Safety and Efficiency of a 2-Portal Lateral Approach to Arthroscopic Subtalar Arthrodesis: A Cadaveric Study

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

“…The anticipated benefits include preservation of as much blood supply as possible to the healing bones to support successful fusion, diminished risk of damage to the sural nerve during the approach, and avoidance of delayed wound healing and surgical site infection. Furthermore, the two-portal sinus tarsi approach aims to avoid the significant risk to the sural nerve associated with using a posterolateral portal [26,27,32,33]. Another key benefit of this approach is by performing decortication of all three articular facets the intraoperative mobility of the arthrodesis site is improved allowing significant deformity correction.…”

Subtalar Joint Arthrodesis

“…[20][21][22][23] Arthroscopic subtalar arthrodesis was first reported in the literature in 1994 by Lundeen 24 and by Tasto at the Arthroscopic Association of North America's annual meeting, also in 1994. 13 Performing this procedure arthroscopically is appealing in its potential advantages compared with open arthrodesis given its smaller incisions, theoretic preservation of calcaneal and talar blood supply, less damage to the soft tissue envelope, and less perioperative morbidity.…”

“…Several portals have been described, including anterolateral, posterolateral, accessory anterolateral and accessory posterolateral, and central portals. 14,20,22,23 Either the 30 2.7-mm or 1.9-mm arthroscope may be used, depending on the amount of distraction obtained. If needed for visualization, the 70 arthroscope can be used as well.…”

“…With lateral subtalar arthroscopy, it has been shown cadaverically that 90% of the posterior facet can be resected using just the central and anterolateral portals, thereby avoiding the posterolateral portal and the potential for sural nerve and small saphenous vein injury. 20 Posterior subtalar arthroscopy offers an alternative to lateral-based arthroscopy, and is performed in the prone position. Proponents of posterior subtalar joint arthroscopy cite improved visualization of the coronal alignment of the hindfoot and subtalar joint (because of prone positioning) and avoidance of damage to the vessels of the sinus tarsi (and thus preserving more talar blood supply) as benefits compared with using strictly laterally based portals.…”

“…13 Performing this procedure arthroscopically is appealing in its potential advantages compared with open arthrodesis given its smaller incisions, theoretic preservation of calcaneal and talar blood supply, less damage to the soft tissue envelope, and less perioperative morbidity. [12][13][14]20 Arthroscopic portals for the subtalar joint can be placed laterally, posteriorly, or both. For lateral arthroscopy of the subtalar joint, the patient is placed in either a supine or lateral position.…”