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Kumamoto W, Lui TH. Arthroscopic Talonavicular Arthrodesis for the Management of Talonavicular Osteoarthritis. Arthrosc Tech 2024; 13:103006. [PMID: 39233805 PMCID: PMC11369957 DOI: 10.1016/j.eats.2024.103006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 03/13/2024] [Indexed: 09/06/2024] Open
Abstract
The talonavicular joint is a common site for osteoarthritis of the foot. Talonavicular arthrodesis is the surgical treatment for symptomatic talonavicular osteoarthritis. Classically, this is performed via an open approach and is associated with a rate of nonunion that ranges from 3% to 37%. Arthroscopic talonavicular arthrodesis has been proposed to provide better intra-articular visualization, conserve bone blood supply to improve the union rate, and reduce soft-tissue complications such as wound dehiscence, infection, and neurovascular injury. The purpose of this Technical Note is to describe the details of arthroscopic talonavicular arthrodesis for management of talonavicular osteoarthritis.
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Affiliation(s)
| | - Tun Hing Lui
- Department of Orthopaedics and Traumatology, North District Hospital, Sheung Shui, NT, Hong Kong SAR, China
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2
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Yeager MT, Nihalani S, Rutz RW, Mohammed ZJ, Hargreaves M, McCrosson M, Scheinberg M, Singh S, Shah AB. Anatomical Structures at Risk in Percutaneous Preparation Talonavicular Fusion. Foot Ankle Int 2024; 45:412-418. [PMID: 38282285 DOI: 10.1177/10711007231224793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
BACKGROUND The stability of the hindfoot greatly relies on the integrity of the talonavicular joint. Pathologies affecting this joint often necessitate fusion. Our study explores the risks posed to neurovascular and tendon structures during simulated percutaneous talonavicular joint preparation for fusion. METHODS In 9 fresh cadaver specimens, the talonavicular joint was accessed through two portals. A 2-mm Shannon burr was employed for joint surface preparation with distraction provided by a pin-based distractor. Dissections were performed to assess potential damage to critical structures, including the dorsalis pedis artery, superficial and deep peroneal nerves, extensor hallucis longus (EHL), and tibialis anterior (TA) tendons. RESULTS The dorsal portal site was found to be significantly closer to important structures compared to the medial portal site. The Shannon burr made contact with various structures, with a single transection identified for both deep and superficial peroneal nerve branches. During the dorsal portal site approach, potential injury to the EHL tendon was identified as concern. CONCLUSION This study sheds light on the potential risks associated with percutaneous dorsal and medial joint preparation approaches using a Shannon burr.Level of Evidence:Level V, mechanism-based reasoning..
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Affiliation(s)
- Matthew T Yeager
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Shrey Nihalani
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert W Rutz
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Zuhair J Mohammed
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mathew Hargreaves
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Matthew McCrosson
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mila Scheinberg
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Swapnil Singh
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ashish B Shah
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
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3
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Derner B, Derner R. Small Joint Arthroscopy of the Foot. Clin Podiatr Med Surg 2023; 40:445-457. [PMID: 37236682 DOI: 10.1016/j.cpm.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Recently, there have been new advances in the arthroscopic approach to small joints of the foot. This is directly related to the improvement of surgical equipment, new techniques, and publications. These improvements led to broadening indications as well as minimizing complications. Several articles recently presented the uses of arthroscopic surgery in the small joints of the foot; however, the use is still relatively limited. Arthroscopic evaluation of the small joints of the foot includes the first metatarsophalangeal, lesser metatarsophalangeal, tarsometatarsal, talonavicular, and calcaneocuboid joints as well as the interphalangeal joint to the great toe and lesser toes.
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Affiliation(s)
- Brian Derner
- Kaiser San Leandro Medical Center, 2500 Merced Street, Suite 403, San Leandro, CA 94577, USA.
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Burns PR, Powers NS. Double versus Triple Arthrodesis for Flatfoot Deformity: When, Why, and How? Clin Podiatr Med Surg 2023; 40:315-332. [PMID: 36841582 DOI: 10.1016/j.cpm.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Different types of arthrodesis for flatfoot deformity have a long history in foot and ankle surgery. Arthrodesis of the rearfoot can be a useful tool in helping correct deformity and maintaining that correction with good long-term results. Questions have risen recently however about the necessity of including the calcaneocuboid joint in the traditional rearfoot arthrodesis or triple arthrodesis. The double arthrodesis of the talonavicular and subtalar joints has grown in popularity and this review helps the reader choose with a review of the biomechanics, surgical approaches, fixation techniques and recent literature outcomes of both procedures.
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Affiliation(s)
- Patrick R Burns
- University of Pittsburgh School of Medicine, University of Pittsburgh Physicians, Comprehensive Foot & Ankle Center, 1515 Locust Street #350, Pittsburgh, PA 15219, USA.
| | - Nicholas S Powers
- Department of Orthopaedic Surgery, Atrium Health Wake Forest Baptist, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA
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Lopes R, Bauer T. Lateral endoscopy of the sinus tarsi: Anatomy, technique and current indications. Orthop Traumatol Surg Res 2022; 108:103383. [PMID: 35926723 DOI: 10.1016/j.otsr.2022.103383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 06/06/2022] [Accepted: 06/22/2022] [Indexed: 02/03/2023]
Abstract
Numerous pathologies are reported in the lateral mid- and hind-foot. Access to the sinus tarsi is difficult, making lateral endoscopy the preferred approach. The present technical note describes the anatomy, technique and current indications for lateral endoscopy of the sinus tarsi.
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Affiliation(s)
- Ronny Lopes
- Clinique Brétéché, 3, Rue de la Béraudière, 44000 Nantes, France; Polyclinique de l'Atlantique, avenue Claude-Bernard, 44800 Saint-Herblain, France.
| | - Thomas Bauer
- Service de chirurgie orthopédique, hôpital Ambroise-Paré, hôpitaux Universitaires Paris Île-de-France Ouest, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
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6
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Lui TH. Role of arthroscopy and endoscopy in management of tuberculosis of the foot and ankle. Foot (Edinb) 2021; 46:101754. [PMID: 33285493 DOI: 10.1016/j.foot.2020.101754] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 11/08/2020] [Accepted: 11/11/2020] [Indexed: 02/04/2023]
Abstract
Tuberculosis of the foot and ankle is rare but destructive. It can affect bones, joints and soft tissue and can mimic a wide range of acute and chronic infections or tumorous conditions. The primary treatment objectives for osteoarticular TB include curing the infection, limiting deformity, maintaining mobility, and reducing discomfort. Chemotherapy remains the mainstay of treatment in acute stage. Indications of surgery include biopsy and debridement in early stages to reduce the tuberculosis load and enable better penetration of anti-tuberculous drugs. Other reported indications for surgery in early stage of TB foot and ankle include resection of lesion not responding to chemotherapy and debridement of lesions close to the articular surface, as surgical debridement might halt progression and joint invasion, avoiding worsening of the prognosis. The success of arthroscopic treatment for infectious arthritis with decreased morbidity and postoperative pain makes arthroscopy an excellent alternative to open surgery. The advantages such as minor trauma, short hospitalization time and short post operative rehabilitation period as well as good cosmetic and therapeutic results should lead to a more frequent use of arthroscopy as early as possible as an adjuvant for the tuberculous joint. However, tuberculosis can involve any joints, bone and soft tissue (tendon) of the foot and ankle and surgeons should equip with various arthroscopic and endoscopic techniques in order to deal with the various situations of tuberculosis of the foot and ankle.
