Eildar Abyar, Ashish Shah
Volume 3 | Issue 2 | May – Aug 2018 | Page 30-37
Author: Eildar Abyar [1], Ashish Shah [1].
[1] Department of Orthopaedic Surgery, University of Alabama at Birmingham
Address of Correspondence
Dr. Eildar Abyar,
Department of Orthopaedic Surgery, University of Alabama at Birmingham, USA.
Email: elder.abiar@gmail.com
Abstract
Arthroscopy of the foot and ankle has become an important therapeutic tool for the management of foot and ankle pathologies. Advantages of the arthroscopic technique over open techniques include low post-operative morbidity and absence of limb-threatening complications, less blood loss, shorter hospital stay, faster rehabilitation and mobilization, and a decreased complication rate. To achieve these advantages the surgeon should be thoroughly skilled and familiar with the anatomy of the region3 and arthroscopic techniques. Arthroscopic surgery and tendoscopy are emerging procedures for management of several disorders of the ankle and subtalar joint. These techniques can be both diagnostic and therapeutic and preserve the soft-tissue envelope to a much greater extent than open surgery. The purpose of this review article is to survey the literature regarding the adjunct use of arthroscopy in the treatment of foot and ankle pathologies with highlights in ankle arthroscopy indications and techniques.
Keywords: Foot, Ankle, Arthroscopy,
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| How to Cite this article: Abyar E, Shah A. Foot and Ankle Arthroscopy: Updates, Indications and Technique. Asian Journal Arthroscopy. May-Aug 2018;3(2):30-37. |
Endoscopic Plantar Fasciotomy with Gastrocnemius Recession for Chronic Plantar Fasciitis
HA-BMAC: The Surgical Technique, Pearls and Pitfalls
Katarzyna Herman, Vetri Kumar, Dawid Szwedowski, Luca Chierici, Alberto Gobbi
Volume 4 | Issue 1 | Jan – April 2019 | Page 34- 37
Author: Katarzyna Herman[1], Vetri Kumar[1], Dawid Szwedowski[1], Luca Chierici[1], Alberto Gobbi[1]
Orthopaedic Arthroscopic Surgery International (OASI) Bioresearch Foundation, Milan, Italy.
Address of Correspondence
Dr.Alberto Gobbi, MD
Orthopaedic Arthroscopic Surgery International (OASI) Bioresearch Foundation, Via G.A. Amadeo 24, 20133, Milan, Italy.
Email: gobbi@cartilagedoctor.it
Abstract
Articular cartilage is a highly specialized tissue with poor healing potential. Damage to the cartilage following an injury to the joint is prevalent which leads to osteoarthritis. More research is aimed towards tissue regeneration and prevention of degeneration. Efforts to repair and restore the hyaline like cartilage using two-stage procedures such as autologous chondrocyte implantation have led to the development of scaffolds. Bone marrow aspirate concentrate that contains multi potent stem cells which has the potential to differentiate into hyaline like cartilage along with the use of a scaffold is an effective, reliable and single-stage method of cartilage restoration
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25. Gobbi A, Scotti C, Karnatzikos G, Mudhigere A, Castro M, Peretti GM. One-step surgery with multipotent stem cells and Hyaluronan-based scaffold for the treatment of full-thickness chondral defects of the knee in patients older than 45 years. Knee Surgery, Sports Traumatology, Arthroscopy. 2017;25(8):2494-2501.
26. Whyte GP, Gobbi A, Sadlik B. Dry Arthroscopic Single-Stage Cartilage Repair of the Knee Using a Hyaluronic Acid-Based Scaffold With Activated Bone Marrow-Derived Mesenchymal Stem Cells. Arthroscopy Techniques. 2016;5(4):e913-e918.
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Gel Based Autologous Chondrocyte Implantation: The Surgical Technique
Deepak Goyal, Vishvas Modi
Volume 4 | Issue 1 | Jan – April 2019 | Page 27- 33
Author: Deepak Goyal[1], Vishvas Modi[1]
Saumya Arthroscopy & Sports Knee Clinic,
Ahmedabad, India.
Address of Correspondence
Dr (Prof) Deepak Goyal
Saumya Arthroscopy & Sports Knee Clinic,
Ahmedabad, India.
