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,

References

1. O’Brien TS, Hart TS, Shereff MJ, Stone J, Johnson J. Open versus arthroscopic ankle arthrodesis: a comparative study. Foot Ankle Int 1999 Jun;20(6):368-74.
2. Willits K, Sonneveld H, Amendola A, Giffin JR, Griffin S, Fowler PJ. Outcome of posterior ankle arthroscopy for hindfoot impingement. Arthroscopy 2008 Feb;24(2):196-202.
3. Barber FA, Click J, Britt BT. Complications of ankle arthroscopy. Foot Ankle 1990 Apr;10(5):263-6.
4. Watanabe M. Selfoc Arthroscope (Watanabe no 24 Arthroscopes). Tokyo, Japan: Teishin Hospital; 1972.
5. Ferkel RD, Orwin JF. Ankle arthroscopy: a new tool for treating acute and chronic ankle fractures (abtract). Arthroscopy. 1993;9:352-353.
6. Van Dijk CN, Verhagen RA, Tole JL. Arthroscopy for problems after ankle fracture. J Bone Joint Surg Br. 1997;79: 280-284.
7. Ferkel RD, Small HN, Gittins JE. Complications in foot and ankle arthroscopy. Clin Orthop Relat Res 2001 Oct;(391):89- 
104.
8. Van Dijk CN, Scholte D. Arthroscopy of the ankle joint. 
Arthroscopy 1997 Feb;13(1):90-6.
9. Van Dijk CN, Scholten PE, Krips R. A 2-portal endoscopic approach for diagnosis and treatment of posterior ankle pathol- ogy. Arthroscopy 2000 Nov;16(8):871-6.
10. Stutz G, Kuster MS, Kleinstück F, Gächter A: Arthroscopic management of septic arthritis: stages of infection and results, Knee Surg Sports Traumatol Arthrosc 8:270–274, 2000.
11. Waguri-Nagaya Y, Kobayashi M, Goto H, et al: Septic arthritis of the right ankle caused by Staphylococcus aureus infection in a rheumatoid arthritis patient treated with etanercept, Mod Rheu­matol 17:338–0, 2007.
12. Kleiger B. Anterior tibiotalar impingement syndromes in dancers. Foot Ankle 3:69–73, 1982.
13. van den Bekerom MP, Raven EE. The distal fascicle of the anterior inferior tibiofibular ligament as a cause of tibiotalar impingement syndrome: a current concepts review. Knee Surg Sports Traumatol Arthrosc 15:465–471, 2007.
14. Umans H. Ankle impingement syndromes. Semin Musculoskelet Radiol 6:133–139, 2002.
15. Renstrom PAFH. Persistently painful sprained ankle. J Am Acad Orthop Surg 2:270–280, 1994.
16. Morris LH. Athlete’s ankle. J Bone Joint Surg 25:220–223, 1943.
17. McMurray TP. Footballer’s ankle. J Bone Joint Surg 32[Br]:68–69, 1950.
18. Ferkel RD, Karzel RP, Del Pizzo W, Friedman MJ, Fischer SP. Arthroscopic treatment of anterolateral impingement of the ankle. Am J Sports Med 19:440–446, 1991.
19. Deberardino TM, Arciero RA, Taylor DC. Arthroscopic treatment of soft tissue impingement of the ankle in athletes. Arthroscopy 13:492–498, 1997.
20. Wolin I, Glassman F, Sideman F, Levinthal DH. Internal derangement of talofibular component of the ankle. Surg Gynecol Obstet 91:193–200, 1950.
21. Bassett FH, Gates HS, Billys JB, Morris HB, Nikolaou PK. Talar impingement by the anteroinferior tibiofibular ligament. A cause of chronic pain in the ankle after inversion sprain. J Bone Joint Surg 72[Am]:55–59, 1990.
22. Akseki D, P´ynar H, Bozkurt M, Yald´yz K, Araç S. The distal fascicle of the anterior inferior tibiofibular ligament as a cause of anterolateral ankle impingement. Acta Orthop Scand 70:478–482, 1999.
23. Meislin RJ, Rose DJ, Parisien JS, Springer S. Arthroscopic treatment of synovial impingement of the ankle. Am J Sports Med 21:186–189, 1993.
24. Liu SH, Raskin A, Osti L, Baber C, Jacobson K, Finerman G. Arthroscopic treatment of anterolateral ankle impingement. Arthroscopy 10:215–218, 1994.
25. Martin DF, Curl WW, Baker CL. Arthroscopic treatment of chronic synovitis of the ankle. Arthroscopy 5:110–114, 1989.
26. Kim SH, Ha KI. Arthroscopic treatment for impingement of the anterolateral soft tissues of the ankle. J Bone Joint Surg 82[Br]:1019–1021, 2000.
27. Amandola A, Petrik J, Webster-Bogaert S. Ankle arthroscopy: outcome in 79 consecutive patients. Arthroscopy 12:565–573, 1996.
28. Ferkel RD, Karzel RP, Del Pizzo W, et al. Arthroscopic treatment of anterolateral impingement of the ankle. Am J Sports Med. 1991;19(5):440–6.
29. DeBerardino TM, Arciero RA, Taylor DC. Arthroscopic treatment of soft-tissue impingement of the ankle in athletes. Arthroscopy. 1997;13(4):492–8.
30. Kim SH, Ha KI. Arthroscopic treatment for impingement of the anterolateral soft tissues of the ankle. J Bone Joint Surg Br. 2000;82(7):1019–21.
31. Arnold H. Posttraumatic impingement syndrome of the ankle: indications and results of arthroscopic therapy. Foot Ankle Surg. 2011;17:85–8.
32. Tol JL, van Dijk CN. Anterior ankle impingement. Foot Ankle Clin 2006 Jun;11(2):297-310, vi.
33. Ogilvie-Harris DJ, Mahomed N, Demaziere A. Anterior impingement of the ankle treated by arthroscopic removal of bony spurs. J Bone Joint Surg Br. 1993;75:437–40. Seventeen patients who performed arthroscopic resection for anterior impingement were reviewed. Pain, swelling, and limping were improved in a 3 year follow-up.
34. Ferkel RD, Karzel RP, Del Pizzo W, et al. Arthroscopic treatment of anterolateral impingement of the ankle. Am J Sports Med. 1991;19(5):440–6.
35. Biedert R. Anterior ankle pain in sports medicine: aetiology and indications for arthroscopy. Arch Orthop Trauma Surg. 1991;110 (6):293–7.
36. Amendola A, Petrik J, Webster-Bogaert S. Ankle arthroscopy: outcome in 79 consecutive patients. Arthroscopy. 1996;12(5):565–73. Study with seventy nine patients who performed ankle arthroscopic debridement after impingement syndrome with 80-86 % improve after surgery.
37. Scranton PE, McDermott JE. Anterior tibiotalar spurs: a comparison of open versus arthroscopic debridement. Foot Ankle. 1992;13 (3):125–9.
38. Niek van Dijk C: Anterior and posterior ankle impingement. Foot Ankle Clin 2006;11(3):663-683.
39. Scholten PE, Sierevelt IN, van Dijk CN. Hindfoot endoscopy for posterior ankle impingement. J Bone Joint Surg Am 2008 Dec;90(12):2665-72.
40. Willits K, Sonneveld H, Amendola A, Giffin JR, Griffin S, Fowler PJ. Outcome of posterior ankle arthroscopy for hindfoot impingement. Arthroscopy 2008 Feb;24(2):196-202.
41. Hamilton WG, Geppert MJ, Thompson FM. Pain in the posterior aspect of the ankle in dancers. Differential diagnosis and operative treatment. J Bone Joint Surg Am 1996 Oct;78(10):1491-500.
42. Van Dijk CN, Lim LS, Poortman A, Strubbe EH, Marti RK. Degenerative joint disease in female ballet dancers. Am J Sports Med 1995 May;23(3):295-300.
