Foot & Ankle Arthroscopy, 2e

Description:

In vivid, step-by-step illustrative detail, Foot and Ankle Arthroscopy, Second Edition thoroughly describes arthroscopic techniques used in the surgical treatment of foot and ankle disorders. Now fully up-to-date, this edition details the advances that have affected the use of arthroscopy in foot and ankle surgery in recent years.  The text covers both the basics of equipment, instrumentation and surgical anatomy, as well as the practical steps surgeons must take to optimize results for each procedure. Key Features:•Comprehensive, current coverage of the basics of ankle arthroscopy, instrumentation and anesthesia, surgical arthroscopy of the foot and ankle, rehabilitation, complications, future developments, and more.•New chapters include: Regional Anesthesia for Foot and Ankle Arthroscopy, Subtalar Joint Pathology, Prone Arthroscopy for Posterior Ankle and Subtalar Joint Pathology, Radiofrequency Use in Ankle and Foot Arthroscopy, Endoscopic Plantar Fascia Release, Gastrocnemius Recession and Intermetatarsal Nerve Decompression, and Endoscopic Procedures for Retrocalcaneal Bursitis, Achilles Tendon, Posterior Tibial Tendon, Peroneal Tendons and Flexor Hallucis Longus Tendon.•Clear, straightforward discussions cover the basics of surgical anatomy, while practical tips and pearls let you learn from master surgeons.•Abundant radiographs and color line drawings explain the techniques and make complex concepts easy to grasp.Now with the print edition, enjoy the bundled interactive eBook edition, which can be downloaded to your tablet and smartphone or accessed online and includes features like: •Complete content with enhanced navigation  •Powerful search tools and smart navigation cross-links that pull results from content in the book, your notes, and even the web•Cross-linked pages, references, and more for easy navigation•Highlighting tool for easier reference of key content throughout the text•Ability to take and share notes with friends and colleagues•Quick reference tabbing to save your favorite content for future use

 

Table of Contents:

 

Section I: Basics of Ankle Arthroscopy

Chapter 1: Historical Developments

Chapter 1 Introduction

Figure 1-1

Figure 1-2

Figure 1-3

Figure 1-4

Figure 1-5

Figure 1-6

Figure 1-7

Figure 1-8

Figure 1-9

Figure 1-10

Figure 1-11

Figure 1-12

Figure 1-13

Figure 1-14

Figure 1-15

Figure 1-16

Figure 1-17

Table 1-1: Time Line of Arthroscopy

Figure 1-18

Figure 1-19

Figure 1-20

Figure 1-21

Figure 1-22: Ankle arthroscopy model.

Advantages and Disadvantages

Indications

Contraindications

Preferred Treatment

References

Suggested Reading

Chapter 2: Preoperative Evaluation and Imaging

Chapter 2 Introduction

Table 2-1: Diagnostic Testing of the Foot and Ankle

History

Physical Examination

Standing Examination

Seated Examination

Ankle

Range of Motion

Ligament Testing

Heel and Heel Cord

Subtalar Joint

Transverse Tarsal Joint

Metatarsophalangeal Joints

Referred Pain

Figure 2-1: Longitudinal arch.

Figure 2-2: Arch types.

Figure 2-3: Windlass mechanism.

Figure 2-4: “Malicious malalignment” syndrome.

Figure 2-5

Figure 2-6: Ankle range of motion.

Figure 2-7: Ankle excursion.

Figure 2-8: Ankle mortise incongruity.

Figure 2-9: Inversion stress test.

Figure 2-10: Anterior drawer test.

Figure 2-11

Figure 2-12

Figure 2-13: Plantar fasciitis.

Figure 2-14: Subtalar motion.

Figure 2-15: Posterior tibial tendon testing.

Figure 2-16

Figure 2-17: Dorsiflexion and plantar flexion of the great toe.

Figure 2-18

Radiologic Imaging

Routine Radiography

Hindfoot Alignment View

Stress Radiographs

Tomography

Fluoroscopy and Arthrography

Nuclear Medicine

Computed Tomography

Figure 2-19: Normal ankle x-rays.

Figure 2-20: Normal radiographic relationships that are important in evaluation of the tibiofibular articulation.

Figure 2-21: Normal foot x-rays.

Figure 2-22: Hindfoot alignment view.

Figure 2-23: Telos pressure bar with LED digital readout.

Figure 2-24

Figure 2-25

Figure 2-26: Telos device positioning for the subtalar stress test.

Figure 2-27

Figure 2-28

Figure 2-29

Figure 2-30

Figure 2-31: Positioning for CT scan images.

Figure 2-32: Comminuted calcaneal fracture with small fracture fragment trapped within the posterior subtalar joint.

Figure 2-33: Triplane fracture of the ankle.

Figure 2-34: Coronal CT scan in a patient with an interosseous ganglion of the talus.

Figure 2-35: Osteochondral lesion of the medial dome of the talus.

Figure 2-36

Figure 2-37: Sagittal CT scans of the foot.

Figure 2-38: Total ankle replacement.

Ultrasound: Musculoskeletal Ultrasound Imaging Pearls

Reporting Gray Scale Shades on Ultrasound

Posterior Region Structures (Fig. 2-45)

Posterior Region Pathology

Medial Region Structures (Fig. 2-49A, B)

Medial Region Pathology

Anterior Region Structures

Anterior Region Pathology

Lateral Region Structures

Lateral Region Common Pathology

Magnetic Resonance Imaging

Ligaments

Anterolateral Soft Tissue Impingement Syndrome

Tendons

Cartilage Imaging

Osteochondral Lesions

Tarsal Tunnel Syndrome

Other Conditions

Imaging in the Diabetic Foot

Kinematic CT and MRI

3-Dimensional Stereoscopic Imaging

Figure 2-39

Figure 2-40: Injection of the ankle joint.

Figure 2-41

Figure 2-42

Figure 2-43

Figure 2-44

Figure 2-45

Figure 2-46

Figure 2-47

Figure 2-48: Achilles tendon partial tear.

Figure 2-49: Medial region structures.

Figure 2-50: Posterior tarsal tunnel.

Figure 2-51

Figure 2-52

Figure 2-53

Figure 2-54

Figure 2-55

Figure 2-56

Figure 2-57: Peroneal brevis (PB) tendon split tear.

Figure 2-58

Table 2-2: Characteristic MRI Findings

Figure 2-59

Table 2-3: Preferred MRI Techniques

Figure 2-60: Fibro-osseous calcaneonavicular coalition.

Figure 2-61: Painful accessory navicular.

Figure 2-62: Acute tear of the anterior tibiofibular ligament.

Figure 2-63: Anterolateral soft tissue impingement.

Figure 2-64: Peroneal brevis tear.

Figure 2-65: Osteochondral lesion, medial talar dome.

Figure 2-66: Advanced Müller-Weiss Syndrome.

