scholarly journals Subtalar Joint Preparation Using 2 Portal Posterior Arthroscopic Technique vs Sinus Tarsi Open Approach: A Cadaveric Study

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0013
Author(s):  
Karthikeyan Chinnakannu ◽  
Eildar Abyar ◽  
Haley M. McKissack ◽  
Martim Pinto ◽  
Aaradhana J. Jha ◽  
...  
Keyword(s):  
Subtalar Joint ◽  
Cadaveric Study ◽  
Joint Surface ◽  
Open Approach ◽  
Open Technique ◽  
Arthroscopic Technique ◽  
Joint Preparation ◽  
Sinus Tarsi ◽  
Subtalar Fusion ◽  
Significant Difference

Category: Ankle, Arthroscopy, Basic Sciences/Biologics Introduction/Purpose: Subtalar fusion is the treatment of choice for subtalar arthritis when conservative management fails. Subtalar fusion can be done through open approach or arthroscopic technique. Arthroscopic technique is associated with rapid recovery; however, it requires adequate training and skill. Arthroscopic technique can be done through lateral or posterior portals. Sometimes it may be necessary to use accessory portal to open or distract the joint for adequate joint preparation. Use of accessory portal may result in injury to the neurovascular structure. Whatever the technique, one of the most important aspects of fusion is adequate preparation of the joint. Aim of our study is to compare the preparation of subtalar joint using sinus tarsi open approach and posterior subtalar scopy using 2 portal technique in cadaveric specimens. Methods: We used 20 below knee fresh-frozen cadaver legs for this cadaveric study. Subtalar joints of ten specimens were prepared through the lateral approach, while the remaining ten joints were prepared using sinus tarsi incisions. After the completion of preparation, all ankles were dissected open, photographic images of calcaneal and talar articular were taken. (Image)Surface areas of each articular facet and prepared area of the talus, distal tibia, and distal fibula were measured and analyzed. Results: Open technique results in better preparation of joint surface in calcaneus and overall. While open technique results in preparation of 92% joint surface (combined talus and calcaneus), arthroscopic technique results in in 80% of joint surface. Open technique results in better preparation of calcaneus (79vs 94%). The anterolateral corner of calcaneus was difficult to be reached using the scope and unprepared in most cases. There was no significant difference in the preparation of talar articular surface. (Table 1) Conclusion: Open sinus tarsi results in more joint preparation compared to 2 portal posterior arthroscopic technique. The less amount of joint preparation in arthroscopic technique is mostly due to less preparation of AL corner. Of calcaneus. When using posterior arthroscopic technique, it is advisable to use accessory portal to distract the joint to aid in adequate preparation.

Subtalar joint preparation using the Two Portal posterior arthroscopic technique versus the sinus tarsi Open approach: A cadaver study

The Foot ◽  
2021 ◽  
Vol 46 ◽  
pp. 101690
Author(s):  
Karthikeyan Chinnakkannu ◽  
Haley McKissack ◽  
Bradley Alexander ◽  
Aaradhana J Jha ◽  
Martim Pinto ◽  
...  
Keyword(s):  
Subtalar Joint ◽  
Cadaver Study ◽  
Open Approach ◽  
Arthroscopic Technique ◽  
Joint Preparation ◽  
Sinus Tarsi

scholarly journals Comparative Outcomes for Treatment of Articular Cartilage Lesions in the Ankle with Particulated Juvenile Cartilage Allograft

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000
Author(s):  
James Deal ◽  
Robert Turner ◽  
Paul Ryan ◽  
Claude Anderson ◽  
Adam Groth
Keyword(s):  
Articular Cartilage ◽  
Outcome Measures ◽  
Lesion Length ◽  
Open Approach ◽  
Osteochondral Defects ◽  
Open Technique ◽  
Arthroscopic Technique ◽  
Cartilage Lesions ◽  
Significant Difference ◽  
Articular Cartilage Lesions