Email: deepak@knee.in
Abstract
Autologous chondrocyte implantation (ACI) is one such technique that has the ability to provide a hyaline (like) repair of the localized cartilage lesions, even when they are of a big size. However, the procedure must be chosen very wisely because of its stringent indications and contraindications. Decision to do ACI procedure is very crucial and the surgeon must come to the decision after a detailed clinic-radiological examination. Gel based ACI is one such technique that allows a 3-dimensional distribution of the autologous cultured chondrocytes in a scaffold that is made of fibrin glue. The technique takes away the common complications that were associated with 1st and 2nd generation ACI; like graft hypertrophy, poor access to the lesion, membrane suturing, monolayer distribution etc. The purpose of this paper is to discuss the indications, contraindications, decision making and preoperative planning for the gel based autologous chondrocyte implantation technique in detail along with the surgical procedure, postoperative rehabilitation and the possible complications.
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Scaffold based Autologous Chondrocyte Implantation: The Surgical Technique
Professor Mats Brittberg
Volume 4 | Issue 1 | Jan – April 2019 | Page 23- 26
Author: Professor Mats Brittberg[1]
[1] Cartilage Research Unit, University of Gothenburg, Region Halland Orthopaedics, Kungsbacka Hospital, S-434 80 Kungsbacka Sweden.
Address of Correspondence
Professor- Mats Brittberg
Cartilage Research Unit, University of Gothenburg, Region Halland Orthopaedics, Kungsbacka Hospital, S-434 80 Kungsbacka Sweden.
Email: Mats.brittberg@telia.com
Abstract
Autologous chondrocyte implantation (ACI) has been used clinically since 1987. Most reports on ACI are on the first and second generation ACI with cells in suspension under a sutured membrane and performed with open surgery. Today’s 3rd and 4th generation ACI with cells seeded and grown in or on scaffolds prior to implantation opens up for transarthroscopic implantations. Transarthroscopic surgery reduces the morbidity for the patients and also fastens up the rehab process. In this paper, techniques used for scaffold-based ACI are presented.
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The Mosaicplasty / OAT procedure: Technique, Pearls and Pitfalls
Rajkumar Amaravathi, Renato Andrade, Ricardo Bastos, João Espregueira-Mendes
Volume 4 | Issue 1 | Jan – April 2019 | Page 15-22
Author: Rajkumar Amaravathi [1], Renato Andrade [2,3,4], Ricardo Bastos [2,3,5,6], João Espregueira-Mendes [2]
[1] Department Of Orthopedics, Division of Arthroscopy and Sports Surgery, St. John’s Medical College and Hospital, Bangalore 560034,India
[2] Clínica do Dragão, Espregueira-Mendes Sports Centre – FIFA Medical Centre of Excellence, Porto, Portugal.
[3] Dom Henrique Research Centre, Porto, Portugal.
[4] Faculty of Sports, University of Porto, Porto, Portugal.
[5] Fluminense Federal University, Niteroi, Brazil.
[6] ICVS/3B’s-PT Government Associate Laboratory, Guimarães, Portugal.
[7] School of Medicine, Minho University, Braga, Portugal.
Address of Correspondence
Dr João Espregueira-Mendes,
M.D., Ph.D.; Clínica do Dragão, Espregueira-Mendes Sports Centre – FIFA Medical Centre of Excellence,
Estádio do Dragão, Entrada Nascente, Piso -3, 4350-415, Porto, Portugal.
Email: espregueira@dhresearchcentre.com
Abstract
Osteochondral autologous transplantation is a surgical procedure that involves the transplant of the autologous cartilage from the non-weight bearing areas of the knee to the articular defect. It has the advantage of being a single stage procedure, repairs the subchondral bone, provides hyaline cartilage and allows a fast return to play. It is indicated for small and medium-sized defects, but the mosaicplasty technique allows treating defects up to 9 cm2. A major disadvantage of this technique is the donor site morbidity associated with the graft harvesting. To overcome this drawback, we harvest the autografts from the upper tibio-fibular joint with low or none donor site morbidity. Osteochondral autologous transplantation and mosaicplasty procedures remain an excellent option for small to medium osteochondral injuries resulting in long-term good to excellent clinical and imaging outcomes.Osteochondral autologous transplantation is a surgical procedure that involves the transplant of the autologous cartilage from the non-weight bearing areas of the knee to the articular defect. It has the advantage of being a single stage procedure, repairs the subchondral bone, provides hyaline cartilage and allows a fast return to play. It is indicated for small and medium-sized defects, but the mosaicplasty technique allows treating defects up to 9 cm2. A major disadvantage of this technique is the donor site morbidity associated with graft harvesting. To overcome this drawback, we harvest the autografts from the upper tibio-fibular joint with low or none donor site morbidity. Osteochondral autologous transplantation and mosaicplasty procedures remain an excellent option for small to medium osteochondral injuries resulting in long-term good to excellent clinical and imaging outcomes.