43. Hedrick MR, McBryde AM. Posterior ankle impingement. Foot Ankle Int 1994 Jan;15(1):2-8.
44. Weinstein SL, Bonfiglio M. Unusual accessory (bipartite) talus simulating fracture. A case report. J Bone Joint Surg Am 1975 Dec;57(8):1161-3.
45. Sarrafian SK. Anatomy of the foot and ankle: descriptive, topographic, functional. Philadelphia: Lippincott; 1983.
46. Bizarro AH. On sesamoid and supernumerary bones of the limbs. J Anat 1921;55:256-68.
47. Lapidus PW. A note on the fracture of os trigonum syndrome. Report of a case. Bull Hosp Jt Dis 1972;33(2):150-4.
48. Ferkel RD. Soft-tissue lesions of the ankle. In: Whipple TL, editor. Arthroscopic surgery: the foot and ankle. Philadelphia: Lippincott-Raven; 1996. p. 121-43.
49. SooHoo NF, Zingmond DS, Ko CY. Comparison of reoperation rates following ankle arthrodesis and total ankle arthroplasty. J Bone Joint Surg Am. 2007;89:2143–9.
50. Haddad SL, Coetzee JC, Estok R, et al. Intermediate and long-term outcomes of total ankle arthroplasty and ankle arthrodesis. A systematic review of the literature. J Bone Joint Surg Am. 2007;89:1899–905.
51. Schneider D. Arthroscopic ankle fusion. Arthroscopic Video J. 1983, 3.
52. Zvijac JE, Lemak L, Schurhoff MR, et al. Analysis of arthroscopically assisted ankle arthrodesis. Arthroscopy. 2002;18(1):70–5.
53. Myerson MS, Quill G. Ankle arthrodesis. A comparison of an arthroscopic and an open method of treatment. Clin Orthop Relat Res. 1991;268:84–95.
54. Peterson KS, Lee MS, Buddecke DE. Arthroscopic versus open ankle Arthroscopic versus open ankle arthrodesis: a retrospective cost analysis. J Foot Ankle Surg. 2010;49(3):242–7.
55. Winson IG, Robinson DE, Allen PE. Arthroscopic ankle arthrodesis. J Bone Joint Surg Br. 2005;87-B(3):343–7.
56. Gougoulias NE, Agathangelidis FG, Parsons SW. Arthroscopic ankle arthrodesis. Foot Ankle Int. 2007;28(6):695–706.
57. Dannawi Z, Nawabi DH, Patel A, et al. Arthroscopic ankle arthrodesis: are results reproducible irrespective of pre-operative deformity? Foot Ankle Surg. 2011;17(4):294–9. This paper supports the use arthroscopic tibiotalar fusion in cases of high angular deformity of the ankle.
58. Pierre A, Hulet C, Locker B, et al. Arthroscopic tibio-talar arthrodesis: limitations and indications in 20 patients. Rev Chir Orthop Reparatrice Appar Mot. 2003;89(2):144–51.
59. Ferkel RD, Hewitt M. Long term results of arthroscopic ankle arthrodesis. Foot Ankle Int. 2005;26(4):275–80.
60. Collman DR, Kaas MH, Schuberth JM. Arthroscopic ankle arthrodesis: factors influencing union in 39 consecutive patients. Foot Ankle Int. 2006;27(12):1079–85.
61. McCullough CJ, Venugopal V. Osteochondritis dissecans of the talus: the natural history. Clin Orthop Relat Res. 1979;144:264-268.
62. Scharling M. Osteochondritis dissecans of the talus. Acta Orthop Scand. 1978;49:89-94.
63. Schenck RC Jr, Goodnight JM. Osteochondritis dissecans. J Bone Joint Surg Am. 1996; 78:439-456.
64. Cahill BR. Osteochondritis dissecans of the knee: treatment of juvenile and adult forms. J Am Acad Orthop Surg. 1995; 3:237-247.
65. McCoy AM, Toth F, Dolvik NI, et al. Articular osteochondrosis: a comparison of naturally-occurring human and animal disease. Osteoarthritis Cartilage. 2013;21:1638-47.
66. O’Driscoll SW. The healing and regeneration of articular cartilage. J Bone Joint Surg Am. 1998;80: 1795-1812.
67. Chuckpaiwong B, Berkson EM, Theodore GH. Micro-fracture for osteochondral lesions of the ankle: outcome analysis and outcome predictors of 105 cases. Arthroscopy. 2008; 24:106-112.
68. Kouvalchouk JF, Schneider-Maunoury G, Rodineau J. Osteochondral lesions of the dome of the talus with partial necrosis. Surgical treatment by curettage and filling. Rev Chir Orthop Reparatrice Appar Mot. 1990;76:480-489.
69. Van Dijk CN, Scholten PE, Krips RA. 2-portal endoscopic approach for diagnosis and treatment of posterior ankle pathology. Arthroscopy 2000;16:871-876.
70. Scholten PE, Sierevelt IN, van Dijk CN. Hindfoot endoscopy for posterior ankle impingement. J Bone Joint Surg Am 2008;90:2665-2672.
71. Willits K, Sonneveld H, Amendola A, Giffin JR, Griffin S, Fowler PJ. Outcome of posterior ankle arthroscopy for hindfoot impingement. Arthroscopy 2008;24:196-202.
72. Galla M, Lobenhoffer P. Technique and results of arthroscopic treatment of posterior ankle impingement. Foot Ankle Surg 2011;17:79-84.
73. Tey M, Monllau JC, Centenera JM, Pelfort X. Benefits of arthroscopic tuberculoplasty in posterior ankle impingement syndrome. Knee Surg Sports Traumatol Arthrosc 2007;15:1235-1239.
74. Russell JA, Shave RM, Yoshioka H, Kruse DW, Koutedakis Y, Wyon MA. Magnetic resonance imaging of the ankle in female ballet dancers en pointe. Acta Radiol 2010;6:655-661.
75. Peace KAL, Hillier JC, Hulme A, Healy JC. MRI features of posterior ankle impingement syndrome in ballet dancers: A review of 25 cases. Clin Radiol 2004;59:1025-1033.
76. Russell JA, Kruse DW, Koutedakis Y, McEwan IM, Wyon M. Pathoanatomy of posterior ankle impingement in ballet dancers. Clin Anat 2010;23:613-621.
77. Ferkel RD, Orwin JF. Ankle arthroscopy: a new tool for treating acute and chronic ankle fractures (abtract). Arthroscopy. 1993;9:352-353.
78. Schuberth JM, Cobb MD, Talarico RH. Minimally invasive arthroscopic-assisted reduction with percutaneous fixation in the management of intra-articular calcaneal fractures: a review of 24 cases. J Foot Ankle Surg. 2009;48:315-322.
79. Hintermann B, Regazzoni P, Lampert C, Stutz G, Gachter A. Arthroscopic findings in acute fractures of the ankle. J Bone Joint Surg Br. 2000;82:345-351.
80. Thordarson DB, Bains R, Shepherd LE. The role of ankle arthroscopy on the surgical management of ankle fractures. Foot Ankle Int. 2001;22:123-125.
81. Olszewski AD, Jones R, Farrell R, Kaylor K. The effects of dilute epinephrine saline irrigation on the need for tourniquet use in routine arthroscopic knee surgery. Am J Sports Med. 1999;27:354-356.
82. Schuberth JM, Collman DR, Rush SM, Ford LA. Deltoid ligament integrity in lateral malleolar fractures: a comparative analysis of arthroscopic and radiographic assessments. J Foot Ankle Surg. 2004;43: 20-29.
83. Schuberth JM, Jennings MM, Lau AC. Arthroscopy-assisted repair of latent syndesmotic instability of the ankle. Arthroscopy. 2008;24:868-874.
