scholarly journals 2-Mm Diameter Operative Tendoscopy of the Tibialis Posterior, Peroneal, and Achilles Tendons: A Cadaveric Study

2019 ◽  
Vol 41 (4) ◽  
pp. 473-478 ◽  
Author(s):  
Tobias Stornebrink ◽  
Sjoerd A. S. Stufkens ◽  
Daniel Appelt ◽  
Coen A. Wijdicks ◽  
Gino M. M. J. Kerkhoffs
Keyword(s):  
New Technology ◽  
Proximal Part ◽  
Tendon Sheath ◽  
Tibialis Posterior ◽  
Cuboid Bone ◽  
Iatrogenic Damage ◽  
Fresh Frozen ◽  
Effective Visualization ◽  
Neurovascular Structures ◽  
Portal Tracts

Background: Technical innovation now offers the possibility of 2-mm-diameter operative tendoscopy with disposable arthroscopes and tablet-like control units. The promises of new technology should be critically scrutinized. Therefore, this study assessed whether 2-mm-diameter operative tendoscopy of the tibialis posterior, peroneal, and Achilles tendons was safe and effective in a cadaveric model. Methods: A 2-mm-diameter arthroscopic system was used to perform a tendoscopic procedure in 10 nonpaired, fresh-frozen, human ankles. Standard tendoscopic portals were utilized. Visual examination and operative reach with tailored tendoscopic instruments within the tendon sheaths were recorded and documented. Adhesiolysis and vincula resections were performed. After dissection, distances between portal tracts and neurovascular structures were measured and the tendons were inspected for signs of iatrogenic damage. Results: The entire tendon sheath and tendon of the tibialis posterior, peroneus brevis, and Achilles tendons were visualized and reached with tailored operative instruments. The proximal part of the peroneus longus tendon was visible and reachable from proximally up to the cuboid bone distally. Adhesiolysis and vincula resections were successfully performed in all specimens. The mean distances between portal tracts and local neurovascular structures ranged between 9.4 and 19.2 mm and there were no cases of contact. None of the tendons showed signs of iatrogenic damage. Conclusion: Two-millimeter-diameter operative tendoscopy provided safe and effective visualization and operative reach of the tibialis posterior, peroneal, and Achilles tendons. Clinical Relevance: Compared with current practice, 2-mm-diameter operative tendoscopy has the potential to make tendoscopy around the ankle less invasive and more accessible. Diagnostic, interventional, and second-look procedures might be performed at substantially reduced risk, time, and costs.

scholarly journals Two-millimetre diameter operative arthroscopy of the ankle is safe and effective

2020 ◽  
Vol 28 (10) ◽  
pp. 3080-3086 ◽  
Author(s):  
Tobias Stornebrink ◽  
J. Nienke Altink ◽  
Daniel Appelt ◽  
Coen A. Wijdicks ◽  
Sjoerd A. S. Stufkens ◽  
...  
Keyword(s):  
Articular Surface ◽  
Anteromedial Portal ◽  
Human Donor ◽  
Articular Surfaces ◽  
Iatrogenic Damage ◽  
Anterolateral Portal ◽  
Fresh Frozen ◽  
Effective Visualization ◽  
Neurovascular Structures ◽  
Portal Tracts

Abstract Purpose Technical innovation now offers the possibility of 2-mm diameter operative arthroscopy: an alternative to conventional arthroscopy that no longer uses inner rod-lenses. The purpose of this study was to assess whether all significant structures in the ankle could be visualized and surgically reached during 2-mm diameter operative arthroscopy, without inflicting iatrogenic damage. Methods A novel, 2-mm diameter arthroscopic system was used to perform a protocolled arthroscopic procedure in 10 fresh-frozen, human donor ankles. Standard anteromedial and anterolateral portals were utilized. Visualization and reach with tailored arthroscopic instruments of a protocolled list of articular structures were recorded and documented. A line was etched on the most posterior border of the talar and tibial cartilage that was safely reachable. The specimens were dissected and distances between portal tracts and neurovascular structures were measured. The articular surfaces of talus and tibia were photographed and inspected for iatrogenic damage. The reachable area on the articular surface was calculated and analysed. Results All significant structures were successfully visualized and reached in all specimens. The anteromedial portal was not in contact with neurovascular structures in any specimen. The anterolateral portal collided with a branch of the superficial peroneal nerve in one case but did not cause macroscopically apparent harm. On average, 96% and 85% of the talar and tibial surfaces was reachable respectively, without causing iatrogenic damage. Conclusion 2-mm diameter operative arthroscopy provides safe and effective visualization and surgical reach of the anterior ankle joint. It may hold the potential to make ankle arthroscopy less invasive and more accessible.