Figure 2-67: Ganglion cyst of the tarsal tunnel.

Figure 2-68: Pigmented villonodular synovitis of the ankle.

References

Suggested Reading

Chapter 3: Instrumentation

Chapter 3 Introduction

Irrigation

Gravity

Preferred Method

Arthroscopy Pumps

Table 3-1: Arthroscopic Solutions

Figure 3-1: Inflow rates.

Figure 3-2: Fluid tubing connection.

Figure 3-3: Arthroscopic pumps.

Figure 3-4

Arthroscopes

Construction and Manipulation

Field of View

Inclination of View

Clarity

Arthroscopic Movement

Pistoning

Angulation

Rotation

Cannulae

Figure 3-5

Figure 3-6

Figure 3-7

Figure 3-8

Figure 3-9

Light Sources/Light Guides

Figure 3-10

Distraction Devices

Noninvasive

Invasive

Preferred Method

Figure 3-11

Figure 3-12: Noninvasive distraction.

Figure 3-13

Video Standards and Formats

Standards

Video Formats (Standard Definition)

Composite

Y-C (S-VHS)

RGB

Preferred Analog Method (Standard Definition)

Digital Video Formats (High Definition)

HD-SDI (High-Definition Serial Digital Interface)

HD-DVI (High-Definition Digital Visual Interface)

Common Video Standards

System Resolution

Figure 3-14

Figure 3-15

Figure 3-16

Figure 3-17: Weak link theory.

Video Cameras and Couplers

Figure 3-18

Figure 3-19

Video Monitors

Documentation

Video Recorders (Standard Definition)

Photography

Video Printing

Digital Imaging

Preferred Method

Figure 3-20

Instrument Sterilization

Figure 3-21

Accessory Instruments

Needles

Probes

Elevators

Graspers

Basket Forceps

Knives

Curettes

Osteotomes and Rasps

Microfracture Picks

Switching Sticks

Retrieving Instruments

Figure 3-22: Small-joint foot and ankle instrument tray.

Figure 3-23: Small-joint probes.

Figure 3-24: Small-joint elevators.

Figure 3-25: Grasping instruments.

Figure 3-26: Different sizes of pituitary forceps are useful for removing soft tissue and small fragments of bone.

Figure 3-27

Figure 3-28: Basket forceps.

Figure 3-29: Small-joint suction punch.

Figure 3-30

Figure 3-31

Figure 3-32: Anterior lesion curette.

Figure 3-33: Small-joint osteotomes.

Figure 3-34: Microfracture picks.

Figure 3-35: Golden retriever suction magnet.

Power Instruments

Figure 3-36

Figure 3-37: Small-joint burrs.

Figure 3-38

Repair Instrumentation

Figure 3-39: Small-joint suture anchors.

Figure 3-40

Figure 3-41

Other Instruments

Thigh Holder

Aiming Devices

Radiofrequency Probes

Figure 3-42

Figure 3-43

Cautions

Table 3-2: Instruments for Ankle and Foot Arthroscopy

Acknowledgments

References

Suggested Reading

Chapter 4: Operating Room Environment and the Surgical Team

Chapter 4 Introduction

Operating Room

Figure 4-1

Patient Preparation and Position

Figure 4-2: Right ankle.

Figure 4-3: OR table preparation.

Figure 4-4: Right ankle.

External Anatomic Landmarks

Figure 4-5: Anterior view, right ankle.

Distraction

Noninvasive

Invasive

Lateral

Medial

Preferred Method

Figure 4-6: Distraction of a right ankle.

Figure 4-7: Setup for soft tissue distraction in a right ankle.

Figure 4-8

Figure 4-9: Insertion of lateral tibial pin.

Figure 4-10: Posterior view.

Figure 4-11

Figure 4-12: Medial pin insertion.

Operating Room Personnel

Figure 4-13

Figure 4-14

Operating Room Setup

Equipment Location

Procedure

Table 4-1: Surgical Team Responsibilities

Figure 4-15: Operative setup.

Figure 4-16: Posterior portal access, right ankle.

References

Suggested Reading

Chapter 5: Correlative Surgical Anatomy

Evolution

Embryology

Skin and Subcutaneous Fascia

Figure 5-1: Cleavage lines on the dorsal skin of the foot.

Landmarks

Figure 5-2: Topical lateral ankle anatomy.

Figure 5-3: Topical medial ankle anatomy.

Figure 5-4

Figure 5-5

Figure 5-6: Dorsal anatomy of the ankle and foot.

Figure 5-7: Lateral anatomy of the ankle and foot.

Figure 5-8: Medial anatomy of the ankle and foot.

Nerves

Subcutaneous Layer

Superficial Peroneal Nerve

Sural Nerve

Saphenous Nerve

Deep Fascial Layer

Deep Peroneal Nerve

Lateral Ankle

Tarsal Tunnel and Tibial Nerve

Ankle Joint

Synovial Folds

Ligaments of the Ankle

Tibiofibular Syndesmosis

Lateral Ligaments

Portals

Figure 5-9: The superficial peroneal nerve.

Figure 5-10

Figure 5-11: Anatomic variations of the superficial peroneal nerve.

Figure 5-12: Posterior view of the hindfoot.

Figure 5-13: Lateral view of a right ankle anatomic specimen.

Figure 5-14

Figure 5-15

Figure 5-16: Anterior view.

Figure 5-17

Figure 5-18: Synovial fringe seen in the recess between the tibia and fibula.

Figure 5-19: Soft tissue folds of the ankle.

Figure 5-20

Figure 5-21: Posterior ankle ligaments.

Figure 5-22: Subtype configurations of posterior inferior tibiofibular ligament (PITFL) and transverse tibiofibular ligament (TTFL).

Figure 5-23: Medial ligaments of the hindfoot.

Figure 5-24

Figure 5-25: The spring ligament.

Figure 5-26

Figure 5-27: Posterior view of a right ankle.

Table 5-1: Portal and the Nearest Anatomy at Risk for Ankle Arthroscopy

Table 5-2: Portal and the Nearest Anatomy at Risk for Subtalar Arthroscopy

Cross-Sectional Anatomy

Distal Tibia

Ankle Joint

Talus

Figure 5-28

References

Suggested Reading

Chapter 6: Regional Anesthesia for Foot and Ankle Arthroscopy

Introduction

Relevant Anatomy

Sciatic Nerve

Tibial Nerve

Medial Plantar Nerve

Lateral Plantar Nerve

Common Peroneal Nerve

Superficial

Deep Peroneal Nerve

Saphenous Nerve

Sural Nerve

Figure 6-1

Table 6-1: Sensory Innervation of Terminal Branches

Figure 6-2: Medial anatomy of the ankle and foot.

Figure 6-3: Dissection of the right medial foot and ankle, including the tarsal tunnel.

