Safety and efficacy of talonavicular arthroscopy in arthroscopic triple arthrodesis. A cadaveric study
Tóm tắt
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 saphaneous 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.
Tài liệu tham khảo
Amendola A, Lee KB, Saltzman CL, Suh JS (2007) Technique and early experience with posterior arthroscopic subtalar arthrodesis. Foot Ankle Int 28:298–302
Beimers L, de Leeuw PA, van Dijk CN (2009) A 3-portal approach for arthroscopic subtalar arthrodesis. Knee Surg Sports Traumatol Arthrosc 17:830–834
Beimers L, Frey C, van Dijk CN (2006) Arthroscopy of the posterior subtalar joint. Foot Ankle Clin 11:369–390
Carro LP, Golano P, Vega J (2007) Arthroscopic subtalar arthrodesis: the posterior approach in the prone position. Arthroscopy 23:445e1–445e4
Child BJ, Hix J, Catanzariti AR, Mendicino RW, Saltrick K (2009) The effect of hindfoot realignment in triple arthrodesis. J Foot Ankle Surg 48:285–293
Daglar B, Deveci A, Delialioglu OM, Kanatli U, Tasbas BA, Bayrakci K, Yetkin H, Gunel U (2008) Results of triple arthrodesis: effect of primary etiology. J Orthop Sci 13:341–347
De Groot IB, Reijman M, Luning HA, Verhaar JA (2008) Long-term results after a triple arthrodesis of the hindfoot: function and satisfaction in 36 patients. Int Orthop 32:237–241
El Shazly O, Nassar W, El Badrawy A (2009) Arthroscopic subtalar fusion for post-traumatic subtalar arthritis. Arthroscopy 25:783–787
Glanzmann MC, Sanhueza-Hernandez R (2007) Arthroscopic subtalar arthrodesis for symptomatic osteoarthritis of the hindfoot: a prospective study of 41 cases. Foot Ankle Int 28:2–7
Lui TH (2006) New technique: arthroscopic triple arthrodesis. Arthroscopy 22:464.e1–464.e5
Lui TH (2007) Current concepts: foot and ankle arthroscopy and endoscopy: indications of new technique. Arthroscopy 23:889–902
Lui TH (2008) Anterior subtalar (talocalcaneonavicular) arthroscopy. Foot Ankle Int 29:94–96
Lui TH (2009) Arthroscopic triple arthrodesis in patients with Müller Weiss disease. Foot Ankle Surg 15:119–122
Oloff L, Schulhofer SD, Fanton G, Dillingham M (1996) Arthroscopy of the calcaneocuboid and Talonavicular joints. J Foot Ankle Surg 35:101–108
Vlachou M, Dimitriadis D (2009) Results of triple arthrodesis in children and adolescents. Acta Orthop Belg 75:380–388