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Affiliation(s)
- Tun Hing Lui
- Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT Hong Kong SAR, China.
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7
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Nakasa T, Ikuta Y, Kanemitsu M, Adachi N. Arthroscopic triple arthrodesis for the patient with rheumatoid arthritis; a case report. Mod Rheumatol Case Rep 2021; 5:29-35. [PMID: 33191869 DOI: 10.1080/24725625.2020.1847430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 10/20/2020] [Indexed: 06/11/2023]
Abstract
We treated a 60 - year - old man with pes planovalgus due to rheumatoid arthritis. He had been suffering from left foot pain with swelling. Despite drug therapy, his foot pain and deformity had got worsen. Taking into consideration his skin and bone quality, arthroscopic triple arthrodesis was performed. To access the subtalar joint, 2 portals were applied at the sinus tarsi, and decortication was performed. For calcaneocuboid joint, 1.5 cm portal was applied along with joint line at calcaneocuboid joint. Calcaneocuboid joint was fully decorticated, then, 1.5 cm portal was applied at the joint line of talonavicular joint in parallel. Synovectomy and decortication under arthroscopy were performed. Once each joint was sufficiently prepared, it was fixed using screws via a percutaneous stab incision with an autologous bone graft from the iliac crest to the calcaneocuboid and talonavicular joint. At 12 weeks postoperatively, bone union was confirmed. The Japan Society for Surgery of the Foot (JSSF) RA foot and ankle scale had improved from the postoperative value of 38 points to a postoperative score of 86 points at one year. Plain radiographs showed that good alignment of the patient's hindfoot was maintained. We found that arthroscopic approach was able to achieve satisfactory outcome and minimise soft tissue trauma in a compromised patient.
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Affiliation(s)
- Tomoyuki Nakasa
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yasunari Ikuta
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Munekazu Kanemitsu
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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8
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Lui TH, Luk WCB. Anterior and Posterior Subtalar Arthroscopy Via Anterolateral and Dorsolateral Portals. Arthrosc Tech 2020; 9:e837-e840. [PMID: 32577360 PMCID: PMC7301332 DOI: 10.1016/j.eats.2020.02.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 02/26/2020] [Indexed: 02/03/2023] Open
Abstract
Sinus tarsi syndrome is the clinical syndrome of lateral heel pain with local tenderness at the sinus tarsi and is frequently associated with a history of inversion sprain to the ankle. The lateral heel pain can be due to the capsule-ligamentous structures lateral to the axis of the anterior and posterior subtalar joints. Anterior and posterior subtalar arthroscopies are needed to detect and treat the disorders of both joints. In this Technical Note, we describe the details of a 2-portal arthroscopic approach to both anterior and posterior subtalar joints. This allows complete examination of all the possible sources of lateral heel pain in sinus tarsi syndrome.
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Affiliation(s)
- Tun Hing Lui
- Department of Orthopaedics and Traumatology, North District Hospital, Hong Kong, China,Address correspondence to Tun Hing Lui, M.B.B.S., F.R.C.S.Ed., F.H.K.A.M.(Ortho), F.H.K.C.O.S., Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Rd, Sheung Shui, NT, Hong Kong SAR, China.
| | - Wing Chung Brian Luk
- Department of Orthopaedics and Traumatology, Tuen Mun Hospital, Hong Kong, China
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9
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Correction of Severe Flatfoot Deformity by 3-Portal Arthroscopic Triple Arthrodesis. Arthrosc Tech 2019; 9:e103-e109. [PMID: 32021782 PMCID: PMC6993535 DOI: 10.1016/j.eats.2019.09.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 09/03/2019] [Indexed: 02/03/2023] Open
Abstract
Severe flatfoot deformity with lack of coverage of the talonavicular joint is frequently treated by triple arthrodesis. Various arthroscopic triple arthroscopic techniques have been described to reduce the extent of soft-tissue dissection. The purpose of this Technical Note is to describe the details of 3-portal arthroscopic triple arthrodesis for correction of severe flatfoot deformity. This approach allows thorough preparation of all fusion surfaces, and the bone removal by decortications facilitates reduction of the talonavicular joint and correction of the forefoot supination.
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10
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Pozzi A, Lewis DD, Hudson CC, Kim SE, Castelli E. Percutaneous Plate Arthrodesis. Vet Clin North Am Small Anim Pract 2019; 50:241-261. [PMID: 31653536 DOI: 10.1016/j.cvsm.2019.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Arthrodesis is an elective surgical procedure that aims at eliminating pain and dysfunction by promoting deliberate osseous fusion of the involved joint(s). Percutaneous plating can be used to perform carpal and tarsal arthrodeses in dogs and cats. After cartilage debridement is performed, the plate is introduced through separate plate insertion incisions made remote to the arthrodesis site and advanced along an epiperiosteal tunnel, and screws are inserted through the 3 existing skin incisions. The primary advantage of this technique is a decreased risk of soft-tissue complications, including postoperative swelling, ischemia, and wound dehiscence. Preliminary clinical results have been promising.
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Affiliation(s)
- Antonio Pozzi
- Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 258c, Zurich 8057, Switzerland.
| | - Daniel D Lewis
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, 2015 Southwest 16th Avenue, Gainesville, FL 32610-0126, USA
| | - Caleb C Hudson
- Gulf Coast Veterinary Specialists, 8042 Katy Freeway, Houston, TX 77024, USA
| | - Stanley E Kim
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, 2015 Southwest 16th Avenue, Gainesville, FL 32610-0126, USA
| | - Emanuele Castelli
- Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 258c, Zurich 8057, Switzerland
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11
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Wan YTO, Lui TH. Arthroscopic Debridement and Microfracture of Osteochondral Lesion of the Talar Head. Arthrosc Tech 2019; 8:e969-e973. [PMID: 31687328 PMCID: PMC6819872 DOI: 10.1016/j.eats.2019.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 05/03/2019] [Indexed: 02/03/2023] Open
Abstract
Osteochondral lesions of the talar head can be classified into 4 types according to their location. A type 1 lesion is located at the anterior part of the talar head. Surgical debridement and microfracture are indicated for symptomatic type 1 lesions if conservative treatment fails to relieve the pain. The purpose of this technical note was to describe the details of arthroscopic debridement and microfracture of the symptomatic type 1 osteochondral lesion of the talar head and the kissing lesion at the navicular bone. The procedure is performed through the standard portals of talonavicular arthroscopy and has the advantages of minimally invasive surgery of better cosmetic results and less surgical trauma.
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Affiliation(s)
- Yue Ting Ophelia Wan
- Department of Orthopaedics and Traumatology, Princess Margaret Hospital, Hong Kong, China
| | - Tun Hing Lui
- Department of Orthopaedics and Traumatology, North District Hospital, Hong Kong, China,Address correspondence to Tun Hing Lui, M.B.B.S.(HK), F.R.C.S.(Edin), F.H.K.A.M., F.H.K.C.O.S., Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong SAR, China.
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12
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Lui TH, Pan XH, Pan Y. Arthroscopic and Endoscopic Management of Common Complications After Displaced Intra-Articular Calcaneal Fractures. Clin Podiatr Med Surg 2019; 36:279-293. [PMID: 30784537 DOI: 10.1016/j.cpm.2018.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The list of late complications after calcaneal fracture that can be treated through arthroscopic and/or endoscopic approach continues to expand. The late complications of calcaneal fractures can be classified into 3 groups: (1) those causing focal hindfoot or ankle pain, (2) those causing functional deficit, and (3) those present with diffuse and poorly localized pain. Many group 1 and some group 2 complications can be managed arthroscopically and/or endoscopically. There are usually multiple coexisting sources of the pain. Careful evaluation and analysis of a problem and detailed surgical planning with combination of arthroscopic/endoscopic and open procedures are key to success.