84. Bonasia DE, Rossi R, Saltzman CL, Amendola A. The role of arthroscopy in the management of fractures about the ankle. J Am Acad Orthop Surg. 2011;19:226-235.
85. Loren GJ, Ferkel RD. Arthroscopic assessment of occult intra-articular injury in acute ankle fractures. Arthroscopy. 2002;18:412-421.
86. Taga I, Shino K, Inoue M, Nakata K, Maeda A. Articular cartilage lesions in ankles with lateral ligament injury. Am J Sports Med. 1993;21:120-127.
87. Aktas S, Kocaoglu B, Gereli A, Nalbantodlu U, Guven O. Incidence of chondral lesions of talar dome in ankle fracture types. Foot Ankle Int. 2008;29:287-292.
88. Leontaritis N, Hinojosa L, Panchbhavi VK. Arthroscopically detected intraarticular lesions associated with acute ankle frctures. J Bone Joint Surg Am. 2009;91:333-339.
89. Sorrento DL, Mlodzienski A. Incidence of lateral talar dome lesions in SER IV ankle fractures. J Foot Ankle Surg. 2000;39:354-358.
90. Lloyd J, Elsayad S, Hariharan K, Tanaka H. Revisiting the concept of talar shift in ankle fractures. Foot Ankle Int. 2006;27:793-796.
91. Ramsey PL, Hamilton W. Changes in tibiotalar area of contact caused by lateral talar shift. J Bone Joint Surg Am.1976;58:356-357.
92. Starkweather MP, Collman DR, Schuberth JM. Early protected weightbearing after open reduction internal fixation of ankle fractures. J Foot Ankle Surg. 2012;51:575-578.
93. Gardner MJ, Demetrakopoulos D, Briggs SM, Helfet DL, Lorich DG. The ability of the Lauge-Hansen classification to predict ligament injury and mechanism in ankle fractures: an MRI study. J Orthop Trauma. 2006;20:267-272.
94. Lui TH, Ip K, Chow HT. Comparison of radiologic and arthroscopic diagnoses of distal tibiofibular syndesmosis disruption in acute ankle fracture. Arthroscopy. 2005;21:1370-1374.
95. Miller AN, Barei DP, Iaquinto JM, Ledoux WR, Beingessner DM. Iatrogenic syndesmosis malreduction via clamp and screw placement. J Orthop Trauma. 2013;27:100-106.
96. Xenos JS, Hopkinson WJ, Mulligan ME, Olson EJ, Popovic NA. The tibiofibular syndesmosis: evaluation of the ligamentous structures, methods of fixation, and radiographic assessment. J Bone Joint Surg Am. 1995;77:847-856.
97. Gardner MJ, Demetrakopoulos D, Briggs SM, Helfet DL, Lorich DG. Malreduction of the tibiofibular syndesmosis in ankle fractures. Foot Ankle Int. 2006;27:788-792.
98. Davidovitch RI, Well Y, Karla R, et al. Intraoperative syndesmotic reduction: three-dimensional versus standard fluoroscopic imaging. J Bone Joint Surg Am. 2013;95:1838-1843.
99. Sri-Ram K, Robinson AH. Arthroscopic assessment of the syndesmosis following ankle fracture. Injury. 2005;36:675-678.
100. Chen SH, Wu PH, Lee YS. Long-term results of pilon fractures. Arch Orthop Trauma Surg. 2007;127:55-60.
101. Conroy J, Agarwal M, Giannoudis PV, Matthews SJE. Early internal fixation and soft tissue cover of severe open tibial pilon fractures. Int Orthop. 2003;27:343-347.
102. Decoster TA, Willis MC, Marsh JL, et al. Rank order analysis of tibial plafond fractures: does injury or reduction predict outcome? Foot Ankle Int. 1999;20:44-49.
103. Kalenderer O, Gunes O, Ozcalabi IT, Ozluk S. Clinical results of tibial pilon fractures treated by open reduction and internal fixation. Acta Orthop Traumatol Turc. 2003;37:133-137.
104. Pollak AN, Mccarthy ML, Bess RS. Outcomes after treatment of high-energy tibial plafond fractures. J Bone Joint Surg Am. 2003;85:1893-1900.
105. Salton HL, Rush S, Schuberth JM. Tibial plafond fractures: limited incision reduction with percutaneous fixation. J Foot Ankle Surg. 2007;46:261-269.
106. Gumann G, Hamilton GA. Arthroscopically assisted treatment of ankle injuries. Clin Podiatr Med Surg. 2009;28:523-538.
107. Ono A, Nishikawa S, Nagao A, et al. Arthroscopically assisted treatment of ankle fractures: arthroscopic findings and surgical outcomes. Arthroscopy. 2004;20:627-631.
108. Hammond AW, Crist BD. Arthroscopic management of C3 tibial plafond fractures: a technical guide. J Foot Ankle Surg. 2012;51:382-386.
109. Kim HS, Jahng JS, Kim SS, Chun CH, Han HJ. Treatment of tibial pilon fractures using ring fixators and arthroscopy. Clin Orthop Relat Res. 1997;334:244-250.
110. Poyanli O, Esenkaya I, Ozkut AT, et al. Minimally invasive reduction technique in split depression type tibial pilon fractures. J Foot Ankle Surg. 2012;51: 254-257.
111. Van Dijk CN, Scholten PE, Krips R: A 2-portal endoscopic approach for diagnosis and treatment of posterior ankle pathology, Arthroscopy 16:871–876, 2000.
112. Acevedo JI, Busch MT, Ganey TM, et al: Coaxial portals for posterior ankle arthroscopy: an anatomic study with clinical correlation on 29 patients, Arthroscopy 16:836–842, 2000.
113. Lohrer H, Arentz S: Posterior approach for arthroscopic treatment of posterolateral impingement syndrome of the ankle in a top-level field hockey player, Arthroscopy 20:e15–e21, 
2004.
114. Shurnas PS, Coughlin MJ: Arthritic conditions of the foot. In Coughlin MJ, Mann RA, Saltzman CL, editors: Surgery of the foot and ankle, ed 8, Philadelphia, 2007, Mosby, pp 801–856.
115. Guhl JF. Foot and ankle arthroscopy. New York: Slack; 1993.
116. Martin DF, Baker CL, Curl WW, Andrews JR, Robie DB, Haas AF. Operative ankle arthroscopy. Long-term follow-up. Am J Sports Med 1989 Jan;17(1):16-23.
117. Barber FA, Click J, Britt BT. Complications of ankle arthroscopy. Foot Ankle 1990 Apr;10(5):263-6.
118. Ferkel RD, Heath DD, Guhl JF. Neurological complications of ankle arthroscopy. Arthroscopy 1996 Apr;12(2):200-8.
119. Amendola A, Lee KB, Saltzman CL, Suh JS. Technique and early experience with posterior arthroscopic subtalar arthrodesis. Foot Ankle Int 2007 Mar;28(3):298-302.
120. Andrews JR, Previte WJ, Carson WG. Arthroscopy of the ankle: technique and normal anatomy. Foot Ankle 1985 Aug;6(1):29-33.
121. Drez D, Jr., Guhl JF, Gollehon DL. Ankle arthroscopy: technique and indications. Foot Ankle 1981 Nov;2(3):138-43.
122. Ferkel RD, Fasulo GJ. Arthroscopic treatment of ankle injuries. Orthop Clin North Am 1994 Jan;25(1):17-32.
123. Guhl JF. New concepts (distraction) in ankle arthroscopy. Arthroscopy 1988;4(3):160-7.
124. Unger F, Lajtai G, Ramadani F, Aitzetmuller G, Orthner E. [Arthroscopy of the upper ankle joint. A retrospective analysis of complications]. Unfallchirurg 2000 Oct;103(10):858-63.