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45. Gudas R, Simonaityte R, Cekanauskas E, Tamosiunas R. A prospective, randomized clinical study of osteochondral autologous transplantation versus microfracture for the treatment of osteochondritis dissecans in the knee joint in children. J Pediatr Orthop. 2012;29:741-748.
46. Lim HC, Bae JH, Song SH, Park YE, Kim SJ. Current treatments of isolated articular cartilage lesions of the knee achieve similar outcomes. Clin Orthop Relat Res. 2012;470:2261-2267.
47. Ulstein S, Aroen A, Rotterud JH, Loken S, Engebretsen L, Heir S. Microfracture technique versus osteochondral autologous transplantation mosaicplasty in patients with articular chondral lesions of the knee: a prospective randomized trial with long-term follow-up. Knee Surg Sports Traumatol Arthrosc. 2014;22:1207-1215.
48. Mithoefer K, Hambly K, Della Villa S, Silvers H, Mandelbaum BR. Return to sports participation after articular cartilage repair in the knee: scientific evidence. Am J Sports Med. 2009;37 Suppl 1:167s-176s.
49. Andrade R, Vasta S, Papalia R, Pereira H, Oliveira JM, Reis RL, Espregueira-Mendes J. Prevalence of articular cartilage lesions and surgical clinical outcomes in football (soccer) players’ knees: a systematic review. Arthroscopy. 2016;32:1466-1477.
50. Krych AJ, Pareek A, King AH, Johnson NR, Stuart MJ, Williams RJ, 3rd. Return to sport after the surgical management of articular cartilage lesions in the knee: a meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2017;25:3186-3196.
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Endoscopic Plantar Fasciotomy with Gastrocnemius Recession for Chronic Plantar Fasciitis
Imaging for Cartilage injuries
Anupama Patil, Aniket Jadhav
Volume 4 | Issue 1 | Jan – April 2019 | Page 4-8
Author: Anupama Patil[1], Aniket Jadhav[1]
STAR imaging and research centre, Joshi Hospital Campus Opposite Kamla Nehru Park, Erandwane, Pune, Maharashtra.
Address of Correspondence
Dr Anupama Patil
STAR imaging and research centre, Joshi Hospital Campus Opposite Kamla Nehru Park, Erandwane, Pune, Maharashtra 411004
Email: anupama.patil2003@gmail.com
Abstract
Chondral injuries can occur in an isolated manner or, more commonly, in association with osseous or soft tissue injuries. Accurate pre-knowledge of the chondral injury and associated injuries help the orthopedic surgeon in planning appropriate treatment procedures. Advances in various treatment techniques for chondral defects places paramount importance on the identification, and quantification of these injuries. Through this article, we present a review of literature regarding Magnetic resonance imaging assessment of chondral injuries, also addressing the scan parameters used, advances in imaging for cartilage, role of Magnetic resonance imaging in postoperative follow-up, comparison of accuracy of Magnetic resonance imaging with arthroscopy as well as the roles of ultrasonography and computed tomography in evaluation of articular cartilage.
Magnetic resonance imaging has an indispensable role in the pre-arthroscopic work-up and post-arthroscopic follow-up of chondral injuries. It gives an accurate knowledge of chondral defects/ injuries, staging of lesions, evaluating subchondral bone, assessing adjacent cartilage, identifying loose bodies in remote recesses likely to be missed on arthroscopy, and identifying another ligament/meniscal tears. It is also useful in assessing the donor and recipient sites in
The post-arthroscopic workup following cartilage repair. Ultrasound arthroscopy is a new quantitative intra-operative imaging modality, still not widely used. Computed tomography doesn’t image the cartilage directly but plays an important ancillary role in the evaluation of subchondral bone and identification of location and size of loose bodies.