Category: Ankle Introduction/Purpose: Treatment of osteochondral defects of the talus with particulated juvenile cartilage allograft is a relatively new procedure. Although other treatment options exist for large osteochondral defects of the talus, the potential advantage of particulated juvenile allograft is the ability to perform the procedure arthroscopically or through a minimal approach. No previous studies have looked at the results of an arthroscopic approach and no previous studies have compared an arthroscopic technique to an open approach. The purpose of this study was to compare the outcomes of an arthroscopic transfer technique to the previously published open technique. Methods: A total of 34 patients underwent treatment of talar cartilage lesions with juvenile particulated cartilage allograft. Twenty of these were done arthroscopically and 14 were done with an open arthrotomy. There was no statistically significant difference between the groups with respect to age, lesion width, lesion depth, lesion length, or operative time. Scores for 6 different validated outcome measures were recorded for patients in each group pre-operatively and subsequently at 6 months, 1 year, 18 months, and 2 years. Results: Comparing outcome measurements at each data point to baseline, there were no statistically significant post-operative differences found between open and arthroscopic approaches with regards to VAS Pain Scale, AOFAS Ankle-Hindfoot Scale, Foot and Ankle Ability Measure - Sport Scale, or SF12 Physical Health Scale. Conclusion: Treatment of talar articular cartilage lesions with particulated juvenile cartilage allograft is associated with improved outcomes at 2 years with regards to several validated outcome measures regardless of technique utilized. At 2 years follow up, there were no statistically significant differences in outcomes utilizing an arthroscopic technique versus open technique with the numbers given. This data supports the use of particulated juvenile cartilage allograft utilizing either arthroscopic or open techniques.

scholarly journals Miniopen vs Lateral Approach for Ankle Arthrodesis, Which Approach is Superior in Joint Preparation: A Cadaver Study

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0013
Author(s):  
Karthikeyan Chinnakkannu ◽  
Haley McKissack ◽  
Gean C. Viner ◽  
Jun Kit He ◽  
Leonardo V. M. Moraes ◽  
...  
Keyword(s):  
Surface Area ◽  
Ankle Arthrodesis ◽  
Lateral Approach ◽  
Fixation Method ◽  
Open Approach ◽  
Ankle Arthritis ◽  
Joint Preparation ◽  
Significant Difference ◽  
In Trans ◽  
Mini Open

Category: Ankle, Ankle Arthritis, Arthroscopy, Basic Sciences/Biologics Introduction/Purpose: Ankle arthrodesis is a gold standard for end-stage ankle arthritis after conservative managements fail. It may be done through direct anterior, lateral, arthroscopic or mini open approaches. Joint preparation, apposition of joint surfaces and stable fixation are very important for successful outcomes. Ankle arthrodesis maybe associated with infection, chronic pain and nonunion - of these, nonunion is the most common complication reported. Achieving union is of utmost importance while minimizing complications associated with the procedure. Regardless of approach or fixation method, preparation of articular surface is of paramount importance for successful union and may be limited by the approach used. Our study aims to evaluate the difference between direct lateral and dual mini-open approaches (extended arthroscopic portals) in terms of joint preparation. Methods: We used 10 below knee fresh-frozen cadaver legs for this cadaveric study. Ankle joints of five specimens were prepared through the lateral approach, while the remaining five ankles were prepared using dual mini incisions. After the completion of preparation, all ankles were dissected to open, photographic images of tibial plafond and talar articular were taken. Surface areas of each articular facet and unprepared cartilage of the talus, distal tibia, and distal fibula were measured and analyzed using ImageJ software. Results: Significantly greater amount of total surface area was prepared among specimens using mini-open approach compared to those with trans-fibular approach. The percentage of total articulating surface area prepared (including talus and tibia/fibula), talus, tibia and fibula in trans-fibular approach were 76.9%, 77.7% and 75% respectively. The percentages were 90.9%, 92.9%, and 88.6% in mini-open approach. While the medial gutter was well prepared with mini incision technique (unprepared surface 44 .64% vs 91.08%), lateral gutter was well prepared in trans-fibular technique (88.82vs 82.04 square cm). There is no difference in the amount of unprepared surface of talar dome between the two approaches. When excluding the medial gutter, there was no significant difference between trans-fibular and mini open techniques (83.94 vs 90.85, p=0.1412). Conclusion: Joint preparation using the mini-open approach (extended arthroscopic portal) is equally as efficacious as the transfibular approach for preparation of the tibiotalar joint. When including preparation of the medial gutter, the mini-open approach provides superior joint preparation. This may be advantageous with decreased rate of nonunion and less complications. But many surgeons fuse only tibiotalar surface, considering that, both approaches yield equal amount of joint preparation. But it needs to be confirmed with clinical studies.

scholarly journals Comparative Outcomes for the Treatment of Articular Cartilage Lesions in the Ankle With a DeNovo NT Natural Tissue Graft: Open Versus Arthroscopic Treatment

2018 ◽  
Vol 6 (12) ◽  
pp. 232596711881271 ◽  
Author(s):  
Paul M. Ryan ◽  
Robert C. Turner ◽  
Claude D. Anderson ◽  
Adam T. Groth
Keyword(s):  
Articular Cartilage ◽  
Open Approach ◽  
Foot And Ankle ◽  
Open Technique ◽  
Cartilage Lesions ◽  
Tissue Graft ◽  
Significant Difference ◽  
Natural Tissue ◽  
Articular Cartilage Lesions ◽  
Time Point