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.

 

(Abstract)      (Full Text HTML)      (Download PDF)

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.

References

1. Wertheimer SJ, Weber CA, Loder BG, Calderone DR, Frascone ST. The role of endoscopy in treatment of stenosing posterior tibial tenosynovitis. J Foot Ankle Surg 1995;34:15-22.
2. Van Dijk CN, Sholten PE, Kort N. Tendoscopy (tendon sheath endoscopy) for overuse tendon injuries. Oper Tech Sports Med 1997;5:170-178.
3. Van Dijk CN, Kort N. Tendoscopy of the peroneal tendons. Arthroscopy 1998;14:471-78.
4. Van Dijk C.N., Scholten P.E., Krips R. A 2-portal endoscopic approach for diagnosis and treatment of posterior ankle pathology. Arthroscopy. 2000;16:871–876.
5. Lui T.H. Flexor hallucis longus tendoscopy: A technical note. Knee Surg Sports Traumatol Arthrosc. 2009;17:107–110.
6. Lui T.H. Endoscopic assisted flexor hallucis tendon transfer in the management of chronic rupture of Achilles tendon. Knee Surg Sports Traumatol Arthrosc. 2007;15:1163–1166.
7. F. Steenstra and C. Niek van Dijk, “Achilles Tendo-scopy,” Foot and Ankle Clinics, Vol. 11, No. 2, 2006, pp. 429-438.
8. Scholten PE, van Dijk CN. Tendoscopy of the peroneal tendons. Foot Ankle Clin 2006;11:415-420.
9. Jerosch J, Aldawoudy A. Tendoscopic management of peroneal tendon disorders. Knee Surg Sports Traumatol Arthrosc 2007;15:806-810.
10. Vega J, Golano P, Batista JP, Malagelada F, Pellegrino A. Tendoscopic procedure associated with peroneal tendons. Tech Foot Ankle Surg 2013;12:39-48.
11. Scholten PE, Breugem SJ, van Dijk CN. Tendoscopic treatment of recurrent peroneal tendon dislocation. Knee Surg Sports Traumatol Arthrosc 2013;21:1304-1306.
12. Guillo S, Calder JD. Treatment of recurring peroneal tendon subluxation in athletes: endoscopic repair of the retinaculum. Foot Ankle Clin 2013;18:293-300.
13. Michels F, Jambou S, Guillo S. Endoscopic treatment of intrasheath peroneal tendon subluxation. Case Rep Med 2013:274685.
14. Cychosz CC, Phisitkul P, Barg A, et al. Foot and ankle tendoscopy: evidence-based recommendations. Arthroscopy 2014;30:755-765.
15. Van Dijk, CN: Anterior and posterior ankle impingement. Foot Ankle Clin North Am. 11:663 – 683, 2006.
16. Keeling, JJ; Guyton, GP: Endoscopic flexor hallucis longus decompression: a cadaver study. Foot Ankle Int. 28:810 – 814, 2007.
17. Lui, TH: Arthroscopy and endoscopy of the foot and ankle: indications for new techniques. Arthroscopy. 23:889 – 902, 2007.
18. Van Dijk CN, Kort N, Scholten PE. Tendoscopy of the posterior tibial tendon. Arthroscopy1997;13:692-698.
19. Bulstra GH, Olsthoorn PG, Niek van Dijk C. Tendoscopy of the posterior tibial tendon. Foot Ankle Clin 2006;11:421-427, viii.
20. Chow HT, Chan KB, Lui TH. Tendoscopic debridement for stage I posterior tibial tendon dysfunction. Knee Surg Sports Traumatol Arthrosc 2005;13:695-698.
21. Khazen G, Khazen C. Tendoscopy in stage I posterior tibial tendon dysfunction. Foot Ankle Clin2012;17:399-406.
22. Lui TH. Endoscopic assisted posterior tibial tendon reconstruction for stage 2 posterior tibial tendon insufficiency. Knee Surg Sports Traumatol Arthrosc 2007;15:1228-1234.
23. Hua Y, Chen S, Li Y, Wu Z. Arthroscopic treatment for posterior tibial tendon lesions with a posterior approach. Knee Surg Sports Traumatol Arthrosc 2015;23:879-883.
24. Monteagudo M, Maceira E. Posterior tibial tendoscopy. Foot Ankle Clin 2015;20:1-13.
25. Maffulli N, Kader D. Tendinopathy of tendo achillis. J Bone Joint Surg [Br] 2002;84-B:1-8.
26. Halasi T, Tállay A, Berkes I. Percutaneous Achilles tendon repair with and without endoscopic control. Knee Surg Sports Traumatol Arthrosc 2003;11:409-414.
27. Maquirriain J. Surgical treatment of chronic achilles tendinopathy: long-term results of the endoscopic technique. J Foot Ankle Surg 2013;52:451-455.
28. Pearce CJ, Carmichael J, Calder JD. Achilles tendinoscopy and plantaris tendon release and division in the treatment of non-insertional Achilles tendinopathy. Foot Ankle Surg 2012;18:124-127.
29. Turgut A, Günal I, Maralcan G, Köse N, Göktürk E. Endoscopy, assisted percutaneous repair of the Achilles tendon ruptures: a cadaveric and clinical study. Knee Surg Sports Traumatol Arthrosc2002;10:130-133.
30. Tang KL, Thermann H, Dai G, et al. Arthroscopically assisted percutaneous repair of fresh closed achilles tendon rupture by Kessler’s suture. Am J Sports Med 2007;35:589-596.
31. Vega J, Cabestany JM, Golanó P, Pérez-Carro L. Endoscopic treatment for chronic Achilles tendinopathy. Foot Ankle Surg 2008;14:204-210.
32. Thermann H, Benetos IS, Panelli C, Gavriilidis I, Feil S. Endoscopic treatment of chronic mid-portion Achilles tendinopathy: novel technique with short-term results. Knee Surg Sports Traumatol Arthrosc2009;17:1264-1269.
33. Lui TH. Treatment of chronic noninsertional Achilles tendinopathy with endoscopic Achilles tendon debridement and flexor hallucis longus transfer. Foot Ankle Spec 2012;5:195-200.
34. Gossage W, Kohls-Gatzoulis J, Solan M. Endoscopic assisted repair of chronic achilles tendon rupture with flexor hallucis longus augmentation. Foot Ankle Int 2010;31:343-347.