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Affiliation(s)
- Tun-Hing Lui
- Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong, China.
| | - Xiao-Hua Pan
- Guangdong Provincial Engineering Research Center of Wound Repair and Regenerative Medicine, Affiliated Baoan Hospital of Shenzhen, Southern Medical University, The 8th People's Hospital of Shenzhen, Shenzhen, Guangdong 518101, China; Guangdong Provincial Academician Workstation of Wound Repair and Regenerative Medicine, Affiliated Baoan Hospital of Shenzhen, Southern Medical University, The 8th People's Hospital of Shenzhen, Shenzhen, Guangdong 518101, China; Department of Trauma and Orthopedics, Affiliated Baoan Hospital of Shenzhen, Southern Medical University, The 8th People's Hospital of Shenzhen, Shenzhen, Guangdong 518101, China
| | - Yu Pan
- Guangdong Provincial Engineering Research Center of Wound Repair and Regenerative Medicine, Affiliated Baoan Hospital of Shenzhen, Southern Medical University, The 8th People's Hospital of Shenzhen, Shenzhen, Guangdong 518101, China; Guangdong Provincial Academician Workstation of Wound Repair and Regenerative Medicine, Affiliated Baoan Hospital of Shenzhen, Southern Medical University, The 8th People's Hospital of Shenzhen, Shenzhen, Guangdong 518101, China; Department of Trauma and Orthopedics, Affiliated Baoan Hospital of Shenzhen, Southern Medical University, The 8th People's Hospital of Shenzhen, Shenzhen, Guangdong 518101, China
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13
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Lui TH, Chow CL. Arthroscopic Management of Osteochondral Lesion of Plantar Medial Talar Head. Arthrosc Tech 2019; 8:e81-e84. [PMID: 30899655 PMCID: PMC6408699 DOI: 10.1016/j.eats.2018.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Accepted: 09/12/2018] [Indexed: 02/03/2023] Open
Abstract
Osteochondral lesions of the talar head can be classified into 4 types: type 1 is located at the anterior part of the talar head, type 2 is at the plantar side of the talar head, type 3 is at the plantar lateral side of the talar head, and type 4 is at the plantar medial aspect of the talar head. The purpose of this Technical Note is to describe the details of arthroscopic management of an osteochondral lesion of the plantar medial talar head. It includes arthroscopic synovectomy of the medial recess of the anterior subtalar joint, debridement, and microfracture of the osteochondral lesion.
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Affiliation(s)
- Tun Hing Lui
- Address correspondence to Tun Hing Lui, M.B.B.S. (H.K.), F.R.C.S. (Edin.), F.H.K.A.M., F.H.K.C.O.S., Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Rd, Sheung Shui, NT, Hong Kong SAR, People's Republic of China
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14
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Lui TH. Endoscopic resection of symptomatic os calcaneus secundarius. Foot (Edinb) 2018; 37:101-104. [PMID: 30336402 DOI: 10.1016/j.foot.2018.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 04/24/2018] [Accepted: 04/25/2018] [Indexed: 02/04/2023]
Abstract
Os calcaneus secundarius is an accessory ossicle resulting from a secondary ossification center of the anterior facet of the calcaneus. It may cause chronic pain and limitation in inversion motion after inversion ankle sprain. Excision of the ossicle is indicated if the symptoms do not resolve with conservative treatment. A case of symptomatic os calcaneus secundarius, which was successfully resected endoscopically, is presented.
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Affiliation(s)
- Tun Hing Lui
- Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong Special Administrative Region.
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15
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Lui TH, Mak CYD. Arthroscopic approach to the spring (calcaneonavicular) ligament. Foot Ankle Surg 2018; 24:242-245. [PMID: 29409252 DOI: 10.1016/j.fas.2017.02.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 02/25/2017] [Accepted: 02/25/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND This research studied the safety and efficacy of a new portal to the spring ligament. This portal is located just plantar to the insertion of the posterior tibial tendon and above the fibrous septum between the posterior tibial and the flexor digitorum longus tendons. METHODS Twelve fresh frozen foot and ankle specimens were used. The distance between the accessory medial portal and the medial plantar nerve was measured. The relation between the medial plantar nerve and the spring ligament was studied. The depth that can be reached through the portal was also assessed. RESULTS The average distance between the insertion point of the 3mm diameter metal rod and the medial plantar nerve was 20(6-27)mm. The medial plantar nerve located at lateral third of the ligament in 8 specimens (67%), middle third in 2 specimens (17%) and medial third in 2 specimens (17%). The tip of rod can reach Zone A in all specimens. CONCLUSION This study demonstrated that arthroscopic approach and repair of the spring ligament can injure the medial plantar nerve. CLINICAL RELEVANCE The clinical relevance of this cadaver study is that it confirmed the feasibility of arthroscopic approach to the whole span of the spring ligament and alerted the potential risk of injury to the medial plantar nerve during arthroscopic assisted repair of the ligament.
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Affiliation(s)
- T H Lui
- Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong SAR, China.
| | - C Y D Mak
- Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong SAR, China.
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16
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Abstract
Ankle, hindfoot, and toe stiffness can result from hindfoot trauma. It can be due to capsular fibrosis, tendon adhesion, muscle fibrosis, or malunion. For symptomatic stiffness that is resistant to nonoperative treatment, operative treatment should be considered. It is important to tackle the sources of stiffness, and careful preoperative clinical assessment is the key for proper formulation of the surgical plan. Whenever possible, arthroscopic/endoscopic surgery is preferable to open surgery because less extensive dissection and small surgical incisions allow immediate vigorous mobilization of the foot and ankle.
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Affiliation(s)
- Tun Hing Lui
- Department of Orthopaedics and Traumatology, North District Hospital, Hong Kong, China,Address for correspondence: Dr. Tun Hing Lui, Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong, China. E-mail:
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Ling SKK, Lui TH. Posterior Tibial Tendon Dysfunction: An Overview. Open Orthop J 2017; 11:714-723. [PMID: 28979585 PMCID: PMC5620404 DOI: 10.2174/1874325001711010714] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 07/23/2016] [Accepted: 07/23/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Adult acquired flatfoot deformity is a commonly seen condition with a large clinical spectrum. It ranges from asymptomatic subjects to severely disabled arthritic patients. Posterior tibialis tendon dysfunction is a common cause of adult acquired flatfoot deformity. METHODS This article systematically reviews the published literature from books and journals that were either originally written or later translated into the English language regarding the subject of posterior tibialis tendon dysfunction. RESULTS Posterior tibialis tendon dysfunction is a primary soft tissue tendinopathy of the posterior tibialis that leads to altered foot biomechanics. Although the natural history of posterior tibialis tendon dysfunction is not fully known, it has mostly been agreed that it is a progressive disorder. While clinical examination is important in diagnosing adult acquired flat-feet; further investigation is often required to delineate the different aetiologies and stage of the disease. The literature describes many different management choices for the different stages of posterior tibialis tendon dysfunction. CONCLUSION Because of the wide range of symptom and deformity severity, surgical reconstruction is based on a-la-carte. The consensus is that a plethora of reconstructive options needs to be available and the list of procedures should be tailored to tackle the different symptoms, especially when managing complex multi-planar reconstructions.