Background: The treatment of osteochondral lesions of the talus (OLTs) with a juvenile cartilage allograft is a relatively new procedure. Although other treatment options exist for large OLTs, the potential advantage of a particulated juvenile allograft is the ability to perform the procedure arthroscopically or through a minimal approach. No previous studies have looked at the results of an arthroscopic approach, nor have any compared an arthroscopic technique with an open approach. Purpose: To compare the outcomes of an arthroscopic transfer technique with the previously published open technique. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 34 patients (mean age, 33 years) underwent treatment of talar cartilage lesions with a DeNovo NT Natural Tissue Graft. Of these treatments, 20 were performed arthroscopically and 14 were performed with open arthrotomy. There was no statistically significant difference between the groups with respect to age, lesion width, lesion depth, lesion length, or operative time. The mean lesion area was 107 mm2. The scores from 6 different validated outcome measures were recorded for patients in each group preoperatively and subsequently at 6 months, 1 year, 18 months, and 2 years. Results: Comparing outcome scores at each time point to baseline, there were no statistically significant postoperative differences found between open and arthroscopic approaches with regard to the visual analog scale (VAS) for pain ( P = .09), American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale ( P = .17), Foot and Ankle Ability Measure (FAAM)–sports subscale ( P = .73), Short Form–12 (SF-12) physical health summary ( P = .85), SF-12 mental health summary ( P = .91), or FAAM–activities of daily living subscale ( P = .76). Conclusion: The treatment of talar articular cartilage lesions with a DeNovo NT Natural Tissue Graft demonstrated no significant differences in outcome at 2 years regardless of whether the graft was inserted with an arthroscopic or open technique. Clinical Relevance: Our analysis demonstrated no significant difference between an arthroscopic versus open approach at any time point for the first 2 years after implantation of a juvenile particulated cartilage allograft for large OLTs. With that said, both groups demonstrated improvement from baseline. These findings indicate that surgeons with different levels of comfort utilizing arthroscopic techniques can offer this treatment modality to their patients without altering their planned surgical approach. In addition, this will be particularly helpful in counseling patients for surgery when the extent of the defect will be evaluated intraoperatively. Patients can be counseled that they will likely have the same incisions regardless of whether they require debridement, microfracture, or implantation of a particulated allograft.

scholarly journals A Comparative Study between Lateral Approach Alone and Combination of Medial and Lateral Approaches for Intra-Articular Calcaneal Fractures with Displaced Sustentaculum Fragment

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0024
Author(s):  
Naohiro Hio ◽  
Masanori Taki
Keyword(s):  
Comparative Study ◽  
Inclination Angle ◽  
Subtalar Joint ◽  
Lateral Approach ◽  
Joint Surface ◽  
Calcaneal Fractures ◽  
Significant Difference ◽  
The Mean ◽  
Type 3

Category: Hindfoot; Trauma Introduction/Purpose: In intra-articular calcaneal fractures, the sustentaculum fragment, which is the reference for reduction, often undergoes varus plantar flexion displacement and requires accurate reduction. Although the lateral approach is generally used as a surgical approach, it is considered that the use of the combination of medial and lateral approaches can achieve more accurate reduction. Here we report a comparative study of between the group with the lateral approach alone (L-group) and the group with the combination of the medial and lateral approaches (ML-group) for calcaneal fractures with displacement of sustentaculum fragment. Methods: L-group included 11 feet, six feet of which were categorized as Sanders classification type 2, four as type 3, one as type 4. ML-group included 14 feet, ten as type 2, two as type 3, two as type 4. In both groups, small incision such as sinus tarsi approach were used for lateral approach and screws and/or plates were used for fixation. We assessed Creighton-Nebraska scale, pre- and postoperative width and height of the calcaneal body, step of subtalar joint surface and inclination angle of the sustentaculum fragment. Results: The mean postoperative clinical evaluation for the L-group / ML-group was 90.5+-7.9 points / 87.2+-9.6 points respectively. The pre- and postoperative image assessments showed improvements in the mean width from 123.4+-15.3% to 110.3+-14.1% / 129.9+-23.1% to 109.9+-14.1%, in the mean height from 88.1+-5.2% to 98.1+-3.7% / 86.0+-9.6% to 95.4+-5.9%, in the step of subtalar joint surface from 9.0+-6.3mm to 0.9+-1.1mm / 10.0+-8.0mm to 0.7+-1.0mm, and in the inclination angle of sustentaculum fragment from 10.3+-5.1 ° to 5.5+-5.0 ° / 12.1+-7.5 ° to 0.5+-1.0 °, respectively. There was a significant difference between the two groups in the inclination angle of the sustentaculum fragment, but no significant difference was observed in the other assessments. Complications were more common with ML-group. Conclusion: Displacement of the sustentaculum fragment in calcaneal fractures can be more reduced accurately by using the combination of medial and lateral approaches, although there is no significant difference in clinical results.