Transthecal Digital Nerve Block

1998 ◽  
Vol 23 (4) ◽  
pp. 490-493 ◽  
Author(s):  
N. S. SARHADI ◽  
J. SHAW-DUNN
Keyword(s):  
Methylene Blue ◽  
Nerve Block ◽  
Flexor Tendon ◽  
Proximal Phalanx ◽  
Proximal Part ◽  
Tendon Sheath ◽  
Areolar Tissue ◽  
Digital Nerve ◽  
Flexor Tendon Sheath ◽  
Digital Nerve Block

Injection studies using methylene blue and latex were used in 60 digits from 40 cadavers to study how anaesthetic fluid injected into the flexor tendon sheath might spread around the proximal part of the finger. The injected solution escaped from the flexor tendon sheath around the vincular vessels which are present near the base and head of the proximal phalanx. Outside the digital canal, the dye flowed smoothly through the perivascular loose areolar tissue and spread alongside the main digital vessels and nerves and their palmar and dorsal branches.

scholarly journals Safe Zone for Percutaneous Screw Fixation - Talonavicular Fusion

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0043
Author(s):  
Ashish Shah ◽  
Sung Lee ◽  
Sameer Naranje ◽  
Zachariah Pinter ◽  
Robert Stibolt ◽  
...  
Keyword(s):  
Medial Branch ◽  
Screw Insertion ◽  
Anterior Branch ◽  
Bony Landmarks ◽  
Medial Plane ◽  
Extensor Hallucis Longus ◽  
Hindfoot Deformities ◽  
Fresh Frozen ◽  
Optimal Fusion ◽  
Neurovascular Structures

Category: Hindfoot Introduction/Purpose: Talonavicular fusion has been established as a reliable intervention for degenerative, inflammatory, and traumatic joint lesions as well as hindfoot deformities. In order to achieve optimal fusion, various versions of the procedure have been introduced in literature and have remained a topic of contention, with the most common variation involving the insertion of 1 to 3 screws dorsomedially and dorsolaterally. Dorsolateral screw placements commonly cause neurovasculature injury. The purpose of our cadaveric study was first to establish the safety of the dorsolateral percutaneous screw insertion in relation to these dorsal neurovascular structures, and then subsequently to standardize the ideal placement of the dorsolateral screw by comparing two insertion sites based on consistent bony landmarks. Methods: Ten fresh-frozen cadaver legs amputated at the knee were used for this study. Percutaneous cannulated screws were inserted to perform isolated talonavicular arthrodesis. The screws were inserted at 3 consistent sites: “medial screw” at dorsomedial navicular where it intersected at the medial plane of the first cuneiform, “central screw” at the edge of dorsal navicular between medial and intermediate cuneiforms, and “lateral screw” at the edge of dorsal navicular between intermediate and lateral cuneiforms. Superficial and deep dissections were carried out to identify any injured nerves, arteries, and tendons. Results: The mean age at death in our sample of cadavers was 80.1 ± 7.5 years (range 68 to 92) and had the BMI of 21.8 ± 2.4 (range 18.1 to 25.1). There were 5 males (50.0%) and 5 females (50.0%). The medial screw injured the anterior tibialis tendon in 2 cases (20.0%), the central screw injured the extensor hallucis longus tendon in 3 cases (30.0%), and the lateral screw injured the anterior branch of SPN, lateral branch of SPN, and medial branch of DPN once each in a total of 3 cases (30.0%). Conclusion: TN fusion with central screw placement at the interspace between the medial and intermediate cuneiforms protects the neurovasculatures of the foot to a superior extent than lateral screws between the intermediate and lateral cuneiforms.

scholarly journals Recurrence of Giant Cell Tumor of Posterior Tibialis Tendon

2017 ◽  
Vol 4 (1) ◽  
pp. 45-48
Author(s):  
Karan R Choudhry ◽  
Vishal N Mandlewala
Keyword(s):  
Soft Tissue ◽  
Giant Cell Tumor ◽  
Giant Cell ◽  
Tendon Sheath ◽  
Soft Tissue Tumors ◽  
Cell Tumor ◽  
Asia Pacific ◽  
Tibialis Posterior ◽  
Medial Malleolus ◽  
Scar Mark