How to Cite this article: Kini A, Munde A. Tendoscopy: A novel way to look at an Enigma; Indications,Technique & Results of managing tendon pathologies in foot and ankle. Asian Journal of Arthroscopy May-Aug 2018;3(2):24-29.

 

(Abstract)      (Full Text HTML)      (Download PDF)

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.

References

1. Wolgin M, Cook C, Graham C, Maudlin D. Conservative treatment of plantar heel pain: Long-term follow-up. FootAnkle Int1994;15:97-102.
2. Zirm R, JimenezAL:Results of Heel SpurSurgery, DiNapoli DR (ed) Reconstructil)e Surgety of tbe Foot and Leg, Update 1990Tucker, GA, Podiatry Institute Publishing, pp 199-201, 1990.
3. Stecco C, Corradin M, Macchi V, et al. Plantar fascia anatomy and its relationship with Achilles tendon and paratenon. J Anat. 2013;223(6):665–676. doi: 10.1111/joa.12111.
4. Ehrmann C, Maier M, Mengiardi B, Pfirrmann CW, Sutter R. Calcaneal attachment of the plantar fascia: MR findings in asymptomatic volunteers. Radiology. 2014;272(3):807–814. doi: 10.1148/radiol.14131410
5. Johal KS, Milner SA (2012) Plantar fasciitis and the calcaneal spur: fact or fiction? Foot Ankle Surg 18(1):39–41.
6. Zhou B, Zhou Y, Tao X, Yuan C, Tang K (2015) Classification of calcaneal spurs and their relationship with plantar fasciitis. J Foot Ankle Surg 54(4):594–600
7. Chimutengwende-Gordon M, O’Donnell P, Singh D. Magnetic resonance imaging in plantar heel pain. Foot Ankle Int. 2010;31(10):865–870. Doi: 10.3113/FAI.2010.0865
8. Barrett SL, Day SV, Pignetti TT, Robinson LB. Endoscopic plantar fasciotomy; a multi surgeon prospective analysis of 652 cases. J Foot Ankle Surg1995;34:400-406.
9. Karr Scott D. Subcalcaneal heel pain. OrthopClin North Am1994;25:161-175.
10. Keat Andrew. Spondyloparthropathies. BMJ 1995;310:1321-1324.
11. Kwong PK, Kay D, Voner RT, et al. Plantar fasciitis. Mechanics and pathomechanics of treatment. Clin Sports Med 1988;7:119-126.
12. Lichniak JE. The heel in systemic disease. ClinPodiatr Med Surg1990;7:225-241
13. Baxter Donald E. The heel in sport. Clin Sports Med 1994;13: 683-693.
14. Leach RE, Seavey MS, Salter DK. Results of surgery in athletes with plantar fasciits. Foot Ankle 1986;7:156-161.
15. Sarrafian SK. Anatomy of the foot and ankle: Descriptive,topographic, functional. Phildelphia: JB Lippincott, 1993;127-137.
16. Arangio GA, Chen C, Kim W. Effect of cutting the plantar fascia on the mechanical properties of the foot. ClinOrthop1997;339:227-231.
17. Hawkins BJ, Langermen RJ, Gibbons T, Calhoun JH. An anatomic analysis of endoscopic plantar fascia release. FootAnkle Int1995;16:552-558
18. Huang CK, Kitaoka HB, An KN, Chao EY Biomechanical evaluation of longitutudinal arch stability. Foot Ankle 1993;14:353-357.
19. Kitaoka HB, Luo ZP, An KN. Effect of plantar fasciotomy on
the stability of the arch of the foot. ClinOrthop1997;344:307- 312.
20. Reeve F, Laughlin RT, Wright DG. Endoscopic plantar fascia release; a cross sectional anatomic study. Foot Ankle Int1997;18:398-401.
21. Kinley S, Frascone S, Calderone E, et al. Endoscopic plantar fasciotomy versus traditional heel spur surgery: A prospective study. J Foot Ankle Surg1993;32:595-603.
22. Tomczak RL, Haverstock BD. A retrospective comparison of endoscopic plantar fasciotomy with heel spur resection for chronic plantar fasciitis/heel spur syndrome. J Foot Ankle Surg1995;34:305-311
23. Daly PJ, Kitaoka HB, Chao EY. Plantar fasciotomy for intractable plantar fasciitis: Clinical results and biomechanical evaluation. Foot Ankle 1992;13:188-195
24. Hoefnagels E, Weereheijm L, Louwerens JW, et al. Chronic therapy resistant plantar fasciitis, the effect of lengthening the gastrocnemius muscle. Foot Ankle Surg. 2016; 22(2):58.
25. Monteagudo M, Maceira E, Garcia-Virto V, Canosa R. Chronic Plantar fasciitis: plantar fasciotomy versus gastrocnemius recession. IntOrthoped. 2013; 37(9):1845-1850

How to Cite this article: Simon R, Kandathil J C, Jose D P. Endoscopic Plantar Fasciotomy with Gastrocnemius Recession for Chronic Plantar Fasciitis. Asian Journal of Arthroscopy May-Aug 2018;3(2):20-23.

(Abstract)      (Full Text HTML)      (Download PDF)

Endoscopic Plantar Fasciotomy with Gastrocnemius Recession for Chronic Plantar Fasciitis

Modern Concept in Posterior Ankle Arthroscopy

Joseph Tracey, Selene G. Parekh

Volume 3 | Issue 2 | May – Aug 2018 | Page 9-12

Author: Joseph Tracey, Selene G. Parekh [2].