References
1. Michel D. Crema, Frank W. Roemer et al.Articular cartilage in the knee: current MR imaging techniques and applications in clinical practice and research.Radiographics.2011;31(1):37-62.
2. Tallal C. Mamisch, Siegfried Trattnig et al. Musculoskeletal Imaging : Quantitative T2 Mapping of Knee Cartilage Differentiation of Healthy Control Cartilage and Cartilage Repair Tissue in the Knee with Unloading—Initial Results.Radiology.2010;254(3):818-26.
3. Garry E. Gold, Christina A. Chen et al. Recent Advances in MRI of Articular Cartilage.American Journal of Roentgenology.2009;193:628-38 .
4. Yon Sun Choi, Hollis G. Potter, Tong Jin Chun. MR imaging of Cartilage Repair in the Knee and Ankle. Radiographics.2008;28(4):1043-59.
5. Christiaan JA van Bergen, Rogier Gerards et al. Diagnosing, planning and evaluating osteochondral ankle defects with imaging modalities.World J Orthop.2015;6(11):944–53.
6. Pekko Penttilä, Jukka Liukkonen et al.Diagnosis of Knee Osteochondral Lesions With Ultrasound Imaging.Arthrosc Tech.2015;4(5):e429–e433.
7. Kira D. Novakofski, Sarah L. Pownder et al. High-Resolution Methods for Diagnosing Cartilage Damage In Vivo. Cartilage. 2016; 7(1): 39–51.
8. Bhawan K Paunipagar, DD Rasalkar et al.Imaging of articular cartilage.Indian J Radiol Imaging.2014;24(3):237-48.
9. Irmak Durur-Subasi, Afak Durur-Karakaya et al.Osteochondral Lesions of Major Joints.Eurasian J Med.2015;47:138-44.
10. Marcelo Bordalo Rodrigues, Gilberto Luís Camanho.MRI EVALUATION OF KNEE CARTILAGE. Rev Bras Ortop.2010;45(4):340-6.
11. Candace L. White, Nancy A. Chauvin et al.MRI of Native Knee Cartilage Delamination Injuries.American Journal of Roentgenology.2017;209(5):W317-W321.
12. Richard Kijowski.Clinical Cartilage Imaging of the Knee and Hip Joints.Americal Journal of Roentgenology.2010;195:618-28.
13. Richard Kijowski, Donna G. Blankenbaker et al. Comparison of 1.5- and 3.0-T MR Imaging for Evaluating the Articular Cartilage of the Knee Joint.Radiology.2009;250(3):839-848.
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Endoscopic Plantar Fasciotomy with Gastrocnemius Recession for Chronic Plantar Fasciitis
Fourth Year of Asian Journal of Arthroscopy
Sachin Tapasvi, Parag Sancheti, Ashok K. Shyam
Volume 4 | Issue 1 | Jan – April 2019 | Page 1
Author: Sachin Tapasvi [1], Parag Sancheti [2], Ashok K Shyam [2,3]
[2] Orthopaedic Speciality Clinic, Pune Mahatrahtra.
[1] Sancheti Institute for Orthopaedics &Rehabilitation, Pune, India
[3] Indian Orthopaedic Research Group, Thane, India
Address of Correspondence
Dr Sachin Tapasvi
AJA Editorial Office, A-203, Manthan Apts, Shreesh CHS, Hajuri Road, Thane [w], Maharashtra, India.