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Affiliation(s)
- Samuel Ka-Kin Ling
- Department of Orthopaedics and Traumatology, North District Hospital, Hong Kong SAR
| | - Tun Hing Lui
- Department of Orthopaedics and Traumatology, North District Hospital, Hong Kong SAR
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18
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Lui TH. Arthroscopic Triple Arthrodesis in Management of Chronic Flatfoot Deformity. Arthrosc Tech 2017; 6:e871-e877. [PMID: 28706845 PMCID: PMC5495991 DOI: 10.1016/j.eats.2017.02.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Accepted: 02/24/2017] [Indexed: 02/03/2023] Open
Abstract
Triple arthrodesis has a significant role in the management of hindfoot osteoarthritis and deformity. Traditionally, it is an open procedure with extensive soft tissue dissection. Arthroscopic triple arthrodesis would appear to provide good visualization and preparation of the fusion surfaces while preserving the soft tissue envelope. The purpose of this Technical Note is to describe a minimally invasive approach of triple arthrodesis to correct chronic flatfoot deformity.
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Affiliation(s)
- Tun Hing Lui
- Address correspondence to Tun Hing Lui, M.B.B.S.(H.K.), F.R.C.S.(Edin.), F.H.K.A.M., F.H.K.C.O.S., Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong SAR, China.Department of Orthopaedics and TraumatologyNorth District Hospital9 Po Kin RoadSheung Shui, NTHong Kong SARChina
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Lui TH. Arthroscopic Repair of Superomedial Spring Ligament by Talonavicular Arthroscopy. Arthrosc Tech 2017; 6:e31-e35. [PMID: 28373937 PMCID: PMC5368055 DOI: 10.1016/j.eats.2016.08.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 08/29/2016] [Indexed: 02/03/2023] Open
Abstract
A spring ligament tear can occur because of failure of the tibialis posterior tendon in adult-acquired flatfoot deformity or as an isolated injury with a normal tibialis posterior tendon. The superomedial spring ligament is the most common site of rupture. Compromise of this ligament is a primary causative factor of peritalar subluxation, and a functioning tibialis posterior tendon cannot prevent or correct a planovalgus foot deformity. Therefore, the spring ligament should be repaired in addition to treatment of tibialis posterior tendon abnormalities. The purpose of this technical note is to describe a minimally invasive approach for repair of the superomedial spring ligament by talonavicular arthroscopy.
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Affiliation(s)
- Tun Hing Lui
- Address correspondence to Tun Hing Lui, M.B.B.S.(HK), F.R.C.S.(Edin), F.H.K.A.M., F.H.K.C.O.S., Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong SAR, China.Department of Orthopaedics and TraumatologyNorth District Hospital9 Po Kin RoadSheung Shui, NTHong Kong SARChina
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20
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Lui TH. Arthroscopic Release of Lateral Half of the Talocalcaneonavicular Joint. Arthrosc Tech 2016; 5:e1471-e1474. [PMID: 28149741 PMCID: PMC5264009 DOI: 10.1016/j.eats.2016.08.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 08/25/2016] [Indexed: 02/03/2023] Open
Abstract
Arthrofibrosis of the talocalcaneonavicular joint can follow trauma or surgery of the joint. Arthroscopic release of the lateral half of the talocalcaneonavicular joint is indicated if the painful restriction of hindfoot inversion together with tenderness of the lateral side of the joint that is not controlled with conservative treatment. This procedure is contraindicated in other causes of painful stiffness including post-traumatic arthritis, osteonecrosis, and malunion. This technique includes arthroscopic release of the lateral side of the anterior subtalar joint and the talonavicular joint. This is a technically demanding technique and should be reserved for the experienced foot and ankle arthroscopists.
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Affiliation(s)
- Tun Hing Lui
- Address correspondence to Tun Hing Lui, M.B.B.S.(HK), F.R.C.S.(Edin), F.H.K.A.M., F.H.K.C.O.S., Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong SAR, China.Department of Orthopaedics and TraumatologyNorth District Hospital9 Po Kin RoadSheung Shui, NTHong Kong SARChina
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21
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Lui TH. Arthroscopically Assisted Modified Jones Procedure. Arthrosc Tech 2016; 5:e1401-e1406. [PMID: 28560138 PMCID: PMC5439078 DOI: 10.1016/j.eats.2016.08.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 08/16/2016] [Indexed: 02/03/2023] Open
Abstract
The modified Jones procedure is the classic operative treatment of symptomatic clawed hallux. It is composed of transfer of the extensor hallucis longus tendon to the first metatarsal neck and fusion of the hallux interphalangeal joint. The purpose of this technical note is to report the technique of an arthroscopically assisted modified Jones procedure. This can be combined with other minimally invasive bone and soft-tissue procedures to correct all aspects of the complex cavus foot deformity.
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Affiliation(s)
- Tun Hing Lui
- Address correspondence to Tun Hing Lui, M.B.B.S.(HK), F.R.C.S.(Edin), F.H.K.A.M., F.H.K.C.O.S., Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong SAR, China.Department of Orthopaedics and TraumatologyNorth District Hospital9 Po Kin RoadSheung Shui, NTHong Kong SARChina
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22
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Lui TH. Arthroscopic Capsular Release of the Talocalcaneonavicular Joint. Arthrosc Tech 2016; 5:e1305-e1309. [PMID: 28560132 PMCID: PMC5439079 DOI: 10.1016/j.eats.2016.07.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 07/22/2016] [Indexed: 02/03/2023] Open
Abstract
Arthrofibrosis of the talocalcaneonavicular joint can follow talar neck fracture especially if anterior approaches have been used for fracture fixation. Capsular release of the talocalcaneonavicular joint is indicated if the painful hindfoot stiffness cannot be controlled with conservative treatment. Open capsular release of the talocalcaneonavicular joint demands extensive soft tissue dissection and hinders early postoperative mobilization exercise of the joint. The purpose of this technical note is to describe a minimally invasive approach of arthroscopic capsular release of the talocalcaneonavicular joint that is composed of arthroscopic release of the talonavicular joint and the anterior subtalar joint. This allows immediate postoperative mobilization of the joint.
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Affiliation(s)
- Tun Hing Lui
- Address correspondence to Tun Hing Lui, M.B.B.S.(HK), F.R.C.S.(Edin), F.H.K.A.M., F.H.K.C.O.S., Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong SAR, China.Department of Orthopaedics and TraumatologyNorth District Hospital9 Po Kin RoadSheung Shui, NTHong Kong SARChina
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23
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Arthroscopic Taloplasty for an Anterolateral Snapping Ankle. Arthrosc Tech 2016; 5:e1287-e1290. [PMID: 28149727 PMCID: PMC5263167 DOI: 10.1016/j.eats.2016.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 07/21/2016] [Indexed: 02/03/2023] Open
Abstract
Anterior ankle snapping syndrome is rare. Snapping of the extensor digitorum longus due to attenuated inferior extensor retinaculum and snapping due to hypertrophied or low-lying peroneal tertius muscle have been reported. We reported a new mechanism of anterolateral snapping due to a hypertrophied talar head. Anterolateral snapping ankle can be revealed by active dorsiflexion and plantarflexion of the ankle with the foot inverted. Foot inversion will tension the inferior extensor retinaculum and uncover the dorsolateral prominence of the talar head. The dorsolateral prominence of the talar head will snap over the proximal edge of the inferior extensor retinaculum. This technical note reports the technique of arthroscopic contouring of the talar head via extra-articular ankle arthroscopy. We named this technique arthroscopic taloplasty.