ABSTRACT Aim To present a case of recurrence of giant cell tumor of the tendon sheath (GCT TS) and its management. Background The GCT TS is a solitary benign soft tissue tumor of the limbs. It usually appears as an enlarging painless mass and has a synovial origin. The GCT TS is approximately 1.6% of all soft tissue tumors. The GCT TS of tibialis posterior is very rare, and recurrence has not been reported. Case report A 21-year-old male patient presents with complaint of swelling over right ankle since 3 years. Patient was operated for swelling 10 years back, and histological examination revealed GCT TS. Patient was asymptomatic for 3 years after operation and then developed swelling since last 3 years. On local examination, hypertrophic scar mark 1 × 4 cm was present at right medial malleolus. Ultrasonography of right medial malleolus and magnetic resonance imaging were done for further evaluation. Under spinal anesthesia and tourniquet control, medial approach was taken extending from 7 cm above the medial malleolus posterior to the tibia up to the talar head. Tissue was cleared and was sent for histopathology, which confirmed the diagnosis of GCT TS. Patient is on regular follow-up since then, and there has not been any recurrence. Conclusion Though rare, recurrence of GCT TS can occur, and it should be properly investigated and completely excised. Clinical significance Though recurrence of GCT TS is rarely reported, it needs to be dealt with a high index of suspicion and treated aggressively. How to cite this article Choudhry KR, Mandlewala VN. Recurrence of Giant Cell Tumor of Posterior Tibialis Tendon. J Foot Ankle Surg (Asia-Pacific) 2017;4(1):45-48.

Percutaneous cubital tunnel release with a dissection thread: a cadaveric study

2019 ◽  
Vol 44 (9) ◽  
pp. 920-924
Author(s):  
Danqing Guo ◽  
Michel Kliot ◽  
Logan McCool ◽  
Alexander Senk ◽  
Brionn Tonkin ◽  
...  
Keyword(s):  
Ulnar Nerve ◽  
Ultrasound Guidance ◽  
Cadaveric Study ◽  
Cubital Tunnel ◽  
Anatomical Dissection ◽  
Direct Injury ◽  
Prerequisite Knowledge ◽  
Fresh Frozen ◽  
Extent Of Damage ◽  
Neurovascular Structures

This cadaveric study tested the feasibility of decompressing the ulnar nerve across the elbow percutaneously with a commercially available surgical dissection thread, a guiding needle, hydrodissection and ultrasound guidance. We performed the procedure in 19 fresh-frozen cadaveric upper extremities. Subsequently, we did an anatomical dissection of the specimens to visualize the extent of ulnar nerve decompression and the extent of damage to surrounding structures. The cubital tunnel and deep across the medial elbow were completely transected leaving the ulnar nerve fully decompressed in all cases. There was no evidence of direct injury to the ulnar nerve or adjacent neurovascular structures. A prerequisite knowledge of sonographic anatomy and experience with interventional ultrasound is essential. Future clinical studies should evaluate this technique’s safety and efficacy compared with conventional ones.

Anatomic Study of Arthroscopic Portal Sites of the Ankle

Foot & Ankle ◽  
1993 ◽  
Vol 14 (3) ◽  
pp. 142-147 ◽  
Author(s):  
Lawrence A. Feiwell ◽  
Carol Frey
Keyword(s):  
At Risk ◽  
Ankle Joint ◽  
Standard Technique ◽  
Joint Capsule ◽  
Anatomic Study ◽  
Fresh Cadaver ◽  
Relative Safety ◽  
Fresh Frozen ◽  
Neurovascular Structures ◽  
Portal Placement

Numerous anatomic structures are at risk when performing ankle arthroscopy through the more commonly utilized portals. The purpose of this paper was to demonstrate the relative safety of each of the arthroscopic portal and Acufex external ankle distractor pin sites by measuring their proximity to the neurovascular structures surrounding the ankle joint. Six fresh cadaver specimens and 12 fresh-frozen, be-low-knee amputations were utilized for this study. An Acufex ankle distractor was applied using the standard technique. Anteromedial, anterolateral, anterocentral, posterolateral, and posteromedial portals were placed using an 11-blade scalpel to make 5-mm longitudinal incisions. The joint capsule was penetrated and a 3-mm arthroscope was placed into the ankle joint. The skin surrounding each of the portals was carefully removed and the proximity of any nerves or vessels was measured with respect to the arthroscope. At least one incidence of contact or penetration of a nerve or vessel was noted for each site. The anterocentral portal was at greatest risk for nerve or vessel damage. The anterolateral, anteromedial, and posterolateral portals were the safest areas for portal placement, with no penetration of neurovascular structures in any case.