Email: asian.arthroscopy@gmail.com
Fourth Year of Asian Journal of Arthroscopy
Journals grow slowly and require immense hard work to sustain them year after year. Maintaining the quality of the journal is paramount and along with that journal too has to innovate itself. Asian Journal of Arthroscopy is now in its fourth year and has gained the support of the Arthroscopy community in India and in Asia too. It is time for us to innovate and to expand our horizons. This issue marks some new things and promotes certain new formats
The first is the Arthroscopy Surgical Video Atlas of AJA. Arthroscopy is one of the most dynamically evolving surgical branch where innovative surgical techniques are being described very frequently. Also even for common surgical techniques, there are many simple steps that vary from surgeon to surgeon. We wish to chronicle these surgical techniques and these variations in surgical steps through this new section in the Journal. This will also mark the beginning of the video format of the article for Asian Journal of Arthroscopy. The articles in the Arthroscopy Atlas section will be in a video format and the details of the format are displayed on the website. Authors can send us a small abstract of the video and the video with voiceover and this will be published in the print as well as the online version of the Journal. To begin this Atlas we are taking one of the videos from our editor Dr. Sachin Tapasvi on Arthroscopic Repair of Bucket Handle Medial Meniscal Tear. We would like to invite our readers to send their surgical videos to us and get a publication out of their videos
The second focus of the journal will be on case reports this year. Case reports are stepping stones, especially for young arthroscopy surgeons and are a way to initiate them in the field of academics. We would request the senior arthroscopy surgeons to make it compulsory for their fellows to at least write one case report in their entire fellowship term. We would be glad to help the fellows in polishing these case reports and publish it in Asian Journal of Arthroscopy.
We would like to thank Dr. Deepak Goyal, the guest editor for this issue for compiling this issue with eminent authors from around the globe
Lastly, we are in need of more editorial board members and would request our interested readers to write an email to us with a letter o intent. The selection process has already started and we wish to bring together a group of interested editorial board members to take the journal ahead into the future.
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A Surgical Perspective to the Modern Cartilage Repair Techniques
Dr. Deepak Goyal
Volume 4 | Issue 1 | Jan – April 2019 | Page 2-3
Author: Deepak Goyal [1]
Consultant Cartilage and Sports Knee Surgeon, Saumya Arthroscopy & Sports Knee Clinic, Ahmedabad, India.
Address of Correspondence
Dr. Deepak Goyal,
Consultant Cartilage and Sports Knee Surgeon
Saumya Arthroscopy & Sports Knee Clinic,
Ahmedabad, India.
Email: deepak@knee.in
Abstract
Hunter [1] in AD 1742 had observed, ‘Cartilage once damaged cannot heal’ and the orthopedic community continued to believe in his statement for over 200 years. There were some scattered attempts and observations to heal the cartilage in the later-half of the twentieth century. We have seen an enthusiastic interest with many new modalities showing varying degrees of cartilage repair success in the last 25 years. While traveling across Asian countries, I come across many surgeons who have an active interest in the cartilage repair. Young enthusiast surgeons are keen to learn techniques and develop skills for various cartilage repair procedures. But, many of them are unable to do more than the microfracture technique, the first line of treatment [2]. Asian Journal of Arthroscopy, is keen to infuse the basic know-how of commonly done procedures along with a stress on practical approach towards the procedures. Literature is abundant about each of the cartilage repair procedures, but a ‘beginner cartilage surgeon’ would like to know the basics of case selection, decision making, surgical techniques, and tips, along with the possible complications. This special issue on cartilage repair invited different surgeons/ doctors who are doing pioneer work in their respective fields of cartilage repair.
Patil and Jadhav [3] have started this edition of AJA with a detailed understanding of various sequences of MRI that are important for the diagnosis of the cartilage lesions. They have not only described the various zones of cartilage on MRI but have also discussed in detail about the T2 mapping. The various MRI characteristics of damaged cartilage and repaired cartilage are also discussed along with the MOCART score.
Devin Leland et at [4] have written a nice article on the microfracture technique that is specifically indicated for the small size lesions. They have given a detailed discussion on the indications, surgical steps, and the site-specific rehabilitation program; while using the microfracture technique. They have also discussed short and long-term results of the microfracture technique along with a brief discussion on various systematic reviews. To conclude, they have also compared the results of the subchondral drilling technique and the osteochondral grafting.
Amaravathi et al [5] advocate osteochondral cylinder transfer technique for mid-size cartilage lesions. They have put a special emphasis on the proper case selection, pre-operative planning, and the surgical technique, along with the detailed tabulated pearls and pitfalls for each. The discussion about long-term results (15 years) of the osteochondral cylinder transfer procedures by various authors is quite promising in favor of the technique. Their suggestion on the use of the proximal tibiofibular joint as the source of the graft will be interesting to watch, with the long-term results in the future.
Mats Brittberg [6] has written a very nice article on 3rd generation ACI and has tried to remove the confusion between the nomenclature of various methods that fall under the ambit of 3rd generation ACI. He has also introduced the 4th generation ACI with this article that will allow the surgeons to use ACI as a single stage surgery.