scholarly journals First Tarsometatarsal Fusion Using Saw Preparation vs. Standard Preparation of the Joint: A Cadaver Study

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0015
Author(s):  
Nicholas Dahlgren ◽  
John L. Johnson ◽  
Samuel R. Huntley ◽  
Karthikeyan Chinnakkannu ◽  
Haley McKissack ◽  
...  
Keyword(s):  
Proximal Phalanx ◽  
Joint Surface ◽  
X Rays ◽  
Percent Change ◽  
Joint Preparation ◽  
Joint Fusion ◽  
Medial Cuneiform ◽  
Significant Difference ◽  
First Ray ◽  
Length Changes

Category: Basic Sciences/Biologics, Midfoot/Forefoot Introduction/Purpose: First tarsometatarsal (TMT) joint fusion is indicated for several underlying causes of first ray dysfunction and pain, including arthritis, traumatic injury, and recurrent hallux valgus. Preparation of the joint surface by denuding the articular cartilage is a key step for arthrodesis, as inadequate preparation may result in poor fixation and non-union. However, excessive removal of cartilage and bone may result in excessive shortening of the ray. Despite the importance of joint preparation on the outcomes of fusion, the effects of using a bone saw versus osteotome on ray length is poorly documented in the literature. The purpose of this study was to investigate whether utilization of an osteotome or saw would minimize shortening of the first ray in TMT arthrodesis. Methods: Ten fresh-frozen cadaver specimens without evidence of musculoskeletal abnormalities were used for this anatomic dissection study. A medial incision was made along the first ray from the medial aspect of the medial cuneiform to the base of the first metatarsal. The first TMT joint was exposed through transverse capsulotomy. The soft tissues surrounding the joint were not removed from the bone. The specimens were randomly assigned to undergo cartilage removal and joint preparation using either an osteotome (n=5) or saw (n=5). Care was taken to reach the plantar-most aspect of the joint. Fusion was then performed using a cross-screw construct through the dorsal aspect of the proximal phalanx and the medial cuneiform. Pre- and post-operative x- rays were taken with a radiopaque ruler in the field, and length changes were compared between osteotome and sawblade groups. Results: The average change in metatarsal length was significantly smaller in the osteotome group (1.6 mm) as compared to the saw group (4.4 mm) (p=0.031). The average percent change in metatarsal length was also significantly smaller in the osteotome group (3.0%) compared to the saw group (8.4%) (p=0.025). There was no significant difference between the two groups with respect to change in cuneiform length. The osteotome group demonstrated a significantly smaller average measured change (3.0 mm vs. 6.9 mm, p=0.001) and percent change (4.1% vs. 9.3%, p<0.001) in total length (cuneiform plus metatarsal) in comparison to the saw group. Conclusion: The results of this study demonstrate that first TMT joint preparation with an osteotome may prevent over- shortening of the first ray, thereby theoretically decreasing the risk of metatarsalgia and the need for additional procedures when compared to utilization of a bone saw. Judicious use of the bone saw for joint preparation may still be beneficial in some cases. This information can be used clinically to implement evidence-based standardization of operative techniques to improve the outcomes of these cases.

Subtalar Fusion Preparation: What Are We Really Doing? A Cadaver Study

2019 ◽  
Vol 13 (3) ◽  
pp. 201-206 ◽  
Author(s):  
Eildar Abyar ◽  
Haley M. McKissack ◽  
Martim C. Pinto ◽  
Zachary L. Littlefield ◽  
Leonardo V. Moraes ◽  
...  
Keyword(s):  
Surface Area ◽  
Subtalar Joint ◽  
Cadaver Study ◽  
Joint Surface ◽  
Lateral Sinus ◽  
Total Percentage ◽  
Sinus Tarsi ◽  
Lateral Incision ◽  
Sinus Tarsi Approach ◽  
Fresh Frozen