[1]  Medical University of South Carolina 96 Johnathan Lucas St., Charleston, SC, 29425
[2] Duke University Medical Center, Orthopaedic Surgery North Carolina Orthopaedic Clinic 3609 Southwest Durham Drive Durham, NC, USA 27707

Address of Correspondence
Dr. Selene G. Parekh,
Medical University of South Carolina 96 Johnathan Lucas St., Charleston, SC, 29425 tracey312@live.com
Email: selene.parekh@gmail.com

Abstract

Ankle arthroscopy has evolved rapidly within the last twenty-five years and is now the principal method of treatment of ankle disorders. It would be prudent for an aspiring orthopaedic surgeon to include this technique in his or her armamentarium of surgical techniques. This will provide the surgeon an inclusive option to obtain accurate diagnosis and to discuss management options with the patient. The minimally invasive technique is biologically friendly by preserving the soft tissue envelope. This will also meet patient expectations to achieve an earlier and predictable functional recovery from ankle pathology. This review article will briefly mention historical aspects and outline the basic technique and relevant benefits of ankle arthroscopy. Indications and contra-indications of ankle arthroscopy will be discussed with pertinent review of literature. Complications and outcomes of the procedure will also be highlighted.
Keywords: Ankle arthroscopy, technique, indications

References

1. van Dijk CN, Scholten PE, Krips R. A 2-portal endoscopic approach for diagnosis and treatment of posterior ankle pathology. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2000 Nov 1;16(8):871-6.
2. Abramowitz Y, Wollstein R, Barzilay Y, London E, Matan Y, Shabat S, Nyska M. Outcome of resection of a symptomatic os trigonum. JBJS. 2003 Jun 1;85(6):1051-7.
3. Marotta JJ, Micheli LJ. Os trigonum impingement in dancers. The American journal of sports medicine. 1992 Sep;20(5):533-6.
4. Willits K, Sonneveld H, Amendola A, Giffin JR, Griffin S, Fowler PJ. Outcome of posterior ankle arthroscopy for hindfoot impingement. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2008 Feb 1;24(2):196-202.
5. Nickisch F, Barg A, Saltzman CL, Beals TC, Bonasia DE, Phisitkul P, Femino JE, Amendola A. Postoperative complications of posterior ankle and hindfoot arthroscopy. JBJS. 2012 Mar 7;94(5):439-46.
6. Lijoi F, Lughi M, Baccarani G. Posterior arthroscopic approach to the ankle. Arthroscopy. 2003 Jan 1;19(1):62-7.
7. Sitler DF, Amendola A, Bailey CS, Thain LM, Spouge A. Posterior ankle arthroscopy: an anatomic study. JBJS. 2002 May 1;84(5):763-9.
8. d’Hooghe PP, van Dijk CN. Hindfoot Endoscopy for Posterior Ankle Impingement. InArthroscopy 2016 (pp. 1067-1077). Springer, Berlin, Heidelberg.
9. Balcı Hİ, Polat G, Dikmen G, Atalar A, Kapıcıoğlu M, Aşık M. Safety of posterior ankle arthroscopy portals in different ankle positions: a cadaveric study. Knee Surgery, Sports Traumatology, Arthroscopy. 2016 Jul 1;24(7):2119-23.
10. Urguden M, Cevikol C, Dabak TK, Karaali K, Aydin AT, Apaydin A. Effect of jointmotion on safety of portals in posterior ankle arthroscopy. Arthroscopy 25:1442–1446, 2009.
11. Van Dijk CN, De Leeuw PA, Scholten PE. Hindfoot endoscopy for posterior ankle impingement: surgical technique. JBJS. 2009 Oct 1;91(Supplement_2):287-98.
12. Tonogai I, Hayashi F, Tsuruo Y, Sairyo K. Anatomic Study of Anterior and Posterior Ankle Portal Sites for Ankle Arthroscopy in Plantarflexion and Dorsiflexion: A Cadaveric Study in the Japanese Population. The Journal of Foot and Ankle Surgery. 2018 May 1;57(3):537-42.
13. Spennacchio P, Cucchi D, Randelli PS, et al. Evidence-based indications for hindfoot endoscopy. Knee Surg Sports TraumatolArthrosc2016;24:1386–95.
14. Van Dijk CN, Vuurberg G, Batista J, d’Hooghe P. Posterior ankle arthroscopy: current state of the art. Journal of ISAKOS: Joint Disorders &Orthopaedic Sports Medicine. 2017 Aug 7:jisakos-2016.
15. van Dijk CN, van Bergen CJ. Advancements in ankle arthroscopy. J Am AcadOrthopSurg2008;16:635–46.
16. van Dijk CN. Hindfoot endoscopy. Foot Ankle Clin2006;11:391–414.
17. Ogut T, Ayhan E, Irgit K, et al. Endoscopic treatment of posterior ankle pain. Knee Surg Sports TraumatolArthrosc2011;19:1355–61.
18. van Dijk CN. Hindfoot endoscopy for posterior ankle pain. Instr Course Lect2006;55:545–54.
19. Smyth NA, Murawski CD, Levine DS, Kennedy JG. Hindfoot arthroscopic surgery for posterior ankle impingement: a systematic surgical approach and case series. The American journal of sports medicine. 2013 Aug;41(8):1869-76.
20. Golanò P, Mariani PP, Rodríguez-Niedenfuhr M, Mariani PF, Ruano-Gil D. Arthroscopic anatomy of the posterior ankle ligaments.Arthroscopy. 2002;18:353-8.
21. Beimers L, de Leeuw PAJ, van Dijk CN. A 3-portal approach for arthroscopic subtalar arthrodesis. Knee Surgery, Sports Traumatology, Arthroscopy. 2009;17(7):830-834.
22. Lee KB, Saltzman CL, Suh JS, Wasserman L, Amendola A. A posterior 3-portal arthroscopic approach for isolated subtalar arthrodesis. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2008 Nov 1;24(11):1306-10.

How to Cite this article: Tracey J, Parekh S G. Modern Concept in Posterior Ankle Arthroscopy. Asian Journal of Arthroscopy May-Aug 2018;3(2): 9-12.

(Abstract)      (Full Text HTML)      (Download PDF)

Ankle Arthroscopy

Rachala Madhu, Kartik Hariharan

Volume 3 | Issue 2 | May – Aug 2018 | Page 3-8

Author: Rachala Madhu, Kartik Hariharan [1].