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Lui TH. Endoscopically and Fluoroscopically Assisted Curettage and Bone Grafting of the Navicular Bone Cyst. Arthrosc Tech 2016; 5:e1221-e1227. [PMID: 28149717 PMCID: PMC5263100 DOI: 10.1016/j.eats.2016.07.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 07/20/2016] [Indexed: 02/03/2023] Open
Abstract
Simple bone cyst is a common tumorlike lesion of the bone and can involve the bones of the foot. It is usually asymptomatic but can also present with pain or pathologic fracture. The purpose of this technical note is to describe the uni-osseous portal approach of endoscopic curettage and bone grafting of simple bone cyst of the navicular bone. The single-portal approach reduces the risk of iatrogenic fracture of the navicular bone. This is indicated for painful bone cyst of the navicular bone resistant to conservative treatment. It is contraindicated in multiple septated cysts, the presence of pathologic fracture, or the presence of aggressive cystic lesions.
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Affiliation(s)
- Tun Hing Lui
- Address correspondence to Tun Hing Lui, M.B.B.S.(HK), F.R.C.S.(Edin), F.H.K.A.M., F.H.K.C.O.S., Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong SAR, China.Department of Orthopaedics and TraumatologyNorth District Hospital9 Po Kin RoadSheung Shui, NTHong Kong SARChina
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25
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Lui TH. Arthroscopic Resection of Too-Long Anterior Process of the Calcaneus. Arthrosc Tech 2016; 5:e1179-e1183. [PMID: 28224074 PMCID: PMC5310192 DOI: 10.1016/j.eats.2016.07.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 07/05/2016] [Indexed: 02/03/2023] Open
Abstract
A too-long anterior process (TLAP) of the calcaneus is an elongated anteromedial process of the calcaneus impinging the navicular or the talar head. TLAP can cause recurrent ankle sprain, peroneal muscle spasm, or persistent tarsal pain in adolescents. Arthroscopic resection is indicated if the symptoms do not respond to conservative treatment. It has the advantage of assessment of completeness of bone resection and treatment of associated lesions of the adjacent joints. The purpose of this technical note is to report an arthroscopic approach of the resection of the TLAP with the lateral midtarsal portal as the viewing portal.
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Affiliation(s)
- Tun Hing Lui
- Address correspondence to Tun Hing Lui, M.B.B.S.(HK), F.R.C.S.(Edin), F.H.K.A.M., F.H.K.C.O.S., Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong SAR, China.Department of Orthopaedics and TraumatologyNorth District Hospital9 Po Kin RoadSheung Shui, NTHong Kong SARChina
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26
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Imaging of Mueller-Weiss Syndrome: A Review of Clinical Presentations and Imaging Spectrum. AJR Am J Roentgenol 2016; 207:W8-W18. [DOI: 10.2214/ajr.15.15843] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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27
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Wicks ED, Morscher MA, Newton M, Steiner RP, Weiner DS. Partial or non-union after triple arthrodesis in children: does it really matter? J Child Orthop 2016; 10:119-25. [PMID: 27039315 PMCID: PMC4837165 DOI: 10.1007/s11832-016-0730-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 03/23/2016] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Triple arthrodesis is a commonly performed salvage procedure to correct hindfoot deformity. Non-union is considered an undesirable radiographic outcome; however, the clinical ramifications of this are not as well defined. The purpose of this study was to determine the incidence of partial or complete radiographic non-union after triple arthrodesis in children and characterize the clinical consequences. METHODS An IRB-approved retrospective review of triple arthrodesis surgeries in patients less than 16 years of age performed by a single surgeon (DSW) identified 159 cases meeting the inclusion criteria. Plain radiographs were reviewed for bony fusion (defined as over 80 % radiographic bony union of the subtalar, calcaneocuboid, and talonavicular bones) and charts for clinical outcomes (pain, return to activity, and subsequent hindfoot surgeries). Statistics were used to compare the fused and unfused cases, with p < 0.05 considered to be significant. RESULTS Of the 159 cases included in the study, 9 % did not achieve at least 80 % plain film radiographic union. The fused and unfused groups had similar clinical outcomes. Only one patient required surgery for sequelae of symptoms arising from a pseudoarthrosis related to the triple arthrodesis. The fused and unfused groups were similar in terms of gender and pin removal time, but differed significantly in surgical age and underlying diagnosis. CONCLUSIONS This is one of the largest case series of pediatric triple arthrodesis surgery presented in the literature. This study demonstrated that good clinical outcomes can be achieved despite the lack of radiographic union after triple arthrodesis surgery in children. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Eric D Wicks
- Northeast Ohio Medical University, Rootstown, OH, 44272, USA
| | | | | | - Richard P Steiner
- Department of Statistics, University of Akron, Akron, OH, 44325, USA
| | - Dennis S Weiner
- Northeast Ohio Medical University, Rootstown, OH, 44272, USA.
- Department of Pediatric Orthopaedic Surgery, Akron Children's Hospital, Akron, OH, USA.
- Regional Skeletal Dysplasia Clinic, Akron Children's Hospital, Akron, OH, 44302, USA.
- Akron Children's Hospital, 300 Locust Street, Ste. 250, Akron, OH, 44302-1821, USA.
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Abstract
There is great potential of managing the complications of total ankle replacement arthroscopically and endoscopically, and these procedures can be summarized into 3 groups. Group 1 includes procedures of the ankle joint proper with close proximity to the articular components of the total ankle replacement. Group 2 includes procedures of the tibia and talus with close proximity to the nonarticular parts of the total ankle replacement. Group 3 includes procedures that are away from the total ankle replacement. However, these remain master arthroscopist procedures and should be performed by foot and ankle surgeons who perform them with regularity.
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Carranza-Bencano A, Tejero S, Fernández Torres JJ, Del Castillo-Blanco G, Alegrete-Parra A. Isolated talonavicular joint arthrodesis through minimal incision surgery. Foot Ankle Surg 2015; 21:171-7. [PMID: 26235855 DOI: 10.1016/j.fas.2014.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 10/13/2014] [Accepted: 11/03/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND The purpose of this study was to analyze bony fusion and functional outcomes after talonavicular arthrodesis (TNA) using an original minimally invasive surgery (MIS). METHODS There was a total of 11 feet in 11 patients who underwent TNA and were followed up for 47 months (range 40.8-53.1). Functional outcomes were measured by AOFAS and quality of life by eight sections of SF-36. RESULTS Radiographic and clinical consolidation was achieved in 10 of 11 cases. In the AOFAS score, physical function improved a mean of 34.4 points (95% CI: 23.2-45.6; p<.0001) and pain improved a mean of 23.6 points (95% CI: 17.4-29.8; p<.0001). One osteoporotic and rheumatic patient had a non-union. No cases of early complications, such as wound infections, neurovascular damage or delayed wound healing, occurred. CONCLUSION Isolated TNA by MIS could be an option for the treatment of TN arthritis, especially for patients at greater risk of wound healing complications. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- A Carranza-Bencano
- University of Sevilla, Spain; Foot Ankle Unit, Universitary Hospital "Virgen del Rocío", Sevilla, Spain.