Endoscopic Flexor Hallucis Longus Decompression: A Cadaver Study

2007 ◽  
Vol 28 (7) ◽  
pp. 810-814 ◽  
Author(s):  
John J. Keeling ◽  
Gregory P. Guyton
Keyword(s):  
Sural Nerve ◽  
Significant Risk ◽  
Cadaver Study ◽  
Flexor Hallucis Longus ◽  
Lateral Plantar Nerve ◽  
Endoscopic Release ◽  
Incision Size ◽  
Large Joint ◽  
Fresh Frozen ◽  
Neurovascular Structures

Background New indications for arthroscopy are being considered because arthroscopy limits incision size and potentially decreases operative morbidity. This cadaver study investigated the utility of performing an all-endoscopic flexor hallucis longus (FHL) decompression. Methods Eight fresh-frozen cadaver legs were used. In the simulated prone position with large joint arthroscopic equipment, posterolateral and posteromedial portals were used to perform posterolateral talar process bony excision and FHL sheath debridement and release. We noted the integrity of the sural nerve, FHL tendon, and medial tibial neurovascular bundle. After open dissection, values for sural nerve distance to the posterolateral portal, the amount of FHL sheath released and the proximity of the arthroscopic instrumentation to the medial tibial neurovascular structures were recorded. Results Three of eight FHL tendons were injured during the attempted FHL release. Furthermore, no FHL sheath was completely released down to the level of the sustentaculum. Although posterolateral portal placement was on average 12.1 mm from the sural nerve, it was only 6.1 mm from the lateral calcaneal branch of the sural nerve. Moreover, in all cases the medial calcaneal nerve and first branch of the lateral plantar nerve were closely juxtaposed and in some cases adherent to the FHL fibro-osseous sheath. Conclusions Although os trigonum or posterolateral talar process excision was performed without difficulty, endoscopic release of the FHL tendon proved technically demanding with significant risk to the local neurovascular structures. Given the reliability and low morbidity of open techniques, this cadaver study calls into question the clinical use of complete endoscopic FHL release to the level of the sustentaculum. Moreover, hindfoot endoscopic surgery should be performed by surgeons familiar with open posterior ankle anatomy and experienced in hindfoot endoscopy.

scholarly journals POS1333 ANKLE ARTHRITIS IN JUVENILE IDIOPATHIC ARTHRITIS: DON’T MISS TENOSYNOVITIS. CLINICAL AND SONOGRAPHIC FEATURES OF ANKLE TENOSYNOVITIS IN JIA

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 948.3-949
Author(s):  
S. Pastore ◽  
S. Della Paolera ◽  
A. Zabotti ◽  
A. Tommasini ◽  
A. Taddio
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Clinical Characteristics ◽  
Color Doppler ◽  
Tendon Sheath ◽  
Response To Treatment ◽  
Tibialis Posterior ◽  
Ultrasound Guided ◽  
Sonographic Examination

