Risks relating to posterior 2-portal arthroscopic subtalar arthrodesis and articular surfaces abrasion quality achievable with these approaches: A cadaver study - 13/05/11

Doi : 10.1016/j.otsr.2011.02.008

F. Mouilhade ^a,^⁎ , P. Oger ^b, X. Roussignol ^a, P. Boisrenoult ^b, J. Sfez ^a, F. Duparc ^a,^c
^a Orthopaedics Department, Charles-Nicolle Hospital, Rouen Teaching Hospital Center, 1, rue de Germont, 76000 Rouen, France
^b Orthopaedics Department, André-Mignot Hospital, Versailles Hospital Center, 177, rue de Versailles, 78150 Le Chesnay, France
^c Anatomy Research Laboratory, Rouen University, 22, boulevard Gambetta, 76183 Rouen, France

Corresponding author.

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Summary

Introduction

Many techniques for arthroscopic subtalar arthrodesis have been described since 1985. The procedure can be challenging because posterior and anterior portals are used conjointly with distraction. A posterior 2-portal approach was described in 2000.

Hypothesis

The goal of this study was to evaluate the quality of the freshening that can be achieved in the posterior subtalar joint using this approach. Does a posterior 2-portal approach allow for a complete freshening of the posterior subtalar joint?

Material and methods

Freshening was performed through an arthroscopic posterior 2-portal approach on 10 cadavers. The quality of bone freshening and proximity of the neurovascular structures to the posterior portals were subsequently evaluated by dissection.

Results

There was one partial laceration of the sural nerve. The posteromedial portal was 6.8mm (95% CI: 4.4 to 9.2) away from the posterior tibial vascular pedicle. The entire talar and calcaneal articular surfaces of the posterior subtalar joint were freshened. In eight of 10 cases (95% CI: 48 to 95%), the posteromedial process of the talus prevented contact between fragments.

Discussion

This study showed that the entire posterior subtalar joint can be freshened through an arthroscopic posterior 2-portal approach with little morbidity.