome, posterior facet of the talus, and posterior facet of the calcaneus. Images of each joint were obtained and ImageJ software was used to calculate the total joint surface area and the area of articular destruction. RESULTS: The mean proportion of articular cartilage destruction was 9.3%, 10.3%, 8.9%, and 10.3% for the tibial plafond, talar dome, posterior facets of the talus and calcaneus, respectively. No joint destruction was observed in the middle facets of the subtalar joint. CONCLUSIONS: Reaming for TTC nail placement violates approximately 10% of each articular surface of the tibiotalar and subtalar joints. Retention of 90% of the articular surface may allow for residual motion at the joints, and therefore, potentially substantial stress on the implant. Formal joint preparation for the purposes of achieving fusion during TTC nail placement may be beneficial to prevent implant loosening or breakage.

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Section: Discussionmentioning

confidence: 99%

Reaming for Tibiotalocalcaneal (TTC) Nailing Removes Only 10% of the Ankle and Subtalar Joints

Baker,

Schroeder,

Kimbler

et al. 2024

Journal of Orthopaedic Trauma

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“…The disadvantage of arthroscopic joint preparation is that the bony debris and bone slurry that is created by preparing the joint is removed because of the circulating arthroscopic fluid. 29 This bony debris created may improve joint fusion rates; therefore, with fluoroscopic joint preparation there is the added benefit of minimally invasive surgery while retaining these bony by-products. 27 Regardless of which technique was used to aid joint preparation, the key difference between open joint preparation, and what may attribute to the difference in outcomes, is the minimal disruption of soft tissues as the outcomes when using an arthroscopic and fluoroscopic guidance were very comparable.…”

Section: Discussionmentioning

confidence: 99%

Transportal Tibiotalocalcaneal Nail Ankle Arthrodesis: A Systematic Review of Initial Series

Lameire

Khalik

Balso

et al. 2023

Foot & Ankle Orthopaedics

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Background: There is currently a scarcity of information and consensus for transportal (arthroscopic or fluoroscopic) joint preparation during tibiotalocalcaneal (TTC) fusion, and therefore this review aims to summarize the available techniques and to evaluate the outcomes after this procedure. Methods: A systematic electronic search of MEDLINE, EMBASE, and Web of Science was performed for all English-language studies published from their inception to April 4, 2022. All articles addressing arthroscopy in TTC nailing were eligible for inclusion. The PRISMA Checklist guided the reporting and data abstraction. Descriptive statistics are presented. Result: A total of 5 studies with 65 patients were included for analysis. All studies used arthroscopic portals for tibiotalar and subtalar joint preparation (in 4 studies) prior to TTC nailing, with 4 studies using an arthroscope and 1 study using fluoroscopy. The overall major complication rate was 13.8%; however, there was only 1 instance of deep wound infection (1.5%) and 4 instances of surgical site infections (6.2%). Full fusion was achieved in 86% of patients with an average time to fusion of 12.9 weeks. The mean American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score preoperatively was 34.0 and postoperatively was 70.5. Conclusion: Although limited by the number of studies, transportal joint preparation during TTC nail ankle fusion is associated with good rates of complications and successful fusion. Level of Evidence: Level III, systematic review of Level III-IV studies.

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“…29 Cadaveric studies have demonstrated a similar percentage of joint surface area preparation. 30 Although outcomes data are limited, one series of 77 MIS subtalar fusions reported a 92% fusion rate with no infections, delayed wound healing, or neurovascular injury. 31 When conducting an MIS fusion, the burr is used under fluoroscopic guidance to first remove the cartilage.…”

Section: Midfoot and Hindfootmentioning

confidence: 99%

Minimally Invasive Foot and Ankle Surgery: A Primer for Orthopaedic Surgeons

Lausé

Miller

Smith

2023

J Am Acad Orthop Surg

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There is rapidly growing interest in minimally invasive surgery (MIS) of the foot and ankle. Technological advances, specifically with the advent of low-speed high-torque burrs, have enabled the expansion of MIS techniques. Accordingly, there is growing literature reporting excellent outcomes of MIS surgery to address many different pathologies of the foot and ankle. MIS techniques are particularly useful for conducting percutaneous osteotomies and bony de ´bridement. These can be used to address bunion deformity, hammertoes, metatarsalgia, bunionette deformity, bone spurs, and hindfoot deformity. A detailed understanding of the technology, equipment, and techniques is crucial to safely conduct MIS of the foot and ankle. When done safely, MIS provides favorable outcomes with an expedited recovery and limited complications. Minimally invasive surgery (MIS) of the foot and ankle refers to percutaneous procedures that use small incisions for deformity correction, osteotomies, and débridement of the foot and ankle. These techniques have gained attention because of reported faster recovery time, early weight bearing, improved cosmesis, and reduced postoperative opioid use. [1][2][3] Although MIS can include many minimal incision techniques, including arthroscopic surgery, for the purposes of this review, we will discuss MIS techniques that use a specialized low-speed high-torque burr.MIS of the foot and ankle initially gained popularity in the United States in the 1980s for treatment of forefoot deformities. However, early procedures were largely abandoned because of poorly reproducible outcomes, soft-tissue complications, and high rates of recurrence and revision surgery. 4 The initial MIS efforts were technically demanding and required challenging postoperative protocols, which were difficult to follow. Subsequent MIS procedures added provisional fixation using Kirschner wires, but these also had issues with stability and osteotomy positioning. 5,6 For these reasons, early MIS efforts failed to take hold in North America. By contrast, MIS interest in Europe remained strong, and with this interest, came additional research into MIS techniques and the development of the first international MIS foot study group: Groupe de Recherche et Etude en Chirurgie Mini-Invasive du Pied in 2002. International surgeons developed new

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Quality of MIS vs Open Joint Preparations of the Foot and Ankle

Cited by 9 publications

References 23 publications

Reaming for Tibiotalocalcaneal (TTC) Nailing Removes Only 10% of the Ankle and Subtalar Joints

Reaming for Tibiotalocalcaneal (TTC) Nailing Removes Only 10% of the Ankle and Subtalar Joints

Transportal Tibiotalocalcaneal Nail Ankle Arthrodesis: A Systematic Review of Initial Series

Minimally Invasive Foot and Ankle Surgery: A Primer for Orthopaedic Surgeons

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