Background:Tenosynovitis can occur in patients with Juvenile Idiopathic Arthritis (JIA) and may be clinically difficult to distinguish from joint synovitis. The role of musculoskeletal ultrasound (msk-US) is still discussed in the management of JIA but recent studies supported the utility of msk-US especially in detection of tenosynovitis. There is no consensus treatment for tenosynovitis in children with JIA and almost all studies focused on tendon sheath injection with glucocorticoids.Objectives:The aims of the study were: i) to define the prevalence of tenosynovitis of the ankle in JIA patients and ankle swelling; ii) to describe the clinical characteristics of patient with tenosynovitis and to analyze different response to treatment.Methods:We conducted an observational cross-sectional study of a group of patients with JIA followed at the Rheumatology Service of the Maternal and Child Institute “Burlo Garofolo” of Trieste. We enrolled all the patients who reported a swelling of the ankle at least once during the follow-up period and, among these patients, we included only those who underwent msk-US. Based on both clinical and sonographic examination, we identified patients with tenosynovitis and we described their demographical and clinical characteristics as well as the therapeutic approach undertaken in this group of patients.Results:On December 31st 2019, 56 swollen ankles of 48 patients were assessed with msk-US: 22 ankles showed sonographic signs of synovitis (39%), 16 ankles of both synovitis and tenosynovitis (28%), 14 ankles of tenosynovitis only (25%). Overall, tenosynovitis was detected on twenty-seven (56%) out of 48 children with at least a swollen ankle. The majority of patient were females (70%) and the most affected tendon was the tibialis posterior (66%). Twenty-five patients with tenosynovitis (92%) achieved clinical and radiological remission: seven out of 26 patients (26%) treated with methotrexate achieved clinical and radiological remission without the addition of other therapies; fifteen out of seventeen patients (88%) treated with a biological drug responded to the therapy, of which eleven (73%) were in combination therapy with methotrexate.Conclusion:We observed that more than 50% of the patients with a swelling of the ankle presented a tenosynovitis and among these patients about 50% did not show sonographic sign of synovitis. Msk-US was decisive in order to identify tenosynovitis and to characterize ankle swelling in JIA patients. Among patients with tenosynovitis biological therapy alone or in association with immunomodulating therapy showed effectiveness in inducing disease remission.References:[1]Peters SE, Laxer RM et al. Ultrasound-guided steroid tendon sheath injections in juvenile idiopathic arthritis: a 10-year single-center retrospective study. Pediatr Rheumatol Online J. 2017 Apr 11;15(1):22.[2]Lanni S, Bovis F et al. Delineating the Application of Ultrasound in Detecting Synovial Abnormalities of the Subtalar Joint in Juvenile Idiopathic Arthritis. Arthritis Care Res (Hoboken). 2016 Sep;68(9):1346-53.[3]Cimaz R, Giani T et al. What is the real role of ultrasound in the management of juvenile idiopathic arthritis? Ann Rheum Dis. 2020 Apr;79(4):437-439. doi: 10.1136/annrheumdis-2019-216358[4]Lanni S, Marafon DP et al. Comparison between clinical and ultrasound assessment of the ankle region in juvenile idiopathic arthritis. Arthritis Care Res (Hoboken). 2020 Apr 27.[5]Laurell L, Court-Payen M et al. Ultrasonography and color Doppler in juvenile idiopathic arthritis: diagnosis and follow-up of ultrasound-guided steroid injection in the ankle region. A descriptive interventional study. Pediatr Rheumatol Online J. 2011 Jan 29;9(1):4.Disclosure of Interests:None declared

The Pellegrini–Stieda Lesion of the Knee: An Anatomical and Radiological Review

2018 ◽  
Vol 32 (07) ◽  
pp. 637-641
Author(s):  
M. P. Somford ◽  
R. P. A. Janssen ◽  
D. Meijer ◽  
T. A. P. Roeling ◽  
C. Brown ◽  
...  
Keyword(s):  
Tibial Plateau ◽  
Gastrocnemius Muscle ◽  
Proximal Part ◽  
Conventional Radiography ◽  
X Rays ◽  
X Ray ◽  
Medial Side ◽  
Superficial Medial Collateral Ligament ◽  
Fresh Frozen ◽  
Correct Structure

AbstractThe Pellegrini–Stieda lesion is a calcification on the medial side of the knee. The origin of this tissue is controversial. The purpose of our study is to investigate the origin of the Pellegrini–Stieda lesion using conventional radiography as to recreate the circumstances in which Pellegrini and Stieda had to study this pathology. Six nonpaired fresh-frozen cadaveric knees were used. A surgical approach to the medial side of the knee was performed using the layered approach. The origin of the gastrocnemius muscle (GM) (n = 3) or the superficial medial collateral ligament (sMCL) (n = 3) were marked with a radio-opaque fluid. X-ray analysis was performed by measuring the distance from the proximal part of the marking to the medial tibial plateau, multilayer views, and comparison to the original X-rays by Pellegrini–Stieda. Two out of three markings in both the GM and sMCL group were matched with the correct structure. The images were digitally processed so that the osseous structures became partly transparent. After overlaying the images, we found a random distribution of the markings. The Stieda/GM group had no overlap of the markings at all. Compared with the original images from the publications by Pellegrini and Stieda, no comparable position could be found between the original lesions and the markings in our specimens. Conventional X-ray of the knee could not reproduce a distinction between the sMCL and GM as origins for the Pellegrini–Stieda lesion as suggested by Pellegrini and Stieda.

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