Figure 6-4

Figure 6-5

Figure 6-6: Right ankle anatomic dissection of the superficial peroneal nerve and its branches.

Figure 6-7

Figure 6-8

Figure 6-9

Figure 6-10: The saphenous nerve.

Figure 6-11: The sural nerve.

Local Anesthetics

Types: Structure and Function

Clinical Utility

Risks of Local Anesthetics

Local Anesthetic Systemic Toxicity

Additives

Table 6-2: Local Anesthetics and Duration of Anesthesia

Types of Lower Extremity Peripheral Nerve Blocks

Introduction

Peripheral Nerve Blocks for Ankle Surgery

Equipment

Peripheral Nerve Stimulator

PNS Advantages

Recommended PNS Set Up for PNB

Mixed Nerve (Most PNB)

Sensory Nerve (i.e., Saphenous)

Diabetic Neuropathy (PNB)

Evoked Motor Response

Common Responses to Nerve Stimulation and Corrective Actions

Ultrasound Guidance for PNB

Ultrasound Guidance Advantages

Sciatic Nerve Block

Infragluteal Parabiceps Approach

Lateral Midfemoral Approach

Lateral Decubitus Approach: Author’s Preferred Approach for Sciatic Block

Popliteal

Classic Approach: Traditional Low Popliteal

Lateral Approach

Supine Approach

Author’s Preferred Approach for Popliteal Block

Ankle

Individual Peripheral Nerves: Author’s Preferred Approaches for Ankle Block

Deep Peroneal Nerve

Superficial Peroneal Nerve

Sural Nerve

Saphenous Nerve

Tibial Nerve

Figure 6-12: Static block using the lateral decubitus position.

Figure 6-13: Popliteal nerve block technique.

Figure 6-14: Nerve localization.

Figure 6-15: Lateral approach for sciatic nerve block.

Figure 6-16

Figure 6-17: Posteromedial view of the right hindfoot.

Figure 6-18

IV Regional Anesthesia (Bier Block)

Contraindications

Advantages

Side Effects

Complications

Summary

Contraindications

Risks

Nerve Injury

Infection

Hemorrhagic Complications

Table 6-3: Recommendations: Performing Regional Anesthesia in Anesthetized or Heavily Sedated* Patients

Neuraxial (Spinal/Epidural) for Lower Extremity Anesthesia

Table 6-4: Advantages and Disadvantages to Neuraxial Anesthesia for the Ambulatory Patient

References

Suggested Reading

Chapter 7: Diagnostic Arthroscopic Examination

Chapter 7 Introduction

Portals

Anterior Portals

Accessory Anterior Portals

Posterior Portals

Accessory Posterior Portals

Transmalleolar and Transtalar Portals

Figure 7-1: Anterior anatomy.

Figure 7-2: Posterior anatomy.

Figure 7-3: Preferred accessory posteromedial portal.

Figure 7-4: Double posteromedial portals for posterior ankle arthroscopy in the supine position.

Figure 7-5: Anterior view.

Surgical Technique (Preferred Method)

Figure 7-6

Figure 7-7

Figure 7-8: Establishing the anteromedial portal.

Figure 7-9

Figure 7-10: Intraoperative picture with cannula through the anterolateral portal with inflow attached.

Figure 7-11: Establishing the posterolateral portal in a right ankle.

Arthroscopic Anatomy

Normal Ankle

Anterior Ankle Examination

Central Ankle Examination

Posterior Ankle Examination

Traction and Neurologic Injury

Figure 7-12: Eight-point anterior examination (viewed from the anteromedial portal).

Figure 7-13: Six-point central examination (viewed from the anteromedial portal).

Figure 7-14: Seven-point posterior examination (viewed from the posterolateral portal).

Figure 7-15

Postoperative Management

Figure 7-16

Figure 7-17

References

Suggested Reading

Section Ii: Surgical Arthroscopy

Chapter 8: Soft Tissue Lesions of the Ankle

Chapter 8 Introduction

Anatomy and Histology

Figure 8-1

Classification

Patient Evaluation

Table 8-1: Management of Chronic Ankle Pain

Congenital Plicae

Trauma

Nonspecific Generalized Synovitis

Nonspecific Localized Synovitis

Soft Tissue Impingement

Anterolateral Impingement

Figure 8-2: Arthroscopic view of a fibrous band traversing the anterior lateral ankle in a 25-year-old patient.

Figure 8-3

Figure 8-4

Table 8-2: Sequence of Lateral Ankle Pain

Anatomy

Figure 8-5: Anterolateral ankle anatomy.

Clinical Presentation

Figure 8-6

Figure 8-7

Arthroscopic Appearance

Figure 8-8: Soft tissue impingement.

Treatment

Preferred Method

Figure 8-9: Debridement of the lateral gutter.

Figure 8-10: The effect of dorsiflexion and plantar flexion of the ankle on the lateral gutter.

Figure 8-11: Visualization of the lateral gutter of the left ankle from the anteromedial portal.

Postoperative Treatment

Pathologic Findings

Figure 8-12

Clinical Results

Syndesmotic Impingement

Figure 8-13: Tibiofibular joint mechanics.

Figure 8-14: Syndesmotic impingement.

Clinical Presentation

Figure 8-15: Accessory fascicle of the AITFL.

Arthroscopic Appearance

Figure 8-16

Figure 8-17

Preferred Method

Posterior Impingement

Figure 8-18: Excision of a frayed syndesmotic ligament.

Figure 8-19: Posterior impingement sites.

Clinical Presentation

Arthroscopic Appearance and Treatment

Medial Impingement

Figure 8-20

Figure 8-21

Figure 8-22: Pseudomeniscus.

Figure 8-23: Posterolateral synovial nodule excision.

Figure 8-24: Medial soft tissue impingement.

Clinical Presentation

Imaging

Arthroscopic Findings and Treatment

Results

Rheumatic Diseases

Rheumatoid Arthritis

Pigmented Villonodular Synovitis

Figure 8-25: Rheumatoid arthritis.

Clinical Presentation

Arthroscopic Appearance and Treatment

Synovial Chondromatosis

Figure 8-26

Figure 8-27: Synovial chondromatosis.

Clinical Presentation

Arthroscopic Appearance and Treatment

Hemophilia and von Willebrand Disease

Figure 8-28: von Willebrand disease.

Clinical Presentation

Other Inflammatory Arthritides

Figure 8-29: Gout.

Infection

Preferred Method of Ankle Synovectomy

References

Chapter 9: Articular Cartilage Defects of the Ankle

Introduction

History

Basic Science

Figure 9-1

Terminology

Etiology and Incidence

Figure 9-2

Location and Characteristics of Lesion

Figure 9-3: Location of osteochondral lesions of the talus.

Figure 9-4: The size of the osteochondral lesion varies by location.

Figure 9-5: Topographic anatomic map of the nine zones of the talar dome.