| | - Sergio Tejero
- University of Sevilla, Spain; Foot Ankle Unit, Universitary Hospital "Virgen del Rocío", Sevilla, Spain
| | - J J Fernández Torres
- University of Sevilla, Spain; Foot Ankle Unit, Universitary Hospital "Virgen del Rocío", Sevilla, Spain
| | | | - A Alegrete-Parra
- Foot Ankle Unit, Universitary Hospital "Virgen del Rocío", Sevilla, Spain
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30
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Jagodzinski NA, Parsons AMJ, Parsons SW. Arthroscopic triple and modified double hindfoot arthrodesis. Foot Ankle Surg 2015; 21:97-102. [PMID: 25937408 DOI: 10.1016/j.fas.2014.10.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 10/11/2014] [Accepted: 10/17/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND Arthroscopic arthrodesis is an accepted technique for the ankle but less commonly reported for multiple hindfoot joints. We present a case series review to establish the feasibility of this surgery. METHODS In a consecutive series of 112 arthroscopic hindfoot arthrodeses, 18 involved decortication and fusion of 2 or 3 hindfoot joints. These were reviewed to identify complications, union rates and improvement over preoperative state. RESULTS Mean age was 62 (45-78). Mean follow-up was 4.4 (1.75-7.5) years. There were no perioperative complications. The four patients with triple fusions united with good or excellent outcomes. Of 14 patients with subtalar and talonavicular arthrodeses there were three talonavicular non-unions. CONCLUSIONS Arthroscopic double and triple arthrodeses appear feasible salvage options for pain and deformity. Decortication of all three joints and rotatory correction of deformity is possible whilst preserving the soft tissue envelope. Late adjacent joint pain and arthrosis can occur.
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Affiliation(s)
| | | | - S W Parsons
- The Royal Cornwall Hospital, Truro, United Kingdom
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31
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Abstract
The clinical application of small joint arthroscopies (metatarsophalangeal joint, Lisfranc joint, Chopart joint, and interphlangeal joint) in the foot has seen significant advancements in the past decades. This article reviews the clinical indications, technical details, outcomes, and potential complications of small joint arthroscopies of the foot.
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Affiliation(s)
- Tun Hing Lui
- Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong 999077, China.
| | - Chi Pan Yuen
- Department of Orthopaedics and Traumatology, Kwong Wah Hospital, 25 Waterloo Road, Hong Kong 999077, China
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Lui TH, Tong SC. Subtalar arthroscopy: When, why and how. World J Orthop 2015; 6:56-61. [PMID: 25621211 PMCID: PMC4303790 DOI: 10.5312/wjo.v6.i1.56] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 07/09/2014] [Accepted: 07/29/2014] [Indexed: 02/06/2023] Open
Abstract
Technique of subtalar arthroscopy is rapidly evolving. Increasing number of traditional open procedures for the subtalar joint can now be done arthroscopically. It is hoped that less wound complications, faster rehabilitation and better cosmetic outcomes can be achieved with this minimally invasive technique.
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Lui TH, Ling SKK. Calcaneal fractures have universally poor outcomes regardless of management. ACTA ACUST UNITED AC 2014; 20:13. [DOI: 10.1136/ebmed-2014-110088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Ross KA, Seaworth CM, Smyth NA, Ling JS, Sayres SC, Kennedy JG. Talonavicular arthroscopy for osteochondral lesions: technique and case series. Foot Ankle Int 2014; 35:909-15. [PMID: 24962526 DOI: 10.1177/1071100714540887] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Traditional treatment of talonavicular osteochondral lesions (OCLs) requires an open procedure. Arthroscopic microfracture of talonavicular OCLs may provide a viable, minimally invasive approach. The purpose of this study was to describe an arthroscopic approach for treatment of talonavicular OCLs, describe the proximity of arthroscopic portals to important structures in cadaver specimens, and report magnetic resonance imaging (MRI) findings and clinical outcomes of this technique. METHODS Five cadaver specimens were dissected so proximity of portals to adjacent tendons and neurovascular structures could be assessed. Subsequently, 3 athletic patients with OCLs of the talonavicular joint were treated with arthroscopic debridement and microfracture. Patient records and imaging studies were retrospectively reviewed. RESULTS In the cadaver specimens, the mean distance between the neurovascular bundle and the medial border of the extensor hallucis longus (EHL) was 9.0 (range, 8 to 10) mm. The saphenous nerve was located a mean of 6.8 (range, 6 to 7) mm from the medial border of the tibialis anterior tendon. Therefore, portals were placed just medial to the EHL and tibialis anterior tendon to avoid the neurovascular bundle and saphenous nerve, respectively. In all patients, access, identification of the OCL, debridement, and microfracture were successfully performed. All patients demonstrated improvements in Foot and Ankle Outcome Scores and Short Form-12 scores and began gradual return to activity within 12 weeks following the operation. No significant complications occurred. MRI indicated signal consistent with reparative fibrocartilage in all patients. CONCLUSION Talonavicular arthroscopy allowed visualization, curettage, synovectomy, loose body removal, and microfracture of OCLs that would have otherwise required an open approach. At early follow-up, all patients had returned to their previous activity levels. Arthroscopy of the talonavicular joint was a viable approach for microfracture of OCLs. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Keir A Ross
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Christine M Seaworth
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Niall A Smyth
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Jeffrey S Ling
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Stephanie C Sayres
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
| | - John G Kennedy
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
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35
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Lui TH. Arthroscopic ganglionectomy of the foot and ankle. Knee Surg Sports Traumatol Arthrosc 2014; 22:1693-700. [PMID: 22648747 DOI: 10.1007/s00167-012-2065-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Accepted: 05/14/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE To study the efficacy of arthroscopic ganglionectomy in the management of ganglia of the foot and ankle. METHODS From 2006 to 2010, arthroscopic ganglionectomy was performed for 89 ganglia in the foot and ankle of 88 patients. Clinical and intra-operative details were reviewed retrospectively. RESULT Ganglion stalk was identified in 6 % of the cases. The overall rate of presence of pathology was 26 %. The overall rate of recurrence or residual lesion was 12 % with high recurrent rate for extensor tendon ganglia and toe pulp ganglia. CONCLUSIONS Arthroscopic ganglionectomy of the foot and ankle ganglion by either internal drainage or complete resection is a feasible approach. Good results can be achieved in case of adequate internal drainage of the ganglion to the joints or fibrous tendon sheath.
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Affiliation(s)
- T H Lui
- Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong SAR, China,
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36
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Hughes AM, Gosling O, McKenzie J, Amirfeyz R, Winson IG. Arthroscopic triple fusion joint preparation using two lateral portals: a cadaveric study to evaluate efficacy and safety. Foot Ankle Surg 2014; 20:135-9. [PMID: 24796834 DOI: 10.1016/j.fas.2014.02.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Revised: 02/05/2014] [Accepted: 02/11/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND Arthroscopic triple fusion has several advantages over open techniques, but its use has yet to become widespread. Preliminary published techniques use five portals with neurovascular risk. Our aim was to assess the safety and efficacy of an alternative lateral two portal technique. METHODS Four cadaveric hindfeet were arthroscopically prepared for a triple fusion using two lateral portals. The distance to relevant subcutaneous nerves was measured as well as the prepared joint surface percentage. RESULTS Mean distance from mid-lateral portal to the nearest sural nerve branch was 22.3mm (range 20-24mm) and from the dorsolateral portal to the intermediate branch of the superficial peroneal nerve was 7.8mm (range 4-11mm). Mean percentages of joint preparation were 63% (talar head), 62% (navicular), 75% (calcaneum) and 74% (cuboid). CONCLUSIONS Two lateral arthroscopic portals allow adequate joint preparation for triple fusion procedures. The proximity of subcutaneous nerves is important to appreciate when using these portals.
