Surgical Treatment of Subtalar Joint Instability: Safety and Accuracy of a New Technique in a Cadaver Model

So, Eric; Weber, Jeffrey S.; Berlet, Gregory C.; Bull, Patrick E.

doi:10.1053/j.jfas.2019.07.003

Cited by 8 publications

(8 citation statements)

References 28 publications

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“…It might be used as an isolated technique, in rare cases of pure subtalar instability, or in combination with other arthroscopic techniques of repair or reconstruction for ankle lateral instability. [5][6][7] In conclusion, we describe an arthroscopic technique for reconstruction of the ITCL for cases of chronic subtalar joint inversion. The technique is reproducible and has fewer steps than other previously described methods, reducing the risk of technical errors.…”

Section: Discussionmentioning

confidence: 99%

Anatomic Arthroscopic Graft Reconstruction of the Interosseous Talocalcaneal Ligament for Subtalar Instability

Iglesias-Durán

Guerra-Pinto

García-Esteo

et al. 2020

Arthroscopy Techniques

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Instabilities of the subtalar joint are commonly overlooked or mismanaged, and chronic instability is a debilitating condition leading to premature joint degeneration. Several methods of treatment have been described, mainly screw fixation, arthrodesis, or ligament reconstruction. Most studies describe open methods for ligament reconstruction. We describe an original technique for "all-inside" arthroscopic graft reconstruction of the interosseous talocalcaneal ligament for subtalar instability.

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Section: Discussionmentioning

confidence: 99%

Anatomic Arthroscopic Graft Reconstruction of the Interosseous Talocalcaneal Ligament for Subtalar Instability

Iglesias-Durán

Guerra-Pinto

García-Esteo

et al. 2020

Arthroscopy Techniques

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“…Therefore, ensuring a stable painless subtalar joint through removal of pain‐generating soft tissue and appropriate ligament reconstruction should be the goal of surgical treatment for CLAI with sinus tarsi pain. Numerous surgical methods have been proposed for the treatment of subtalar instability [9, 14, 16, 32, 35]; recently, there have been efforts to perform minimally invasive ITCL reconstruction [13, 36]. In case of isolated or combined STI, proper subtalar joint stabilisation procedures should be performed to address CLAI and the sinus tarsi pain.…”

Section: Discussionmentioning

confidence: 99%

A high rate of talocalcaneal interosseous ligament tears was found in chronic lateral ankle instability with sinus tarsi pain

Song¹,

Lee

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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Purpose To evaluate the arthroscopic indings of subtalar joints, including interosseous talocalcaneal ligament (ITCL) tear, in patients with chronic lateral ankle instability (CLAI) and sinus tarsi pain. Methods A total of 118 ankles (109 patients) having CLAI with sinus tarsi pain who had undergone subtalar arthroscopy and lateral ankle ligament surgery were evaluated. The medical records, radiologic images, and the arthroscopic images and videos were reviewed. ITCL tears were classiied into 4 grades: grade 0 (no tear), grade 1 (mild), grade 2 (moderate), and grade 3 (severe). The eicacy of magnetic resonance imaging (MRI) in diagnosing ITCL tears was also evaluated by comparing preoperative oicial readings of MRI to arthroscopic indings. The pre-and postoperative functional scores were also assessed. ResultsThe overall tear rate of ITCL was 107/118 (90.7%). There were 29 ankles (23.6%) with grade 1, 42 ankles (35.6%) with grade 2, and 36 ankles (30.5%) with grade 3 tears. Isolated lateral ankle instability (LAI) was diagnosed in 43 ankles (36.4%), subtalar instability (STI) in 30 ankles (25.4%), and LAI with STI in 45 ankles (38.1%). There was a statistically signiicant relationship between the ITCL tear grade and the inal diagnosis. ITCL tear was conirmed or suspected in 81 ankles (68.6%) on preoperative MRI. Pain Visual Analog Score and functional outcome scores including the American Orthopaedic Foot & Ankle Society and Karlsson-Peterson scores showed signiicant improvement after the surgery. Conclusion A high rate (90.7%) of ITCL tears was noted in CLAI patients with sinus tarsi pain. ITCL damage may play an important role in subtalar instability in patients with CLAI and sinus tarsi pain. Subtalar arthroscopic evaluation for ITCL tear is important for correct diagnosis for CLAI with sinus tarsi pain. Level of evidence IV.

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“…Therefore, several authors have proposed a reconstruction of the subtalar ligaments (Pereira et al, 2021). Some publications described the reconstruction of the interosseous talocalcaneal ligament using a partial Achilles tendon graft (Kato, 1995), the anterior half of the peroneus brevis tendon (Pisani, 1996), a gracilis tendon autograft (Liu et al, 2011) or a suture button (So et al, 2020). More recently, newer techniques with straight bone tunnels have been published (Iglesias-durán et al, 2020;So et al, 2020;Michels et al, 2022b).…”

Section: Ligament Reconstructionmentioning

confidence: 99%

Role of the intrinsic subtalar ligaments in subtalar instability and consequences for clinical practice

Michels

Vereecke

Matricali

2023

Front. Bioeng. Biotechnol.

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Subtalar instability (STI) is a disabling complication after an acute lateral ankle sprain and remains a challenging problem. The pathophysiology is difficult to understand. Especially the relative contribution of the intrinsic subtalar ligaments in the stability of the subtalar joint is still controversial. Diagnosis is difficult because of the overlapping clinical signs with talocrural instability and the absence of a reliable diagnostic reference test. This often results in misdiagnosis and inappropriate treatment. Recent research offers new insights in the pathophysiology of subtalar instability and the importance of the intrinsic subtalar ligaments. Recent publications clarify the local anatomical and biomechanical characteristics of the subtalar ligaments. The cervical ligament and interosseous talocalcaneal ligament seem to play an important function in the normal kinematics and stability of the subtalar joint. In addition to the calcaneofibular ligament (CFL), these ligaments seem to have an important role in the pathomechanics of subtalar instability (STI). These new insights have an impact on the approach to STI in clinical practice. Diagnosis of STI can be performed be performed by a step-by-step approach to raise the suspicion to STI. This approach consists of clinical signs, abnormalities of the subtalar ligaments on MRI and intraoperative evaluation. Surgical treatment should address all the aspects of the instability and focus on a restoration of the normal anatomical and biomechanical properties. Besides a low threshold to reconstruct the CFL, a reconstruction of the subtalar ligaments should be considered in complex cases of instability. The purpose of this review is to provide a comprehensive update of the current literature focused on the contribution of the different ligaments in the stability of the subtalar joint. This review aims to introduce the more recent findings in the earlier hypotheses on normal kinesiology, pathophysiology and relation with talocrural instability. The consequences of this improved understanding of pathophysiology on patient identification, treatment and future research are described.

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Surgical Treatment of Subtalar Joint Instability: Safety and Accuracy of a New Technique in a Cadaver Model

Cited by 8 publications

References 28 publications

Anatomic Arthroscopic Graft Reconstruction of the Interosseous Talocalcaneal Ligament for Subtalar Instability

Anatomic Arthroscopic Graft Reconstruction of the Interosseous Talocalcaneal Ligament for Subtalar Instability

A high rate of talocalcaneal interosseous ligament tears was found in chronic lateral ankle instability with sinus tarsi pain

Role of the intrinsic subtalar ligaments in subtalar instability and consequences for clinical practice

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