Mechanism of Injury

Figure 9-6

Figure 9-7: Development of the osteochondral lesion.

Clinical Presentation

Diagnosis

Figure 9-8: Hindfoot CT scan in two planes.

Figure 9-9: MRI of osteochondral lesion of the talus.

Figure 9-10: A sagittal cropped and colored T2 map is depicted of the knee.

Classification and Staging

Figure 9-11: Drawings illustrating the methods of manipulation of amputation specimens.

Table 9-1: CT Classification

Figure 9-12: CT scan classification.

Table 9-2: MRI Classification

Figure 9-13

Figure 9-14

Table 9-3: Surgical Grade Based on Articular Cartilage

Figure 9-15

Surgical Indications

Treatment Goals

Surgical Treatment

Table 9-4: Comparison of Arthrotomy Treatment Results

Preferred Approach

Technique for Acute and Chronic OLT

Principles of Acute OLT

Principles of Chronic OLT

Table 9-5: Treatment of Acute OLT

Figure 9-16: Acute osteochondral lesion of the talus.

Figure 9-17

Table 9-6: Treatment of Chronic OLT

Specific Lesions

Acute Anterolateral Lesions

Chronic Anterolateral Lesions

Posterolateral Lesions

Anteromedial Lesions

Posteromedial Lesions

Large Cystic OLT

Osteochondral Lesions of the Tibial Plafond

Postoperative Care

Results

Newer Treatment Alternatives

Osteochondral Autograft Transplantation

Results

Osteochondral Allograft Transplantation

Results

Autologous Chondrocyte Implantation

Results

Second-Generation ACI

Hyalograft C

Membrane/Matrix Autologous Chondrocyte Implantation

Postoperative Management

Figure 9-18: Arthroscopic example of an acute LIFT lesion in a right ankle.

Figure 9-19: Acute osteochondral lesion of the talus.

Figure 9-20: Case of an acute LIFT lesion treated arthroscopically with absorbable pin fixation.

Figure 9-21: Schematic diagram of longitudinal incision with “Broström” approach to talar dome for lateral OLT.

Figure 9-22: Case of open fixation of an acute-on-chronic anterolateral osteochondral lesion of the talus in a left ankle in a 17-year-old male.

Figure 9-23: Diagram of the posterior ankle ligaments.

Figure 9-24

Figure 9-25: Case of a posterolateral osteochondral lesion of the talus in a left ankle.

Figure 9-26

Figure 9-27: Excision of a chronic osteochondral lesion of the medial dome of the talus.

Figure 9-28: Curettage of the osteochondral lesion base.

Figure 9-29

Figure 9-30: Transmalleolar drilling with the arthroscope in the anterolateral portal.

Figure 9-31: Transmalleolar drilling with the arthroscope posterolaterally.

Figure 9-32: Use of the offset drill guide.

Figure 9-33: Transmalleolar drilling technique.

Figure 9-34: Transtalar (TT) drilling through the sinus tarsi.

Figure 9-35: Case of a 13-year-old girl with a posteromedial cystic lesion with an intact cartilage rim.

Figure 9-36

Table 9-7: Tips for Improved Access to PM OLT

Figure 9-37: Transtalar drilling of an osteochondral lesion of the medial dome of the talus.

Figure 9-38

Figure 9-39: Preparation of bone graft for cystic lesions.

Figure 9-40: Case of a large cystic osteochondral lesion of the talus in a left ankle.

Figure 9-41: Anatomic topographic map of the distal tibial plafond.

Figure 9-42: Case of an osteochondral lesion of the tibial plafond (OLTP).

Figure 9-43

Figure 9-44

Figure 9-45

Figure 9-46

Figure 9-47

Figure 9-48: Osteochondral graft harvested from a fresh, frozen talus allograft.

Figure 9-49: Medial malleolar osteotomy in a left ankle.

Figure 9-50: Case of autologous chondrocyte implantation (ACI).

Figure 9-51: Schematic of sandwich procedure.

Figure 9-52

Figure 9-53

Figure 9-54

The Future

Third-Generation ACI

Conclusion

Figure 9-55: Juvenile particulated cartilage insertion in a right ankle.

Figure 9-56: Metallic focal resurfacing implant, as demonstrated on a cadaver right ankle.

Table 9-8: Guideline for Treatment of Osteochondral Talar Lesions

References

Suggested Reading

Chapter 10: Osteophytes, Loose Bodies, Posttraumatic Problems, and Foreign Bodies

Chapter 10 Introduction

Anterior Bony Impingement

Etiology

Figure 10-1

Figure 10-2: Bony anatomy of the talus.

Clinical Presentation

Radiographic Evaluation

Figure 10-3: Anterior tibial osteophytes.

Figure 10-4

Table 10-1: Scranton-McDermott Classification of Anterior Ankle Impingement

Table 10-2: van Dijk Osteoarthritis Classification

Figure 10-5: Anteromedial impingement view (AMI).

Figure 10-6: Osteophyte formation.

Figure 10-7: Anterior bony impingement.

Nonoperative Management

Operative Technique

Figure 10-8: Arthroscopic setup in a left ankle with noninvasive distraction.

Figure 10-9

Figure 10-10: Removal of osteophyte with a burr.

Figure 10-11

Figure 10-12

Figure 10-13: Excision of osteophyte by burr.

Figure 10-14

Figure 10-15: Excision of a large anterior distal tibial osteophyte.

Figure 10-16: Osteophyte removal using the posterolateral portal.

Nonunion of Osteophytes

Figure 10-17: Nonunion of osteophyte.

CAM-Type Impingement

Figure 10-18: Ankle cam impingement.

Tram Tracks

Figure 10-19: Tram tracks.

Figure 10-20: Tram tracks.

Divot Sign

Postoperative Care

Results of Anterior Bony Impingement

Posterior Bony Impingement

Figure 10-21: Posterior bony impingement in a ballet dancer.

Figure 10-22: Posterior bony impingement.

Table 10-3: Posterior Ankle Pain Syndromes in Dancers

Figure 10-23

Table 10-4: Flexor Hallucis Longus Tendinitis versus Posterior Impingement of the Ankle

Figure 10-24: Posterior talus morphology.

Figure 10-25

Figure 10-26

Figure 10-27: Posterior ankle arthroscopy in the prone position.

Posteromedial Impingement

Loose Bodies

Figure 10-28

Symptoms

Physical Examination

Radiographic Evaluation

Figure 10-29

Figure 10-30: Extensive anterior ankle loose bodies and osteophytes.

Surgical Approach

Figure 10-31: Loose body removal.

Figure 10-32

Figure 10-33

Figure 10-34: Multiple posterior ankle loose bodies.

Arthrofibrosis

Foreign Bodies

Figure 10-35: Screw penetration into the joint.

Figure 10-36: Broken grasper.

