Subtalar Joint Arthroscopy

Srour, Jonathon; Rubin, Laurence G.

doi:10.1016/j.cpm.2023.03.001

Cited by 2 publications

(1 citation statement)

References 15 publications

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“… 8 This arthroscopic approach avoids extensive joint dissection and disruption of the soft tissue envelope, thereby reducing the risk of postoperative wound complications while facilitating accelerated return to activities compared to traditional open techniques. 9 This is reflected in this current retrospective study as no wound complications nor infections were observed in this study. In addition, arthroscopic evaluation of OCLs has been demonstrated to provide superior assessment of the size of OCLs in comparison with MRI, 1 thus making subtalar arthroscopic evaluation an attractive diagnostic modality.…”

Section: Discussionmentioning

confidence: 53%

Osteochondral Lesions of the Subtalar Joint: Clinical Outcomes in 11 Patients

Buck,

Butler,

Azam

et al. 2023

CARTILAGE

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Objective The purpose of this retrospective case series was to evaluate clinical outcomes following both conservative treatment and arthroscopic bone marrow stimulation (BMS) for the management of symptomatic subtalar osteochondral lesions (OCLs). Design All symptomatic subtalar OCLs with a minimum of 12 months follow-up having undergone either a conservative management or arthroscopic procedure were included. Patient-reported outcomes were collected via questionnaires consisting of the Foot and Ankle Outcome Score (FAOS), Numeric Rating Scale (NRS) of pain in rest, during walking, during stair climbing, and during running. In addition, return to sports data, return to work data, reoperations, and complications were collected and assessed. In total, 11 patients across 2 academic institutions were included (3 males, 8 females). The median age was 43 years (interquartile range [IQR]: 32-53). Results All patients underwent conservative treatment first; in addition, 9 patients underwent subtalar arthroscopic debridement with or without BMS. The median follow-up time was 15 months (IQR: 14-100). In the surgically treated group, the median NRS scores were 2 (IQR: 1-3) during rest, 3 (IQR: 2-4) during walking, 4 (IQR: 4-5) during stair climbing, 5 (IQR: 4-5) during running and the median FAOS score at final follow-up was 74 (IQR: 65-83). In the conservatively treated patients, the median NRS scores were all 0 (IQR: 0-0) and the median FAOS scores were 90 (IQR: 85-94). In the group of surgical treated patients, 4 were able to return to the same level of sports, 2 returned to a lower level of sports. Both conservatively treated patients returned to the sport and the same level of prior participation. All patients except one in the surgical group returned to work. Conclusions This retrospective case series demonstrated that a high number of patients converted to surgery after initial conservative treatment. In addition, debridement and BMS show good clinical outcomes for the management of symptomatic subtalar OCLs at short-term follow-up. No complications nor secondary surgical procedures were noted in the surgically treated group. The high rate of failure of conservative treatment suggests that surgical intervention for symptomatic subtalar OCLs can be the primary treatment strategy; however, further research is warranted in light of the small number of patients.

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Section: Discussionmentioning

confidence: 53%

Osteochondral Lesions of the Subtalar Joint: Clinical Outcomes in 11 Patients

Buck,

Butler,

Azam

et al. 2023

CARTILAGE

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Anterolateral and accessory anterolateral portals are safe to avoid subcutaneous nerve injury during subtalar arthroscopy—Definition of safe zones for standard lateral portals

Hirtler,

Bussek,

Kleinberger

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeInjury to the superficial peroneal nerve (SPN) or the sural nerve (SN) is a common complication in subtalar arthroscopy. The purpose of this anatomical study was to evaluate the distance to surrounding subcutaneous nerves in the vicinity of three standard arthroscopic portals for subtalar joint arthroscopy and through actual portal placement for arthroscopic procedures, in order to define anatomical safe zones.MethodsForty paired fresh‐frozen foot‐and‐ankle specimens were used. Subtalar arthroscopy using a three‐portal technique (anterolateral [AL], posterolateral [PL] and accessory anterolateral [AAL] portals) was performed. After completion of subtalar arthroscopy, the portals were marked, and all surrounding subcutaneous nerves, that is, the branches of the SPN and SN, were dissected. The distance of the nearest nerve at the level of the respective portal was measured and potential injury was recorded.ResultsThe nearest nerve at the level of the AL portal was the intermediate dorsal cutaneous nerve at a mean of 15.4 ± 5.1 mm medial to the portal. The nearest nerve at the level of the AAL portal was the lateral dorsal cutaneous nerve at a mean of 17.7 ± 4.8 mm, being lateral to the portal. The nearest nerve at the level of the PL portal was the SN at a mean of 6.7 ± 4.7 mm anterior to the portal. Based on the measurements, safe zones were defined.ConclusionsPlacement of the AL and AAL portals in subtalar arthroscopy is saved using standard anatomical landmarks and a thorough surgical technique. At the level of the PL portal, the SN is the most endangered structure in subtalar arthroscopy. Surgeons should be aware of the proximity of the SN to the PL portal and take the utmost care during portal placement and instrument insertion to avoid iatrogenic injury. The risk of nerve damage during portal placement may be reduced when positioning the portals in the defined safe zones.Level of EvidenceNot applicable.

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Subtalar Joint Arthroscopy

Cited by 2 publications

References 15 publications

Osteochondral Lesions of the Subtalar Joint: Clinical Outcomes in 11 Patients

Osteochondral Lesions of the Subtalar Joint: Clinical Outcomes in 11 Patients

Anterolateral and accessory anterolateral portals are safe to avoid subcutaneous nerve injury during subtalar arthroscopy—Definition of safe zones for standard lateral portals

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