Introduction. The open, lateral sinus tarsi approach is the most commonly used technique for subtalar arthrodesis. In this cadaver study, we measured the maximum joint surface area that could be denuded of cartilage and subchondral bone through this approach. Methods. Nine fresh frozen above-knee specimens were used. The subtalar joint was accessed through a lateral incision from the fibular malleolus distally over the sinus tarsi area to the level of the calcaneocuboid joint. Cartilage was removed from the anterior, middle, and posterior facets of the calcaneus and talus using an osteotome and/or curette. ImageJ was used to calculate the surface areas of undenuded cartilage. Results. No specimens were 100% denuded of cartilage on all 6 measured surfaces. The greatest percentages of unprepared surface area remained on the middle facet of the talus (18.66%) and the middle facet of the calcaneus (14.51%). The anterior facet of the talus was 100% denuded in 6 specimens, while the middle and posterior facets were 100% denuded in 3 specimens. The anterior facet of the calcaneus was also 100% denuded in 6 specimens, while the middle and posterior facets were 100% denuded in 3 and 4 specimens, respectively. The average total unprepared surface area per specimen was 8.67%. Conclusion. The lateral sinus tarsi approach provides adequate denudation of cartilage of the subtalar joint in most cases. Total percentage of unprepared joint surface may range from approximately 2% to 18%. Future clinical studies are warranted to assess whether this technique results in optimal union rates. Levels of Evidence:V, Cadaveric Study

Common Pitfalls in Subtalar Joint Preparation for Arthrodesis via Sinus Tarsi Approach

2020 ◽  
Vol 59 (2) ◽  
pp. 253-257
Author(s):  
Neil B. Patel ◽  
Cody Blazek ◽  
Rick Scanlan ◽  
Jeffrey M. Manway ◽  
Patrick R. Burns
Keyword(s):  
Subtalar Joint ◽  
Joint Preparation ◽  
Sinus Tarsi ◽  
Sinus Tarsi Approach

scholarly journals Evaluating the Subtalar Joint in Tibiotalocalcaneal Nail

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0040
Author(s):  
Megan Reilly ◽  
Kurosh Darvish ◽  
Soroush Assari ◽  
John Cole ◽  
Tyler Wilps ◽  
...  
Keyword(s):  
Surface Area ◽  
Subtalar Joint ◽  
Articular Surface ◽  
Joint Surface ◽  
Central Dome ◽  
Below The Knee ◽  
Joint Surfaces ◽  
Circular Surface ◽  
The Mean ◽  
Pass Through

Category: Hindfoot Introduction/Purpose: In tibiotalocalcaneal nails for arthrodesis, the path of the nail through the subtalar joint has not been well documented. Ideally, the defect caused by reaming and the nail does not pass through the joint surface so that the amount of bony contact between the talus and calcaneus is maintained in order to optimize fusion. Our hypothesis is that the TTC nail does not destroy a significant amount contact area between the talus and calcaneus. However, using larger diameter nails (which are inherently stronger) will have more of an effect on the contact surface. Methods: Five cadaveric below the knee specimens were obtained. The ankle was disarticulated on each specimen. Subsequently, a guidepin was drilled from the central dome of the talus down to the calcaneus. The 11 mm reamer was then passed over the guidepin through the calcaneus to simulate retrograde reaming of a TTC nail. Then, the subtalar joint was dissected open and the articular surface was documented in comparison with the area that was reamed out. Measurements were then made, using software that calculated two dimensional surface area to determine the percentage of actual subtalar joint area that was reamed out. The mean percentage of articular area that was removed with the reamer was then calculated. Results: Among the five specimens, in the calcaneus, the mean total articular area was 599mm2±113 and the mean drilled articular area was 21mm2±16. The percentage of the calcaneal articular surface that was removed with the reamer was 3.4%±1.9. In the talus, the mean total articular area was 782mm2±130 and the mean drilled articular area was 39mm2±18. The percentage of the talar articular surface that was removed with the reamer was 5.0%±2.3. Additionally, an 11 mm reamer makes a circular surface area of 95mm2, and the statistics above indicate that a significant portion of the reamed area is nonarticular, within the calcaneal sulcus or the talar sulcus. Conclusion: In a tibiotalocalcaneal nail the subtalar joint is typically incompletely visualized, however this anatomic study demonstrates that the 11 mm reamer eliminates about 3.4% of the calcaneal articular surface and about 5% of the talar articular surface. Therefore, the majority of the articular surface is left intact, which is ideal in optimizing arthrodesis outcomes. Furthermore, this study could extrapolate the effects of a larger nail on the availability of joint surface. It could also be used to argue for cartilage stripping of the affected joint surfaces in arthrodesis preparation, because the majority of the articular surface is, in fact, left intact.

Sign in / Sign up

Export Citation Format

Share Document