Figure 10-37: Broken needle after nerve conduction velocity test.

References

Suggested Reading

Chapter 11: Arthroscopic Treatment of Acute Ankle Fractures and Postfracture Problems

Chapter 11 Introduction

Advantages of Arthroscopy

Indications

Contraindications

Acute Ankle Fractures

Articular Injuries Associated with Fractures

Figure 11-1: Talar articular surface lesions.

Preoperative Planning

General Principles of Arthroscopic-Assisted Fracture Treatment

Postoperative Care

Author’s Preferred Method

Treatment of Specific Fracture Patterns

Medial Malleolar Fracture

Fibular Fracture with Osteochondral Lesion

Posterior Malleolar Fracture

Syndesmotic Injuries

Figure 11-2

Figure 11-3: Medial malleolar fracture.

Figure 11-4

Figure 11-5

Figure 11-6: Weber type B fracture/subluxation of the right ankle.

Figure 11-7: Weber type B fracture/subluxation of the ankle.

Figure 11-8

Figure 11-9: Posterior malleolus fracture.

Figure 11-10: Fracture of the right lateral and posterior malleoli.

Figure 11-11

Figure 11-12: Syndesmotic injury of left ankle.

Figure 11-13: Syndesmotic injury.

Figure 11-14: Syndesmotic injury.

Figure 11-15: Maisonneuve fracture–dislocation.

Anterior Margin Fracture

Pilon Fractures

Talus Fractures

Pediatric Fractures

Epiphyseal Fractures

Tillaux Fracture

Triplane Fracture

Complications

Clinical Results

Chronic Ankle Problems

Arthroscopic Treatment

Setup and Procedure

Figure 11-16

Figure 11-17: Adult Tillaux fracture of a left ankle.

Figure 11-18: Arthroscopic reduction and internal fixation of an anterolateral fracture of the tibia.

Figure 11-19: Arthroscopic evaluation and reduction of a pilon fracture.

Figure 11-20: Pilon fracture.

Figure 11-21: Displaced talus fracture.

Figure 11-22

Figure 11-23: Tillaux fracture of a left ankle.

Figure 11-24: Triplane fractures of a right ankle.

Figure 11-25: Triplane fracture of a left ankle.

Arthrofibrosis and Ankle (Bone and Soft Tissue) Impingement

Figure 11-26: Arthrofibrosis in a left ankle after fracture and ORIF.

Figure 11-27: Arthrofibrosis of the ankle.

Syndesmotic Impingement

Synovitis

Hardware Removal

Figure 11-28: Hardware complication.

Figure 11-29: Hardware removal.

Clinical Results

Conclusion

References

Suggested Reading

Chapter 12: Arthroscopic and Open Approaches to Ankle Instability

Introduction

Figure 12-1

History

Anatomy and Biomechanics

Figure 12-2

Figure 12-3

Figure 12-4

Figure 12-5

Figure 12-6

Mechanisms of Injury

Clinical Presentation

Figure 12-7: Anterior drawer stress test.

Figure 12-8: Plantar flexion inversion stress test.

Diagnosis

Figure 12-9

Figure 12-10

Figure 12-11

Surgical Indications

Surgical Treatment

Figure 12-12: Arthroscopic view of a right ankle demonstrating the lateral gutter.

Figure 12-13: ArthroBrostrom: anatomical study.

Figure 12-14: Arthroscopic ArthroBrostrom procedure.

Preferred Techniques

Anatomic Repair

Hamstring Reconstruction

Broström-Evans Procedure

Repair of Deltoid Ligament

Allograft Reconstruction

Figure 12-15: Modified Broström procedure.

Figure 12-16: Modified Broström procedure.

Figure 12-17

Figure 12-18

Figure 12-19

Table 12-1: Indications for Using Semitendinosus Allograft to Correct Lateral Ankle Instability

Figure 12-20: Hamstring reconstruction.

Figure 12-21: Hamstring reconstruction.

Figure 12-22: Hamstring reconstruction.

Figure 12-23: Securing the graft.

Figure 12-24: Hamstring reconstruction.

Figure 12-25: Hamstring reconstruction.

Figure 12-26: Hamstring reconstruction.

Figure 12-27: Broström-Evans procedure.

Figure 12-28: Broström-Evans procedure.

Figure 12-29: Broström-Evans procedure.

Figure 12-30: Deltoid ligament repair.

Figure 12-31: Deltoid allograft reconstruction.

Postoperative Rehabilitation

Results

Conclusion

References

Suggested Readings

Chapter 13: Arthroscopic Ankle Arthrodesis

Chapter 13 Introduction

Advantages and Disadvantages

Indications and Contraindications

Figure 13-1: Mortise x-ray of the right ankle demonstrating significant talar tilt and varus angulation.

Fusion Position and Biomechanics

Figure 13-2: Fusion position.

Operative Technique

Setup and Instrumentation

Distraction

Portals

Intraoperative Imaging

Procedure

Cartilage Removal

Bone Removal

Guide Pin Insertion

Bone Grafting

Figure 13-3

Figure 13-4

Figure 13-5

Figure 13-6: Lateral pin distraction is done through the distal tibia and calcaneus.

Figure 13-7

Figure 13-8: Prearthrodesis evaluation.

Figure 13-9: Preparing the joint surfaces for fusion.

Figure 13-10

Figure 13-11

Figure 13-12: Osteophyte excision while visualizing from the posterior portal.

Figure 13-13

Figure 13-14: Inserting the cannulated screws in right ankle.

Figure 13-15

Deformity Correction

Figure 13-16: Correction of ankle deformities.

Figure 13-17: Correcting resistant ankle deformity.

Postoperative Care

Results

Table 13-1: Recommended Sports Participation after Ankle Arthrodesis

Case Studies

Figure 13-18: A 53-year-old male presents with several years of ankle pain demonstrating osteoarthritis of the ankle and normal preoperative alignment.

Figure 13-19: A 65-year-old male rancher presents with end-stage degenerative arthritis of the ankle in severe valgus preoperative alignment after failing conservative management.

Figure 13-20: A 53-year-old male construction foreman presents with severe varus preoperative ankle alignment after several work-related injuries to the affected leg.

Figure 13-21: A 56-year-old male presents with history of recurrent ankle sprains and large cystic lesions in his talus with concomitant posttraumatic tibiotalar arthritis.

Conclusions

References

Suggested Reading

Chapter 14: Subtalar Arthroscopy: Anatomy, Setup, and Normal Exam

Chapter 14 Introduction

Embryology and Morphology

Landmarks

Intra-articular Anatomy

Indications for Arthroscopy

Contraindications

Portals

Instrumentation

Technique

Preferred Approach

Diagnostic Examination

Anterior Subtalar Arthroscopy

Simultaneous Subtalar and Ankle Arthroscopy

Subtalar Pathology

Figure 14-1: Ligaments of the right subtalar joint.

