Introduction: This document is our report on the prospective follow-up of 38 patients operated between May 1998 and May 2005. If the technique in itself hardly poses any difficulty, our experience of talo-crural and sub-talar arthroscopy has proved to be a major asset.

Materials and method: This involved 38 patients (23 men and 16 women) mean age 55y who received a double or triple talar arthrodesis by means of retrograde nailing. 4 patients had a septic history, and 7 an anterior sub-talar arthrodesis. In 19 cases, sub-talar refreshing was carried out in accordance with our arthroscopic principles. Whenever possible, the same procedure was followed at the talo-crural stage, despite an anterior or anterolateral approach (cartilaginous refreshing as regards the geometry of the surfaces, and careful refreshing of the splints and trans-osseous perforations).

In one case, the technique was purely bifocal arthroscopy, 26 patients had bone grafts (25 autografts, 1 allograft). Indications therefore were 7 failed talar arthroplasties, 6 ankle pseudarthrodesis with side-effects in the sub-talar joint, 5 primitive bifocal arthosis, 5 complex traumatisms in the hinde foot, 4 neurological varus equinus feet, 3 side-effects of talar laxity, 1 diabetic osteo-arthropathy and one pseudarthrosis of the leg with subjacent talo-crural arthrosis. The average follow-up is of 38 months (12–90).

Results: Complete weight bearing has always been possible, except for a paraplegic patient. 2 non-fusions (one at each level) are noted in two patients who were succesfully treated with a change of method. All of the other set within an average period of 2.6 months. We note one resolvent aseptic discharge in a looking screw, one algodystrophy, one sepsis of the iliac site, and one of a locking screw. The patients were evaluated by the AFCP, SFMCP talar score, whose average value rose from 20.7 to 66/100. 19 patients were very satisfied, 15 satisfied, 2 disappointed and 2 dissatisfied.

Discussion: This osteosynthesis, very reliable biomechanically, enabled a number of delicate situations to be recovered, using a graft, however, in 68%of cases. Applying the principle of endoscopic refreshing resulted in a fusion rate of 97.5%. In our experience, a septic history doesn’t contra-indicate nailing.

Conclusion: This technique, often reserced for difficulty cases, has proved to be extremely reliable, with an excellent fusion rate.

Purpose: Endoscopy provides an attractive alternative to open surgery for diagnostic and therapeutic purposes in patients with ankle tendon disease. Early work was published by Van Dijk in 1994.

Material and methods: Twenty patients (mean age 34.7 years, range 20–59 years), 16 with posttraumatic lesions, underwent 22 tendinoscopy procedures using a slightly modified technique with a 4.5 optical. The procedures, conducted under general anaesthesia, were performed to explore fibular (n=15), posterior tibial (n=6), and anterior tibial (n=1) tendons. Prospective follow-up was at least six months (6 – 30). Preoperatively, all patients presented more or less localised pain with signs of tendon suffering. Fifteen had undergone prior explorations (ultrasound=4, MRI=7, CT scan=1, MRI+ultrasound=3) which had not revealed any anomaly in seven.

Results: Peritendinous adherences were observed intra-operatively in 18 cases with inflammatory reactions requiring resection in 13. A lesion of the tendon itself was found in seven cases-fissure (n=2), superficial dilaceration (n=2), induration (n=2), strangulation (n=1)-which required specific cure with forceps or motorised instrumentation. No explanation of the pain could be identified in one patient. Postoperatively, 17 patient achieved complete pain relief which persisted for at least six months. At last follow-up, one patient had not been reviewed, twelve were totally pain free and five had developed associated symptoms (cracking, swelling). Overall, four patients were very satisfied, eight were satisfied, four were disappointed, and three were dissatisfied (no improvement). There were no signs of worsening and no complications directly related to the method.

Conclusion: These results of early experience in France are less satisfactory than those reported by Van Dijk who had 80% good results for 85 tendinoscopic procedures in 70 patients. They do however confirm the usefulness of this technique for the management of patients with tenosynovitis, adherences, and partial ruptures of the ankle tendons which cannot always be identified with classical imaging techniques. Definitive evaluation will require analysis of a larger series of well selected patients.