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Affiliation(s)
- Adrian M Hughes
- Avon Orthopaedic Centre, North Bristol Trust, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB, UK.
| | - Oliver Gosling
- Avon Orthopaedic Centre, North Bristol Trust, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB, UK
| | - James McKenzie
- Avon Orthopaedic Centre, North Bristol Trust, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB, UK
| | - Rouin Amirfeyz
- University Hospitals Bristol, Bristol Royal Infirmary, UK
| | - Ian G Winson
- Avon Orthopaedic Centre, North Bristol Trust, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB, UK
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37
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Abstract
Anterior tarsal tunnel syndrome is a rare entrapment neuropathy of the deep peroneal nerve beneath the inferior extensor retinaculum of the ankle. We report a patient with anterior tarsal tunnel syndrome who was successfully treated with endoscopic anterior tarsal tunnel release. Our endoscopic technique, because it preserves the inferior extensor retinaculum, is potentially less traumatic than traditional surgical techniques for repairing this entrapment neuropathy.
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Affiliation(s)
- Tun Hing Lui
- Department of Orthopaedics and Traumatology, North District Hospital, Sheung Shui, New Territory, Hong Kong Special Administrative Region, People's Republic of China.
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38
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Safety and efficiency of a 2-portal lateral approach to arthroscopic subtalar arthrodesis: a cadaveric study. Arthroscopy 2013; 29:1217-23. [PMID: 23809457 DOI: 10.1016/j.arthro.2013.04.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 04/17/2013] [Accepted: 04/17/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the safety and efficiency of a 2-portal lateral (anterior and middle) approach to arthroscopic subtalar arthrodesis. METHODS A cadaveric study was performed on 30 feet of 15 fresh cadaveric bodies (15 right and 15 left; 21 female specimens and 9 male specimens). The mean age at death was 78 ± 6.7 years. The procedure was performed with the specimen in the supine position through 2 lateral (anterior and middle) sinus tarsi portals by use of a 4.0-mm arthroscope. A 3.5-mm synovial shaver was used for debridement, and a 4.5-mm shielded bur was used to resect posterior subtalar facets. The feet were then dissected. The primary outcomes were the percentage of resected joint surface and the distances between portals and both sural and superficial peroneal nerves. The secondary outcomes were injury of sinus tarsi ligaments and lateral arterial network, calcaneofibular ligament, peroneal tendons, flexor hallucis longus tendon, and posterior tibial neurovascular bundle. RESULTS The mean percentages of resected talar and calcaneal posterior subtalar facets were 94% ± 7.2% and 91% ± 6.8%, respectively. The minimum distance of either subtalar portal to the nerves was 4 mm. No nerve injury was observed. In 28 of 30 cases, the lateral sinus tarsi arterial network was found intact. In all cases the inferior retinaculum extensor was transfixed by the portals. In all cases both cervical and interosseous talocalcaneal ligaments were found intact. In 3 cases a shaving lesion was observed on the peroneus brevis tendon. CONCLUSIONS According to this cadaveric study, more than 90% freshening of the posterior subtalar articular facets can be achieved through a 2-portal lateral (anterior and middle) approach. This technique is reproducible and safe with regard to the surrounding nerves. CLINICAL RELEVANCE The 2 lateral portals may offer a safe and effective alternative approach for arthroscopic arthrodesis of the posterior subtalar joint.
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Lui TH, Chan KB. Arthroscopic management of late complications of calcaneal fractures. Knee Surg Sports Traumatol Arthrosc 2013; 21:1293-9. [PMID: 22692516 DOI: 10.1007/s00167-012-2086-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2011] [Accepted: 05/29/2012] [Indexed: 12/14/2022]
Abstract
PURPOSE To review retrospectively the results of arthroscopic management of late complications of calcaneal fractures. METHODS Fifty patients (32 males, 18 females) with late complications of calcaneal fractures were managed arthroscopically. The median age at the time of arthroscopic surgery was 45 (19-63) years old. Detailed history taking, physical examination, standing lateral radiograph of the foot and axial view of the calcaneus and computed tomogram study were performed in all of the patients in order to identify the sources of symptoms. The arthroscopic treatment was then planned accordingly. The patients were assessed according to the AOFAS ankle-hindfoot score and the standing radiographs of the foot and ankle, both preoperatively and at the latest follow-up consultation. RESULT A median of 1 arthroscopic procedure was performed for each patient (range, 1-4). The median follow-up after the latest arthroscopic surgery was 49 (range, 24-85 months) months. In all of the cases, the symptoms improved after the arthroscopic surgery and all the arthrodesis sites healed. The overall median preoperative AOFAS ankle-hindfoot score was 60.5 (27-75). The overall median AOFAS ankle-hindfoot score at the time of latest follow-up was 90 (73-100). CONCLUSIONS The arthroscopic approach focuses on the patient's symptoms. It is a feasible approach to alleviate patient's symptoms. Detailed history taking and clinical examination to determine the sources of the patient's symptoms are the keys to success.
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Affiliation(s)
- T H Lui
- Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong SAR, China.
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Affiliation(s)
- Tun Hing Lui
- Department of Orthopaedics and Traumatology, North District Hospital, Sheung Shui, Hong Kong.
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Pozzi A, Lewis DD, Hudson CC, Kim SE. Percutaneous Plate Arthrodesis in Small Animals. Vet Clin North Am Small Anim Pract 2012; 42:1079-96, viii. [DOI: 10.1016/j.cvsm.2012.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
The arthroscopic approach to small joints of the foot has made many advances in recent years, which can be directly related to the improvement of the surgical equipment. This improvement has led to more indications for the use of arthroscopy as well as minimizing the complications. Several articles recently have presented experiences in arthroscopic surgery in the small joints of the foot; however, its use is still relatively limited. Approaches to small joints of the foot involve the first metatarsophalangeal joint, tarsometatarsal joint, and Chopart joint, as well as the interphalangeal joint to the great toe and lesser toes.
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Affiliation(s)
- Richard Derner
- Private Practice, Associated Foot & Ankle Centers of Northern Virginia, Lake Ridge, VA, USA
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Lui TH. Endoscopic excision of symptomatic nonunion of anterior calcaneal process. J Foot Ankle Surg 2011; 50:476-9. [PMID: 21601485 DOI: 10.1053/j.jfas.2011.04.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Indexed: 02/03/2023]
Abstract
Most fractures of the anterior process of the calcaneus are successfully treated with cast immobilization. Large fragments might be amenable to open reduction and internal fixation. The correct initial diagnosis and treatment are important, particularly if the fracture fragment is large. An improper initial diagnosis will lead to painful nonunion requiring surgical intervention. We present a case of symptomatic nonunion of the anterior calcaneal process that was successfully treated by endoscopic resection of the fragment. The adjacent structures can be examined arthroscopically for concomitant lesions and treated accordingly.
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Affiliation(s)
- Tun Hing Lui
- Department of Orthopaedics and Traumatology, North District Hospital, Sheung Shui, NT, Hong Kong SAR, China.