Figure 14-2: Posterolateral view of the right ankle.

Figure 14-3

Figure 14-4

Figure 14-5: Sinus tarsi.

Table 14-1: Lateral Ligamentous Support of the Subtalar Joint

Figure 14-6: Peripheral ligaments.

Figure 14-7: Deep ligaments.

Figure 14-8: Subtalar portals.

Figure 14-9: Posterolateral and posteromedial portals.

Figure 14-10: The posterolateral portal in a right ankle.

Table 14-2: Instruments for Subtalar Arthroscopy

Figure 14-11

Figure 14-12

Figure 14-13: Noninvasive distraction in a right ankle.

Figure 14-14: Distention of the subtalar joint.

Figure 14-15

Figure 14-16: Intra-articular shaving.

Figure 14-17: Creating the anterolateral portal.

Figure 14-18: Three-portal technique.

Table 14-3: 13-Point Subtalar Examination

Figure 14-19: Six-point examination of the subtalar joint (viewed from the central portal).

Figure 14-20: Seven-point examination of the subtalar joint (viewed from the posterolateral portal).

Figure 14-21: Key point.

References

Suggested Reading

Chapter 15: Subtalar Joint Pathology

Chapter 15 Introduction

Painful OS Trigonum

Introduction

Anatomy

Table 15-1: Etiologic Classification of Posterior Ankle Impingement Syndrome

Figure 15-1: Subtalar anatomy of a right ankle.

Figure 15-2: Posterior talus morphology.

Figure 15-3: Bipartite os trigonum.

Classification

Clinical Presentation and Treatment

Author’s Preferred Technique: Os Trigonum Removal

Postoperative Care

Results

Figure 15-4: Plantar flexion of the ankle.

Figure 15-5: Painful os trigonum.

Figure 15-6: Painful os trigonum.

Figure 15-7

Table 15-2: Flexor Hallucis Longus Tendinitis versus Posterior Impingement of the Ankle

Figure 15-8: Arthroscopic setup for excision of os trigonum in a right ankle.

Figure 15-9: Excision of os trigonum, right ankle.

Figure 15-9

Figure 15-9

Figure 15-9

Sinus Tarsi Syndrome, Chronic Sprain Pain, and Other Soft Tissue Lesions of the Subtalar Joint

Introduction

Anatomy

Clinical Presentation and Treatment

Author’s Preferred Technique

Postoperative Care

Results

Figure 15-10: Ganglion cyst in the posterior subtalar joint.

Figure 15-11: Sinus tarsi syndrome.

Figure 15-12: Sinus tarsi syndrome.

Osteochondral Lesions of the Subtalar Joint and Removal of Loose Bodies

Introduction

Clinical Presentation and Treatment

Author’s Preferred Technique

Postoperative Care

Results

Figure 15-13: Osteochondral lesion of the talus in a left subtalar joint.

Figure 15-14: Osteochondral lesion of the calcaneus in a right subtalar joint.

Figure 15-15

Intra-Articular Talus and Calcaneus Fractures

Introduction

Clinical Presentation and Treatment

Technique

Talar Neck and Body Fractures

Lateral Process Fractures

Calcaneus Fractures

Postoperative Care

Results

Anterior Calcaneal Process Fractures

Figure 15-16: Talar neck fracture.

Figure 15-17: Intra-articular subtalar fracture.

Figure 15-18: Lateral talar process fracture.

Figure 15-19: Nonunion of a lateral talar process fracture in a left hindfoot.

Figure 15-20: Depressed lateral posterior facet fragment of the calcaneus.

Figure 15-21: Sanders type 2B fracture of the calcaneus in a 22-year-old patient.

Subtalar Arthritis

Introduction

Clinical Presentation and Treatment

Author’s Preferred Technique

Postoperative Care

Results

Unusual Causes of Subtalar Pain

Figure 15-22

Figure 15-23: Arthroscopic right subtalar arthrodesis.

Figure 15-24: Bullet in subtalar joint.

Figure 15-25: Removal of a STA-peg–type implant in the subtalar joint.

Figure 15-26: Intraosseous tophus deposits in the os trigonum.

References

Suggested Readings

Chapter 16: Arthroscopy of the Great and Lesser Toes

Introduction

Gross Anatomy

Figure 16-1

Figure 16-2: Sesamoid position.

Figure 16-3

Figure 16-4

Figure 16-5: Dorsal view of the neurovascular supply of the great toe.

Biomechanics

Patient Evaluation

Indications for Arthroscopy

Portals

Figure 16-6: Dorsal view of great-toe portals.

Figure 16-7: Medial oblique view of great-toe portals.

Figure 16-8

Instrumentation

Figure 16-9: Small-joint video arthroscopes.

Figure 16-10

Distraction

Table 16-1: Suggested Equipment for Great-Toe and Lesser-Toe Arthroscopy

Preferred Method

Figure 16-11: Great-toe arthroscopy setup.

Figure 16-12: Preferred method for great-toe arthroscopy.

Arthroscopic Anatomy

Figure 16-13: Thirteen-point examination of the great-toe MTP joint (viewed from the dorsolateral portal).

Figure 16-14: Five-point medial examination of the great toe MTP joint (viewed from the medial portal, sagittal head removed).

Pathology

Synovitis and Chondromalacia

Figure 16-15

Treatment of Dorsal Impingement in Hallux Rigidus, Type 1 and 2

Osteochondral Lesions of the Metatarsal Heads and Phalanx

Loose Bodies

Arthrofibrosis

Gout

Sesamoidectomy

Hallux Valgus Medial Capsule Imbrication18,19,20

Arthrodesis

Infection

Figure 16-16: Excision of dorsal osteophyte.

Figure 16-17: Osteochondral lesion of the metatarsal head in a 35-year-old professional basketball player.

Figure 16-18

Figure 16-19

Figure 16-20: Gouty tophi.

Clinical Results

Arthroscopy of the Lesser Toes

Table 16-2: Diagnosis of Great-Toe Arthroscopy Patients

Figure 16-21: Freiberg infraction.

Figure 16-22: Freiberg infraction.

Figure 16-23

References

Suggested Reading

Chapter 17: Prone Arthroscopy for Posterior Ankle and Subtalar Joint Pathology

Introduction

Normal Anatomy of the Posterior Ankle

Figure 17-1: Right subtalar joint bony anatomy.

Figure 17-2: Posterior aspect of the left ankle and subtalar joints.

Indications, Clinical Examination, and Workup

Setup

Figure 17-3: Patient positioning.

Surgical Technique and Normal Arthroscopic Anatomy

Figure 17-4: Prone left hindfoot arthroscopy.

Figure 17-5: Normal arthroscopic anatomy of the left subtalar joint.

Figure 17-6: Operative picture showing the distractor in place with the minimally invasive distraction device attached to a frame.