[1] Department of Orthopaedic and Foot and Ankle Surgeon Royal Gwent Hospital

Address of Correspondence
Dr. Kartik Hariharan,
Consultant Orthopaedic and Foot and Ankle Surgeon Royal Gwent Hospital Cardiff Rd Newport NP20 2UB United Kingdom
Email: h.kartik@gmail.com

Abstract

Ankle arthroscopy has evolved rapidly within the last twenty-five years and is now the principal method of treatment of ankle disorders. It would be prudent for an aspiring orthopaedic surgeon to include this technique in his or her armamentarium of surgical techniques. This will provide the surgeon an inclusive option to obtain accurate diagnosis and to discuss management options with the patient. The minimally invasive technique is biologically friendly by preserving the soft tissue envelope. This will also meet patient expectations to achieve an earlier and predictable functional recovery from ankle pathology. This review article will briefly mention historical aspects and outline the basic technique and relevant benefits of ankle arthroscopy. Indications and contra-indications of ankle arthroscopy will be discussed with pertinent review of literature. Complications and outcomes of the procedure will also be highlighted.
Keywords: Ankle arthroscopy, technique, indications

References

1. Burman MS: Arthroscopy or the direct visualization of joints: An experimental cadaver study. J Bone Joint Surg Am 1931; 13:669-695.
2. Watanabe M: Sefloc-Arthroscope (Watanabe no. 24 arthroscope): Monograph. Tokyo, Japan: Teishin Hospital, 1972.
3. Chen YC: Clinical and cadaver studies on the ankle joint arthroscopy. J Jpn Orthop Assoc 1976; 50: pp. 631-651.
4. Kim et al. Reliability and Validity of Magnetic Resonance Imaging for the Evaluation of the Anterior Talofibular Ligament in Patients Undergoing Ankle Arthroscopy. Arthroscopy. 2015 Aug; 31(8):1540-7.
5. Accuracy of MRI scan in the diagnosis of ligamentous and chondral pathology in the ankle. Joshy S, Abdulkadir U, Chaganti S, Sullivan B, Hariharan K. Foot Ankle Surg. 2010 Jun;16(2):78-80.
6. Dowdy PA, Watson BV, Amendola A, and Brown JD: Noninvasive ankle distraction: relationship between force, magnitude of distraction, and nerve conduction abnormalities. Arthroscopy 1996; 12: pp. 64-69
7. van Dijk CN, Scholte D. Arthroscopy of the ankle joint. Arthroscopy. 1997 Feb; 13(1):90-6.
8. Gulihar A, Bryson DJ, Taylor GJ. Effect of different irrigation fluids on human articular cartilage: an in vitro study. Arthroscopy 2013; 29:251–6.
9. Ferkel, Richard D.; Dierckman, Brian D.; Phisitkul, Phinit. Mann’s Surgery of the Foot and Ankle. 9 th ed. Philadelphia, PA: Saunders, an imprint of Elsevier Inc; 2014. p.1723-1827.
10. Stetson WB, and Ferkel RD: Ankle arthroscopy: I. Technique and complications. J Am Acad Orthop Surg 1996; 4: pp. 17-23
11. Molloy S, Solan MC, Bendall SP. Synovial impingement in the ankle. A new physical sign. J Bone Joint Surg Br. 2003 Apr;85(3):330-3.
12. Brennan SA, Rahim F, Dowling J, Kearns SR. Arthroscopic debridement for soft tissue ankle impingement. Ir J Med Sci 2012; 181(2):253–6.
13. Parma A, Buda R, Vannini F, Ruffilli A, Cavallo M, Ferruzzi A, et al. Arthroscopic treatment of ankle anterior bony impingement: the long-term clinical outcome. Foot Ankle Int 2014; 35(2):148–55.
14. Jones CR, Wong E, Applegate GR, Ferkel RD. Arthroscopic Ankle Arthrodesis: A 2-15 Year Follow-up Study. Arthroscopy. 2018 May; 34(5):1641-1649.
15. Quayle J, Shafafy R, Khan MA, Ghosh K, Sakellariou A, Gougoulias N. Arthroscopic versus open ankle arthrodesis. Foot Ankle Surg. 2018 Apr; 24(2):137-142.
16. Zengerink M, Struijs PA, Tol JL, van Dijk CN. Treatment of osteochondral lesions of the talus: a systematic review [Review]. Knee Surg Sports Traumatol Arthrosc. 2010; 18(2):238-46.
17. Murawski CD, Duke GL, Deyer TW, Kennedy JG. Bone marrow aspirate concentrate (BMAC) as a biological adjunct to the surgical treatment of osteochondral lesions of the talus. Tech Foot Ankle Surg. 2011; 10:18-27.
18. Chen XZ, Chen Y, Liu CG, Yang H, Xu XD, Lin P.Arthroscopy-Assisted Surgery for Acute Ankle Fractures: A Systematic Review. Arthroscopy. 2015 Nov; 31(11):2224-31.
19. O’Loughlin PF, Murawski CD, Egan C, Kennedy JG. Ankle instability in sports [review]. Phys Sportsmed 2009; 37:93-103.
20. Brown AJ, Shimozono Y, Hurley ET, Kennedy JG. Arthroscopic Repair of Lateral Ankle Ligament for Chronic Lateral Ankle Instability: A Systematic Review. Arthroscopy. 2018 May 2. pii: S0749-8063(18)30185-3.
21. Choi WJ, Choi GW, Lee JW. Arthroscopic synovectomy of the ankle in rheumatoid arthritis. Arthroscopy. 2013 Jan; 29(1):133-40.
22. Kunzler DR, Shazadeh Safavi P, Warren BJ, Janney CF, Panchbhavi V. Arthroscopic Treatment of Synovial Chondromatosis in the Ankle Joint. Cureus. 2017 Dec 23; 9(12):e1983.
23. Saxena A, St Louis M. Synovial Chondromatosis of the Ankle: Report of Two Cases With 23 and 126 Loose Bodies. J Foot Ankle Surg. 2017 Jan – Feb; 56(1):182-186. doi: 10.1053/j.jfas.2016.02.009. Epub 2016 Apr 5. Review.
24. Kanatli U, Ataoğlu MB, Özer M, Yildirim A, Cetinkaya M. Arthroscopic treatment of intra-artricularly localised pigmented villonodular synovitis of the ankle: 4 cases with long-term follow-up. Foot Ankle Surg. 2017 Dec; 23(4):e14-e19.
25. Mankovecky MR, Roukis TS. Arthroscopic synovectomy, irrigation, and debridement for treatment of septic ankle arthrosis: a systematic review and case series. J Foot Ankle Surg. 2014 Sep-Oct; 53(5):615-9.
26. Zengerink M, van Dijk CN. Complications in ankle arthroscopy. Knee Surg Sports Traumatol Arthrosc. 2012 Aug; 20(8):1420-31. Epub 2012 Jun 5.
27. Deng DF, Hamilton GA, Lee M, Rush S, Ford LA, Patel S. Complications associated with foot and ankle arthroscopy. J Foot Ankle Surg. 2012 May-Jun; 51 (3):281-4. Epub 2011 Dec 20.
28. Ferkel RD, Heath DD, Guhl JF. Neurological complications of ankle arthroscopy. Arthroscopy. 1996 Apr; 12(2):200-8.
29. Nickisch F, Barg A, Saltzman CL, Beals TC, Bonasia DE, Phisitkul P, Femino JE, Amendola A. Postoperative complications of posterior ankle and hindfoot arthroscopy. J Bone Joint Surg Am. 2012 Mar 7; 94(5):439-46.
30. Vega J, Golan´o P, Peña F. Iatrogenic articular cartilage injuries during ankle arthroscopy. Knee Surg Sports Traumatol Arthrosc. 2016 Apr; 24(4):1304-10. Epub 2014 Aug 24.
31. Koehler RJ, Amsdell S, Arendt EA, Bisson LJ, Braman JP, Butler A, Cosgarea AJ, Harner CD, Garrett WE, Olson T, Warme WJ, Nicandri GT. The Arthroscopic Surgical Skill Evaluation Tool (ASSET). Am J Sports Med. 2013 Jun; 41(6):1229-37. Epub 2013 Apr 2
32. Martin KD, Patterson D, Phisitkul P, Cameron KL, Femino J, Amendola A. Ankle Arthroscopy Simulation Improves Basic Skills, Anatomic Recognition, and Proficiency During Diagnostic Examination of Residents in Training. Foot Ankle Int. 2015 Jul; 36(7):827-35.