Goyal and Modi [7] have advocated the use of the gel based ACI procedure, another 3rd generation ACI, mainly for the large chondral lesions with a cautious use in the extra-large lesions. They have heavily emphasised on a very careful selection of the patient using stringent guidelines and a preoperative planning methodology. A detailed step-by-step surgical technique discussion and a postoperative rehabilitation program is also discussed, along with an insight into the possible complications.
Herman et al [8] have stressed the importance of a single stage technique of cartilage repair using hyaluronic acid-based scaffold with the bone marrow aspirate concentrate. They have described the surgical technique along with a detailed understanding of the various phases of the rehabilitation program.
I hope, many youngsters as well as seniors will find this special issue on cartilage repair, useful.
References
1. Hunter W. Of the structure and diseases of articulating cartilages, by William Hunter, surgeon. Philos Trans R Soc Lond 1742;42:514-521.
2. Goyal D, Keyhani S, Lee EH, Hui JHP. Evidence-Based Status of Microfracture Technique: A Systematic Review of Level I and II Studies. Arthroscopy. 2013;29(9):1579-1588.
3. Patil A, Jadhav A. Imaging for Cartilage injuries. Asian Journal Arthroscopy. Jan-April 2019;4(1): 4-8.
4. Leland DP, Bernard CD, Krych AJ. The Microfracture Technique: Pearls and Pitfalls. Asian Journal Arthroscopy. Jan-April 2019;4(1):9-14
5. Amaravathi R, Andrade R, Bastos R, Espregueira-Mendes J. The Mosaicplasty/ OAT procedure: Technique, Pearls, and Pitfalls. Asian Journal Arthroscopy. Jan-April 2019;4(1): 15-22.
6. Brittberg M. Scaffold-based autologous chondrocyte implantation: The surgical technique. Asian Journal Arthroscopy. Jan-April 2019;4(1):23-26
7. Goyal & Modi. Gel-Based Autologous Chondrocyte Implantation: The Surgical Technique. Asian Journal Arthroscopy. Jan-April 2019;4(1):27-33.
8. Herman K, Kumar V, Szwedowski D, Chierici L, Gobbi A. HA-BMAC: The Surgical Technique, Pearls and Pitfalls. Asian Journal Arthroscopy. Jan-April 2019;4(1):34-37
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Endoscopic Plantar Fasciotomy with Gastrocnemius Recession for Chronic Plantar Fasciitis
Foot and Ankle Arthroscopy: Updates, Indications and Technique
Eildar Abyar, Ashish Shah
Volume 3 | Issue 2 | May – Aug 2018 | Page 30-37
Author: Eildar Abyar [1], Ashish Shah [1].
[1] Department of Orthopaedic Surgery, University of Alabama at Birmingham
Address of Correspondence
Dr. Eildar Abyar,
Department of Orthopaedic Surgery, University of Alabama at Birmingham, USA.
Email: elder.abiar@gmail.com
Abstract
Arthroscopy of the foot and ankle has become an important therapeutic tool for the management of foot and ankle pathologies. Advantages of the arthroscopic technique over open techniques include low post-operative morbidity and absence of limb-threatening complications, less blood loss, shorter hospital stay, faster rehabilitation and mobilization, and a decreased complication rate. To achieve these advantages the surgeon should be thoroughly skilled and familiar with the anatomy of the region3 and arthroscopic techniques. Arthroscopic surgery and tendoscopy are emerging procedures for management of several disorders of the ankle and subtalar joint. These techniques can be both diagnostic and therapeutic and preserve the soft-tissue envelope to a much greater extent than open surgery. The purpose of this review article is to survey the literature regarding the adjunct use of arthroscopy in the treatment of foot and ankle pathologies with highlights in ankle arthroscopy indications and techniques.
Keywords: Foot, Ankle, Arthroscopy,
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Endoscopic Plantar Fasciotomy with Gastrocnemius Recession for Chronic Plantar Fasciitis
Tendoscopy: A novel way to look at an Enigma; Indications,Technique & Results of managing tendon pathologies in foot and ankle
Abhishek Kini, Amit Munde
Volume 3 | Issue 2 | May – Aug 2018 | Page 24-29
Author: Abhishek Kini [1], Amit Munde [1].