Figure 17-7: Normal arthroscopic anatomy of the left tibiotalar joint.

Osteochondral Lesions

OS Trigonum Syndrome and FHL Tenosynovitis

Figure 17-8

Figure 17-9: FHL debridement and removal of enlarged posterolateal process of the right talus.

Posterior Arthroscopic Subtalar Arthrodesis

Figure 17-10: Posterior arthroscopic subtalar arthrodesis.

Figure 17-11: Posterior arthroscopic subtalar arthrodesis.

Fractures

Posteromedial Impingement

Coalition Excision

Table 17-1: Indications and Contraindications for Arthroscopic Resection of TCCs

Figure 17-12: Nonosseous talocalcaneal coalition (TCC).

Table 17-2: Treatment of Talocalcaneal Coalition

Conclusions

Table 17-3: Key Points to Improve Safety of Posterior Hindfoot Endoscopy

References

Suggested Reading

Chapter 18: Radiofrequency Use in Ankle and Foot Arthroscopy

Chapter 18 Introduction

History

Principles

Technique

Figure 18-1

Arthroscopic Indications

Figure 18-2

Figure 18-3: Synovitis of the posterior ankle joint.

Minimally Invasive Surgical Indications

Figure 18-4

Figure 18-5

Conclusion

References

Suggested Reading

Chapter 19: Endoscopic Plantar Fascia Release, Gastrocnemius Recession, and Intermetatarsal Nerve Decompression

Chapter 19 Introduction

Endoscopic Plantar Fascia Release

Anatomy

Indications/Contraindications

Instrumentation and Portals

Author’s Preferred Technique

Results

Complications

Controversy

Conclusions

Figure 19-1

Figure 19-2: Windlass mechanism.

Table 19-1: Differential Diagnosis for Heel Pain

Figure 19-3

Figure 19-4

Figure 19-5

Figure 19-6: Establishing the medial portal in a right hindfoot.

Figure 19-7

Figure 19-8

Figure 19-9: Use of the fascial elevator to clear the pathway for the arthroscope.

Figure 19-10

Figure 19-11: Establishing the lateral portal.

Figure 19-12: Inserting the arthroscope.

Figure 19-13

Figure 19-14

Figure 19-15: Plantar fascia incision.

Figure 19-16: Plantar fascia release.

Table 19-2: Summary of the Literature and Reported Outcomes with EPFR

Figure 19-17

Endoscopic Gastrocnemius Resection

Anatomy

Indication/Contraindications

Portals and Instrumentation

Preferred Technique

Postoperative Care

Results

Future

Figure 19-18

Figure 19-19: Positioning for release of the gastrocnemius recession.

Figure 19-20

Figure 19-21

Figure 19-22

Figure 19-23

Figure 19-24

Endoscopic Decompression for Intermetatarsal Nerve

Figure 19-25: Minimal invasive methods for intermetatarsal nerve decompression are demonstrated.

References

Suggested Reading

Chapter 20: Endoscopic Procedures for Retrocalcaneal Bursitis, Achilles Tendon, Posterior Tibial Tendon, Peroneal Tendons, and Flexor Hallucis Longus Tendon

General Introduction

Achilles Tendoscopy for Achilles Tendinopathy and Paratendinopathy

Introduction

Anatomy

Clinical and Physical Examination

Diagnostic Imaging

Treatment

Conservative Treatment

Surgical Intervention

Figure 20-1: Positioning for hindfoot endoscopy.

Figure 20-2: Portal placement in Achilles tendoscopy of the left foot and ankle.

Figure 20-3: Tendoscopy of the left Achilles tendon in a 41-year-old male patient with pain during palpation at medial side of the Achilles tendon.

Endoscopic Calcaneoplasty for Retrocalcaneal Bursitis

Introduction

Anatomy

Clinical and Physical Examination

Diagnostic Imaging

Operative Treatment

Figure 20-4: Preoperative lateral radiograph of a right foot and ankle with retrocalcaneal bursitis and prominence of the posterosuperior part of the calcaneus.

Figure 20-5: Portal placement in endoscopic calcaneoplasty in a right ankle; the patient is in the prone position.

Figure 20-6

Figure 20-7: Endoscopic calcaneoplasty in the same patient.

Figure 20-8

Endoscopic Flexor Hallucis Longus Release

Introduction

Anatomy

Clinical and Physical Examination

Diagnostic Imaging

Treatment

Conservative Treatment

Portals

FHL Release

Figure 20-9: During posterior ankle arthroscopy, the patient is placed in the prone position.

Figure 20-10: Creation of the posterolateral portal.

Figure 20-11: Creation of the posteromedial portal.

Figure 20-12: Posterior endoscopic technique with the use of two portals.

Figure 20-13: FHL tendoscopy of the left ankle in a 20-year-old male patient.

Peroneal Tendoscopy

Introduction

Anatomy

Clinical and Physical Examination

Diagnostic Imaging

Treatment

Operative Technique

Figure 20-14: Portal placement in peroneal tendoscopy in a left ankle.

Figure 20-15: A 54-year-old patient with pain over the peroneal tendons behind the lateral malleolus of the right ankle.

Posterior Tibial Tendoscopy

Introduction

Anatomy

Clinical Symptoms and Physical Examination

Diagnostic Imaging

Surgical Procedure

Figure 20-16: Portal placement in posterior tibial tendoscopy in a left hindfoot.

Figure 20-17: Posterior tibial tendoscopy in the right hindfoot of a 45-year-old male patient.

References

Suggested Reading

Chapter 21: Rehabilitation of the Foot and Ankle

Introduction

Framework of Patient Interaction: The International Classification of Functioning, Disability, and Health (ICF) Model

Figure 21-1

Figure 21-2: International Classification of Function, Disability, and Health (ICF) model of health and disability.

Figure 21-3

Physical Therapy Assessment

Structure and Function

Figure 21-4

Figure 21-5

Figure 21-6: Axis of rotation of the ankle and subtalar joints.

Table 21-1: Movements of the Foot That Produce Pronation and Supination

Patient Examination

Gathering of Background Information

Prescription

Operative Notes

Past Medical History

History Related to Current Condition

Self-Reported Outcome Studies

Physical Examination

Neurological and Circulatory Screen

Assessment of Edema

Observational Gait Assessment

Figure 21-7

Figure 21-8: Stages of gait.

Table 21-2: Gait Summary

Weight Acceptance

Single-Limb Support

Limb Advancement

Observation of Balance

Functional Testing

Dynamic Testing: Double-Limb and Single-Limb Squat

Dynamic Testing: Bilateral Heel Raise

Dynamic Testing: Excursion Tests of Anterior or Medial Reach

Knee-to-Wall Dorsiflexion Measure

Figure 21-9: Single-limb balance.

Figure 21-10: Anterior and medial reach measures.