How to Cite this article:. Rachala M, Hariharan K. Ankle Arthroscopy. Asian Journal Arthroscopy. May-Aug 2018;3(2):3-8 .

(Abstract)      (Full Text HTML)      (Download PDF)

Arthroscopy in foot & ankle – Open your mind for your eyes to see

Abhishek Kini, Sachin Tapasvi

Volume 3 | Issue 2 | May – Aug 2018 | Page 2

Author: Abhishek Kini [1], Sachin Tapasvi [2].

[1] Department of Orthopaedics, P.D.Hinduja Hospital& Medical Research Centre, Mumbai, India.
[2] Orthopaedic Speciality Clinic, Pune Mahatrahtra.

Address of Correspondence
Dr. Abhishek Kini,
Dept. of Orthopaedics, PD Hinduja hospital & Medical research centre, Mahim, Mumbai, India. Email: kiniabhishek@gmail.com

One of the best paradoxes in medicine is the need to be stubborn and open-minded. A good doctor must insist on sticking to the vision and stay on course to achieve his treatment goal. But he must be open-minded during the process to newer technologies and advances. One should always look to add a few threads to their existing surgical skills. Foot and ankle arthroscopy is one such thread in modern medicine. It has made significant progress over the last 25 years. Small arthroscopes and instrumentation have been developed to work in tighter spaces, to facilitate small joint surgery. The technique started to gain acceptance in the sports medicine and arthroscopy world more so in the last decade.
These advances have allowed for shorter hospital stays and a shift toward more outpatient procedures, which can lower the rate of complications and decrease the overall cost of care. While the aforementioned trends are exciting for patients and surgeons alike, novel technologies must undergo thorough scientific analysis so that we can offer unbiased options to our patients. With this in mind, we must continue to push the envelope and develop more arthroscopic techniques in the foot and ankle that benefit our patients and return them back to work and sports more quickly and efficiently.
The general orthopaedic surgeon sees a multitude of ankle
 disorders. Potential surgical interventions can be better recognized with a little
more basic knowledge of arthroscopic techniques. It is surprising that ankle arthroscopy is not emphasized in current residency curriculum. The learning curve for ankle arthroscopy is far more rapid than for arthroscopies of the shoulder and the hip. Minimal time investment to develop this skill-set is genuinely worthwhile.
However any new technique or methods should be used in proper indication. “Just because we have a hammer, the world doesn’t become our nail”. Judicious use of the technique and technology is essential for positive growth of any technology. However, once we are sure that new techniques are safe and effective, can we trade in that hammer for an arthroscope?
This issue has contributions from With this issue, we have invited stalwarts in the field of foot and ankle arthroscopy from around the world. It starts with a basic introduction to anterior ankle arthoscopy, followed by modern concepts in posterior ankle arthroscopy. Further, advanced techniques like the arthroscopic management of osteochondral lesions of talus, lateral ankle ligament instabilities, plantar fasciitis and tendon pathologies have been written in a simplified manner. Finally, a review article on foot and ankle arthroscopy, summing up with current updates, indications and techniques completes this issue. This issue. You may add valuable knowledge about foot and ankle arthroscopy to your toolbox, and some of the ideas and results presented will definitely help in decision making for your patients.
As usual your feedback is very important to us and we would love to hear from you about this issue and about the Journal as a whole. As mentioned in the Editorial, the forthcoming issues have some major changes added to the journal format and we take this opportunity to invite you to contribute to Asian Journal of Arthroscopy.

How to Cite this article: Kini A, Tapasvi S. Arthroscopy in foot & ankle – Open your mind for your eyes to see. . Asian Journal of Arthroscopy May-Aug 2018;3(2):3

(Abstract)      (Full Text HTML)      (Download PDF)

Third Year of Asian Journal of Arthroscopy

Sachin Tapasvi, Parag Sancheti , Ashok K. Shyam

Volume 3 | Issue 2 | May – Aug 2018 | 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

Patellofemoral Instability Symposium

The editors and the editorial board are proud to announce that Asian Journal of Arthroscopy is in its third year now. Running a clinical Journal is not an easy task, specially when the all involved are active clinicians. With AJA in its third year, the seriousness of running an academic journal is upon us. We understand that the journal is now consolidated and further we just have to keep moving forward.
We are now looking at making some major changes in the Journal format. Till now the Journal was more of a review article Journal where complete issues were dedicated to symposia on single focussed topic. We plan to continue with the symposia’s in future too but a section on Original article, case reports and arthroscopic techniques will be added to the table of contents. We are specially inviting original articles as it will help us in getting better indexing faster.
Arthroscopic techniques section will have articles in a combined video and text part. The text will provide the background of the procedure and details of innovations in the technique and video will describe the entire procedure in details. These video articles will not only be on newer innovation but also from established standard procedures will also be invited to be published by experts. This will help the readers learn many individual nuances that are included in an arthroscopy procedure conducted by experts. This will be started from the upcoming issues.
Case reports are specially invited from the young Arthroscopy Surgeons who see a varied number of cases and presentation and also from the senior surgeons who see really complex cases. Arthroscopy as a science has developed a lot with contributions from single case reports which demonstrated unique challenges and forced surgeons to improvise or develop new techniques and technologies. A special section of Case reports will be kept in every issue of the Journal and if a video can be provided with the case report, it would have much better chance of being accepted
Lastly we are eager to hear from our readers and we invite them to contribute letters to editors to the journal. These letters can be related to articles in the journal or even can be a commentary on a new concept or idea. Questions to editorial board in terms of management of difficult cases are also invited.
As the journal evolves over a period of time, many more new features will be added to it. Feedback from our readers is essential and we request you to write your comments to us

How to Cite this article: Tapasvi S, Sancheti PK, Shyam AK. Third year of Asian Journal of Arthroscopy Asian Journal of Arthroscopy May-Aug 2018;3(2):1.

(Abstract)      (Full Text HTML)      (Download PDF)