Abstract
Technique, inducations, complications and early outcomes with posterior ankle and subtalar arthroscopy
A. ANKLE ARTHROSCOPY: Tips and Pearls on Avoiding Complications
a. Introduction
i. understanding of the anatomy of the foot and ankle is critical to safe performance of arthroscopic procedures and prevention of complications
ii. understanding of the surface and intra-articular anatomy of the ankle/subtalaar region is essential
iii. topographical anatomy serves as a guide to the successful placement of arthroscopic portals in the ankle
iv. neurovascular and tendinous structures are most at risk
b. Indications for Posterior/Subtalar Arthroscopy
i. Posterior ankle/ST Impingement
ii. OLT Ankle (usually posteromedial)
iii. Assist operative reduction of calc or post mal fractures
iv. Arthrodesis ankle/ST or both
c. Portals
i. Know the anatomy, use blunt dissection, minimize re-entry
ii. Preoperative plan for access, pathology, visualization
d. Prone Position
a. Posteromedial
b. Posterolateral
c. Accessory posterolateral
e. Set-up/instrumentation
i. Positioning -
ii. posterior, prone
iii. Distraction- non-invasive vs invasive (trans-calcaneal thin wire)
iv. Equipment - general set-up/instruments
- scopes (4.0 for outside joint or fusions; 2.7 otherwise)
- irrigation/pump (run at lowest flow possible)
f. Tips on Avoiding Complications
i. Patient selection and education
ii. Careful preoperative planning, evaluation
iii. Know/respect your anatomy
iv. Meticulous portal placement/care
v. Limit operative time/distension/tissue damage
vi. Use mini C-arm to monitor
vii. Plan, plan and plan, if you are prepared, all will work out
viii. Rehabilitation protocol and follow up.