Figure 21-11: Knee-to-wall dorsiflexion measure.

Active Range of Motion

Passive Range of Motion

Passive Accessory Movement

Figure 21-12: Anterior–posterior glide of talus.

Muscular Length and Flexibility

Resistive Tests

Special Tests

Anterior Drawer

Tinel Sign

Assessment of Neural Mobility

Treatment Strategies for the Postoperative Patient Following Ankle Arthroscopy and Related Surgery

Immediate Postoperative Care

Phases of Rehabilitation

Therapeutic Agents

Edema and/or Pain Management

Rice

Cryotherapy

Contrast Bath

Electrical Stimulation

Ultrasound

Phonophoresis

Iontophoresis

Gait Training

Manual Therapy

Soft Tissue Mobilization

Joint Mobilization

Cardiovascular Exercise

Therapeutic Exercise

Flexibility Exercises

Strengthening of Muscle

Balance and Proprioceptive Exercise

Movement Re-education Exercise

Sports- and Activity-Specific Training

Agility Training

Plyometric Training

Phases of Rehabilitation

Phase I: Immediate Postoperative Care

Phase II: Direct Foot and Ankle Intervention

Phase III: Restoration of Activities of Daily Living

Phase IV: Sports- or Work-Specific Training

Figure 21-13: Methods of cryotherapy.

Figure 21-14: Kinesiotape technique to control swelling of the lateral ankle.

Figure 21-15: Electrical stimulation/ultrasound unit.

Figure 21-16: Iontophoresis device.

Figure 21-17: Upper body ergometer (UBE).

Figure 21-18: Pilates reformer.

Figure 21-19: Various balance surfaces.

Figure 21-20: Biomechanical ankle platform system (BAPS) board balance device.

Figure 21-21: AlterG treadmill.

Return to Play in Athletes after Surgery

Figure 21-22: T-test to evaluate agility function.

Figure 21-23: Sargent/vertical jump test.

Future Considerations

Case Presentations

Patient Case Number One

Pertinent Examination Findings

Exhibit 893

Exhibit 894

Exhibit 895

Exhibit 896

Exhibit 897

Exhibit 898

Patient Case Number Two

Exhibit 900

Exhibit 901

Exhibit 902

Exhibit 903

Exhibit 904

Exhibit 905

References

Suggested Readings

Chapter 22: Complications in Ankle and Foot Arthroscopy

Chapter 22 Introduction

History

Types of Complications

Neurovascular Injury

Tourniquet

Tendon Injuries

Ligament Injuries

Articular Cartilage Injury

Instrument Breakage

Fluid Management Complications

Compartment Ischemia

Wound Complications

Infection

Postoperative Swelling

Thrombophlebitis and Pulmonary Embolism

Complex Regional Pain Syndrome

Postoperative Stress Fractures

Figure 22-1: Arthroscopy complications.

Table 22-1: Complications of Foot and Ankle Arthroscopy

Figure 22-2

Figure 22-3: Posterior arthroscopic portals.

Figure 22-4

Figure 22-5: Aneurysm formation.

Figure 22-6: Pseudoaneurysm formation.

Figure 22-7: False FHL.

Figure 22-8

Figure 22-10

Figure 22-9: Technique to prevent arthroscope breakage.

Figure 22-11: Broken Freer.

Figure 22-12: Broken microfracture pick.

Figure 22-13: Broken ring curette.

Figure 22-14: Golden Retriever.

Figure 22-15: Broken microfracture pick.

Figure 22-16

Figure 22-17

Figure 22-18

Figure 22-19

Figure 22-20

Figure 22-21

Figure 22-22: Stress fracture of the anterior distal tibia.

Figure 22-23: Stress fracture of the posterior tibia.

Results

Table 22-2: Comparison of Complication Rates in Foot and Ankle Arthroscopy

Table 22-3: Complications

Table 22-4: Tips to Avoid Complications

Conclusions

References

Suggested Reading

Chapter 23: Future Developments in Foot and Ankle Arthroscopy

Future Developments in Foot and Ankle Arthroscopy

Endoscopic Distal Soft Tissue Procedure for Hallux Valgus Correction

Anatomy

Indication/Contraindication

Technique

Lateral Release

Medial Exostectomy

Intermetatarsal Suturing

Medial Capsular Plication

Proximal Screw Fixation

Advantages/Complications

Figure 23-1: Lateral release.

Figure 23-2: Bunion removal.

Figure 23-3: Intermetatarsal suturing.

Figure 23-4: Intermetatarsal suturing.

Figure 23-5: Intermetatarsal suturing.

Figure 23-6: Capsular plication.

Figure 23-7: Capsular plication.

Figure 23-8: Capsular suturing.

Figure 23-9: Proximal screw fixation.

Arthroscopic–Assisted Plantar Plate Tenodesis

Anatomy

Indication/Contraindication

Technique

Figure 23-10: Arthroscopic–assisted plantar plate tenodesis.

Figure 23-11: Arthroscopic-assisted plantar plate tenodesis.

Arthroscopic Triple Arthrodesis

Anatomy

Indication/Contraindication

Portals

Instrumentation

Technique

Figure 23-12: Arthroscopic triple arthrodesis in a left foot.

Arthroscopic Lapidus Arthrodesis

Anatomy

Indication/Contraindication

Portals

Technique

Figure 23-13: Arthroscopic Lapidus arthrodesis.

Arthroscopic Lisfranc Arthrodesis

Anatomy

Indication/Contraindication

Portals

Technique

Figure 23-14: Arthroscopic Lisfranc arthrodesis.

Endoscopic–Assisted Posterior Tibial Tendon (PTT) Reconstruction

Anatomy

Indication/Contraindication

Technique

Figure 23-15: Endoscopic-assisted posterior tibial tendon (PTT) reconstruction.

Figure 23-16: Endoscopic-assisted PTT reconstruction.

Figure 23-17: Endoscopic-assisted PTT reconstruction.

Arthroscopic Interpositional Arthroplasty

Anatomy

Indication/Contraindication

Technique

Figure 23-18: Arthroscopic interpositional arthroplasty.

Endoscopic Release of First Branch of Lateral Plantar Nerve

Anatomy

Indication/Contraindication

Technique

Figure 23-19: Endoscopic release of the first branch of the lateral plantar nerve.

Arthroscopic Resection of Tlap, Calcaneonavicular Coalition

Anatomy

Indication/Contraindication

Portals

Technique

Figure 23-20: Arthroscopic resection of the “too-long” anterior process (TLAP) of the calcaneus and calcaneonavicular coalition.

Summary

References

Suggested Reading

Appendix

Remarks

 

 

An aparitie	2013
Autor	Richard D Ferkel
Dimensiuni	1.3 x 22.9 x 27.9 cm
Editura	LWW
Format	Hardback
ISBN	9780781783415
Limba	Engleza
Nr pag	592