[1] Department of Orthopaedics, P.D.Hinduja Hospital& Medical Research Centre, Mumbai, India.
Address of Correspondence
Dr. Abhishek Kini,
Dept. of Orthopaedics, PD Hinduja hospital & Medical research centre, Mahim, Mumbai, India.
Email: kiniabhishek@gmail.com
Abstract
Background: Lack of consensus remains regarding management of the myriad of etiologies that affect the tendons traversing the hindfoot. Commonly affected tendons include the peroneals, flexor hallucis longus (FHL), tibialis posterior and the Achilles tendons. Tendoscopy is a largely unexplored approach in treatment of these varied causes. There is not enough international literature available on the utility of this novel technique. With this paper we aim to study the indications for tendoscopy, describe its technique and present its results.
Methods: Sixteen patients with failed conservative care for the above mentioned tendon related complaints were treated tendoscopically from June 2013 to December 2015. We detail the surgical steps to perform tendoscopy. Age, gender, timing of surgery, work & activity demands, preop & 6 months postop AOFAS hindfoot score were noted. At final followup patients were asked to rate their overall result as excellent, good, fair or poor & whether they were satisfied.
Results: Five patients had peroneal tendon, six patients had FHL, two tibialis posterior tendon and 3 Achilles tendon pathologies. 11 active high demand individuals were part of this group and all of these could resume their high demand activity by 6 to 12 weeks. AOFAS hindfoot score improved from 58.6 +/-8.9 to 81.3 +/-7.1 (p>0.05). All patients were satisfied with their surgical outcome.
Conclusion: Tendoscopy is a safe technique to treat the tendons traversing the hindfoot. Advantage being ability to examine longer length of tendon in a minimally invasive manner leading to low morbidity, early recovery to activities.
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Endoscopic Plantar Fasciotomy with Gastrocnemius Recession for Chronic Plantar Fasciitis
Endoscopic Plantar Fasciotomy with Gastrocnemius Recession for Chronic Plantar Fasciitis
Rajesh Simon, Julio C Kandathil, Dennis P Jose
Volume 3 | Issue 2 | May – Aug 2018 | Page 20-23
Author: Rajesh Simon [1], Julio C Kandathil [1], Dennis P Jose [1].
[1] Dept. of Orthopaedics, VPS Lakeshore Hospital & Research Centre, Nettoor P.O. , Kochi, Kerala,
India
Address of Correspondence
Dr. Rajesh Simon,
VPS Lakeshore Hospital and Research Centre,
Nettoor P.O. , Kochi, Kerala, India.
Email: rajeshsimon@gmail.com
Abstract
Background: Plantar fasciitis is one of the most common pathologies seen by foot and ankle surgeon. Treatment is mostly conservative. Further intervention of injections and shock wave therapies have given improvement to many patients. However, when all these therapy fails, surgical intervention is warranted. A thorough investigation is again done to confirm any other cause of pain. MRI usually reveals the thickened medial cord way beyond its normal size. Endoscopic plantar fascioctomy is done to release the thickened medial cord of the plantar fascia. Gastroc recession is added in case of tight gastrocnemius.
Materials and Methods: 11 foot (1M/8F) (2-B/L) treatedfor chronic Plantar fascioctomy with or without Gastroc recession were reviewed in this retrospective sturdy. The mean follow-up was 9 months(range 6 to 24 months). All patients underwent atleast 6 months of conservative management. They were further evaluated with proper evaluation and pre op MRI to confirm the thickness of the plantar fascia pre operatively. All patients were operated with endoscopic plantar fascioctomy with or without gastroc recession depending on the tightness of the gastrocnemius.
Results: At the follow up improvement was noted in all the patients compared to their pre op status. All patients returned to their pre op activity. No major complication was seen.
Conclusion: Endoscopic Plantar fascioctomy with added gastroc recession is a safe and effective procedure for the treatment of chronic plantar fasciitis that gives good relief of symptoms and allow a successful return to normal activity levels
Keywords: Chronic Plantar fasciitis, Endoscopic plantar fasciotomy, Heel pain, Gastrocnemius Recession.
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(Abstract) (Full Text HTML) (Download PDF)
Endoscopic Plantar Fasciotomy with Gastrocnemius Recession for Chronic Plantar Fasciitis