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Hammond AW, Phisitkul P, Femino J, Amendola A. Arthroscopic debridement of the talonavicular joint using dorsomedial and dorsolateral portals: a cadaveric study of safety and access. Arthroscopy 2011; 27:228-34. [PMID: 21030202 DOI: 10.1016/j.arthro.2010.07.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2009] [Revised: 07/21/2010] [Accepted: 07/22/2010] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to examine the safety and access talonavicular arthroscopy provides for the purpose of arthrodesis through dorsomedial and dorsolateral portals in a cadaveric model. METHODS The talonavicular joints of 8 cadaveric specimens were arthroscopically debrided, by use of a dorsomedial instrumentation portal and a dorsolateral visualization portal. The specimens were dissected with the arthroscopic equipment left in place, the distances from the edge of the instrument to the neurovascular structures were measured, and the specimens were then examined for signs of damage. Finally, the naviculars and tali were removed, and the percentage of debrided subchondral bone was determined by use of ImageJ software (National Institutes of Health, Bethesda, MD). RESULTS Examination of the talonavicular joint showed mean subchondral debridement of 98.6% of the navicular and 83.2% of the talus. The dorsomedial portal had a median distance of 4.5 mm, 10.5 mm, and 7 mm to the superficial peroneal nerve, the medial terminal branch of the deep peroneal nerve, and the dorsalis pedis, respectively. The dorsolateral portal had a median distance of 1 mm to the lateral branch of the deep peroneal nerve, with the nerve found resting on the arthroscope in 2 specimens. CONCLUSIONS Arthroscopic debridement of the talonavicular joint is possible. Because of the risk of damage to the lateral terminal branch of the deep peroneal nerve, an alternative to the dorsolateral portal should be considered. CLINICAL RELEVANCE This study provides evidence that arthroscopic assisted talonavicular arthrodesis is possible but that further research is needed to ensure the safety of the technique.
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Affiliation(s)
- Allan William Hammond
- Department of Orthopedics, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
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Safety and efficacy of talonavicular arthroscopy in arthroscopic triple arthrodesis. A cadaveric study. Knee Surg Sports Traumatol Arthrosc 2010; 18:607-11. [PMID: 20217388 DOI: 10.1007/s00167-010-1098-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2009] [Accepted: 02/16/2010] [Indexed: 12/21/2022]
Abstract
This is a cadaveric study on the safety and efficacy of talonavicular arthroscopy in arthroscopic triple arthrodesis. Talonavicular arthroscopy was performed in 18 feet of 9 fresh frozen cadavers. The specimens were divided into 3 groups (6 feet in each group). The articular cartilage of the talar and navicular facet was abraded with a hemostat through the dorsolateral portal in group 1 specimens. The cartilage was abraded through the dorsomedial portal in group 2 specimens and through the medial portal in group 3 specimens. The area of cartilage abrasion represented the working area of the corresponding portal. The working area of individual portal and the relationship of individual portal to the adjacent neurovascular structure were studied. The medial portal averaged 12 mm medial to the long saphenous vein and saphenous nerve. The dorsomedial portal was 1 mm lateral to the intermediate cutaneous branch of superficial peroneal nerve and 5 mm lateral to the extensor hallucis longus tendon. It was 4 mm lateral to the deep peroneal nerve. The dorsolateral portal was 4 mm medial to the lateral branch of superficial peroneal nerve. In group 1, the working area of the dorsolateral portal averaged 60 +/- 4% for the talar facet and 66 +/- 12% for the navicular facet. In group 2, the working area of the dorsomedial portal averaged 56 +/- 3% for the talar facet and 64 +/- 8% for the navicular facet. In group 3, the working area of the medial portal averaged 40 +/- 4% for the talar facet and 55 +/- 11% for the navicular facet. Most of the talar and navicular surfaces can be prepared for fusion without the need of excessive bone removal during arthroscopic triple arthrodesis. This study confirmed the efficacy of the arthroscopic triple arthrodesis and arouses the surgeon about the risk of neural damage especially at the dorsomedial portal.
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Lui TH, Chan KB, Chan LK. Portal safety and efficacy of anterior subtalar arthroscopy: a cadaveric study. Knee Surg Sports Traumatol Arthrosc 2010; 18:233-7. [PMID: 19779892 DOI: 10.1007/s00167-009-0917-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2009] [Accepted: 09/01/2009] [Indexed: 12/24/2022]
Abstract
Anterior subtalar arthroscopy was performed in 14 feet of 7 cadaveric bodies using the primary visualization and working portals. The cartilage of the anterior/middle calcaneal facet that can be reached was marked. The feet were dissected and the distances between the portals and surrounding cutaneous nerves were measured. Any damage to the ligaments of the sinus tarsi was noted. The percentage area of the articular cartilage that was marked was measured. In all specimens, the primary visualization portal tract passed through the lateral root of the inferior extensor retinaculum. The primary working portal tract passed through the lateral root in nine specimens (64%). Cervical ligament was intact in all specimens. In three specimens (21%), the primary visualization portal tract passed through the posterior edge of the intermediate root of the inferior extensor retinaculum. The interosseous talocalcaneal ligament was intact in all specimens. The primary visualization portal tract passed through the medial root of the inferior extensor retinaculum in eight specimens (57%). The primary working portal tract passed through the medial root of the inferior extensor retinaculum in one specimen. The average working area on the calcaneal facet was 95% +/- 4% of the total articular surface. There was no case of nerve injury in all specimens. In conclusion, anterior subtalar arthroscopy is a minimally invasive approach to deal with pathologies of this joint without the need of extensive resection of the ligamentous structures of the sinus tarsi.
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Affiliation(s)
- Tun Hing Lui
- Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong SAR, China.
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Arthroscopic triple arthrodesis in patients with Müller Weiss disease. Foot Ankle Surg 2009; 15:119-22. [PMID: 19635417 DOI: 10.1016/j.fas.2008.08.010] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2008] [Revised: 07/30/2008] [Accepted: 08/27/2008] [Indexed: 02/04/2023]
Abstract
BACKGROUND Müller Weiss disease is a rare disease characterized by collapse of the lateral part of the navicular, outwards protrusion of the talar head and peri-navicular osteoarthrosis. We review the result of six patients treated by arthroscopic triple arthrodesis. METHODS Since 1998, arthroscopic triple arthrodesis was performed in six feet with Müller Weiss disease. The arthroscopic findings were analyzed. The feet were graded by the pre-operative X-rays according to Mareira classification. The consolidation of the triple arthrodesis was assessed by the post-operative X-rays of the operated feet. The clinical outcome was assessed by the modified AOFAS ankle-hindfoot scale. RESULTS All the operated feet fused solidly. The average time for solid fusion was 21 weeks (16-22 weeks). The overall American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was 81.5. CONCLUSIONS Arthroscopic triple arthrodesis is an alternative surgical treatment in management of Müller Weiss disease resisted to conservative treatment. LEVEL OF EVIDENCE Level 4 therapeutic study.
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Minimally invasive soft-tissue and osseous stabilization (MISOS) technique for midfoot and hindfoot deformities. Clin Podiatr Med Surg 2008; 25:655-80, ix. [PMID: 18722905 DOI: 10.1016/j.cpm.2008.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The surgical repair of unstable midfoot and hindfoot deformities in the high-risk patient remains a challenge with little guidance available in the literature. The author presents a proposed surgical intervention for midfoot and hindfoot deformities utilizing a minimally invasive soft-tissue and osseous stabilization (MISOS) approach. The article presents a detailed, step-by-step description of the procedure used for these difficult limb salvage cases.
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