Simple 1-Step Ankle Arthroscopy Distraction

Unangst, Alicia M.; Martin, Kevin D.

doi:10.1016/j.eats.2015.08.017

Cited by 16 publications

(14 citation statements)

References 8 publications

(14 reference statements)

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“…Using noninvasive distraction in ankle arthroscopy therefore did not improve accessibility to the talar dome but could also be associated with a higher risk of neurovascular complications. 7,17,18,21,29,45,55 Limitations Some disadvantages in the use of anatomical specimens have to be mentioned, which may have an effect on the interpretation of the results of this study. The age of the donors is in general higher than the average age of OCD patients, and their joints may have been altered by degeneration.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Although noninvasive distraction may improve accessibility in posterior arthroscopy 2,35 and even wire-based invasive distraction may have its place in specific cases, 2,32,57,58,63 one should nonetheless take all possible means to minimize complication rate, which has been shown to be higher in procedures using invasive or noninvasive distraction. 3,7,11,12,14,17,18,21,25,29,39,43,45,52,54,55,58 Though most talar OCDs may be addressed though anterior arthroscopy, there can arise situations in which the location of the specific OCD may warrant a posterior approach. As the majority of OCDs treated by arthroscopic approaches commonly do not exceed 1 cm 2 , 19,38,60 the authors feel certain that the results shown in this study are clinically significant as the information presented may affect preoperative planning and the arthroscopic treatment of some talar lesions.…”

Section: Discussionmentioning

confidence: 99%

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Accessibility to Talar Dome in Neutral Position, Dorsiflexion, or Noninvasive Distraction in Posterior Ankle Arthroscopy

2019

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Background: Osteochondral lesions of the talus are frequent pathologies of the ankle joint. Especially through arthroscopy, the treatment is kept as minimally invasive as possible. However, there are some drawbacks as to the reachability because of the high congruency of the ankle joint. Here, either noninvasive distraction or maximal dorsiflexion may be an option for better access to the lesion. The purpose of this study was to evaluate maximal dorsiflexion compared to neutral position or noninvasive distraction of the ankle joint in the arthroscopic reachability of the talar dome. The hypothesis of this study was that maximal dorsiflexion would allow for greater accessibility of the talar dome compared to neutral position or noninvasive distraction of the joint. Methods: Twenty matched pairs (n=40) of anatomical ankle specimens were used. The effects of neutral position, maximal dorsiflexion, and noninvasive distraction of the ankle joint on arthroscopic accessibility of the ankle joint were tested. After disarticulation of the talus, reach was measured and compared between the 3 positions. Results: In neutral position, 13.7±1.2 mm of the talar dome was reached laterally and 14.0±1.0 mm medially. In maximal dorsiflexion, the distance was 19.0±1.1mm laterally and 19.8±1.4 mm medially, and in noninvasive distraction it was 16.1±1.5 mm laterally and 15.7±1.0 mm medially. The statistical comparison showed a significantly better reach in dorsiflexion laterally ( P = .003) and medially ( P = .026). Conclusion: Accessibility of the talar dome in maximal dorsiflexion was superior to that in neutral position or noninvasive distraction. Clinical Relevance: Results of this study may allow for better planning in arthroscopic treatment of osteochondral lesions of the talus.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Accessibility to Talar Dome in Neutral Position, Dorsiflexion, or Noninvasive Distraction in Posterior Ankle Arthroscopy

2019

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“…An external positioning arm, Trimano (Arthrex, Naples, FL), and an ankle distraction strap were used to assist in gentle distraction and positioning. 20,28…”

Section: Methodsmentioning

confidence: 99%

Outcomes of Posterior Arthroscopic Reduction and Internal Fixation (PARIF) for the Posterior Malleolar Fragment in Trimalleolar Ankle Fractures

2020

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Background: Posterior malleolar fractures within a trimalleolar ankle fracture pattern are challenging to manage. Posterior ankle arthroscopy provides a means to assess the intra-articular and syndesmotic reductions, while removing loose bodies. The purpose of this study was to determine the radiographic and patient reported outcomes of posterior arthroscopic reduction and internal fixation (PARIF) in trimalleolar ankle fractures. Methods: From November 2015 to March 2019, we prospectively enrolled consecutive trimalleolar ankle fractures that underwent PARIF by a single surgeon. Preoperative and postoperative computed tomography (CT) scans were interpreted by 2 blinded musculoskeletal radiologists for articular reduction, syndesmosis congruity, and presence of ossific loose bodies. Patient outcomes were assessed using the Foot and Ankle Disability Index (FADI), American Orthopaedic Foot & Ankle Society (AOFAS) ankle score, Olerud-Molander Ankle Score (OMAS), and visual analog scale (VAS). A total of 28 trimalleolar ankle fractures were treated with PARIF. Mean patient age was 36 years (range, 19-69). Results: Preoperative CT identified 18 intra-articular loose bodies (range, 0-4) in 36% of ankles and 75% (n = 21) syndesmosis incongruity. Postoperative CT scans demonstrated anatomic intra-articular reduction in all fractures, 41.7% (5/12) syndesmosis incongruity without fixation, and 0% (0/9) with suture-button fixation. At mean 2-year follow-up, the results were good to excellent with mean VAS score 1 (range, 0-4), AOFAS score 84 (range, 63-100), FADI 85 (range, 59-100), and OMAS 76 (range, 40-100). Conclusion: The PARIF technique for displaced posterior malleolar fractures was effective in achieving anatomic intra-articular reduction, syndesmosis congruity, and intra-articular loose body removal, while safely preserving the soft tissues. Level of Evidence: Level IV, prospective case series.

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“…An external positioning arm, Trimano (Arthrex, Naples, FL) or Spider (Smith & Nephew, Andover, MA), is attached to the bed, ensuring adequate noninvasive traction can be applied and aid in reduction ( Figure 1B, D). 11 This allows the surgeon freedom of movement while allowing fluoroscopic access. We prefer positioning the mini C-arm on the operative side of the bed.…”

Section: Parif Is Performed Under General Anesthesia Ormentioning

confidence: 99%

Posterior Arthroscopic Reduction and Internal Fixation for Treatment of Posterior Malleolus Fractures

Martin

2019

Foot Ankle Int.

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Posterior malleolus fractures and pilon variants refer to a pattern of fractures involving the posterior weightbearing surface of the tibial plafond. The surgical indications for fixation of posterior malleolus fractures varies considerably throughout the literature, based on the size and/or displacement. There is controversy on how to best address fracture fixation, with the main workhorses being either the posterior-lateral approach or indirect anterior-posterior–directed screws. We present an alternative technique for posterior malleolus fracture fixation using a direct posterior arthroscopic-assisted reduction internal fixation method. With this method, posterior malleolus fractures are reduced arthroscopically and percutaneous fixation is placed through the arthroscopic portals. Level of Evidence: Level V, expert opinion

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Simple 1-Step Ankle Arthroscopy Distraction

Cited by 16 publications

References 8 publications

Accessibility to Talar Dome in Neutral Position, Dorsiflexion, or Noninvasive Distraction in Posterior Ankle Arthroscopy

Accessibility to Talar Dome in Neutral Position, Dorsiflexion, or Noninvasive Distraction in Posterior Ankle Arthroscopy

Outcomes of Posterior Arthroscopic Reduction and Internal Fixation (PARIF) for the Posterior Malleolar Fragment in Trimalleolar Ankle Fractures

Posterior Arthroscopic Reduction and Internal Fixation for Treatment of Posterior Malleolus Fractures

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