Arthroscopic Techniques and Anatomy of the Foot and Ankle: A Surgical Atlas

Preface
Acknowledgments
Contents
Contributors
1: Gross Anatomy of the Ankle Joint for Arthroscopy
1.1 Skin and Landmarks
1.2 Ankle Joint
1.2.1 Ankle Mortise
1.2.2 The Inferior Syndesmosis
1.3 Anatomy of the Talus
1.4 Anatomy of the Subtalar Joint
1.5 The Capsule of the Ankle Joint
1.6 The Ligaments Around the Ankle Joint
1.6.1 Medial Ligament
1.6.2 Lateral Ligament
1.6.3 Posterior Intermalleolar Ligament
1.7 Deep Fascia Layer
1.7.1 Anterior Region
1.7.2 Posterior Superficial Compartment
1.7.3 Posterior Deep Compartment
1.7.4 Lateral Region
1.7.5 Medial Region
1.8 Superficial Nerves and Veins
1.8.1 Superficial Peroneal Nerve
1.8.2 Sural Nerve and Lesser Saphenous Vein
1.8.3 Saphenous Nerve
Further Reading
2: Arthroscopy Instruments and Applications
2.1 Arthroscopic Equipment
2.1.1 Arthroscope
2.1.2 Trocar, Obturator, and Cannula
2.2 Camera, Video Monitor, and Printer
2.2.1 Camera Control Unit and Camera Head
2.2.2 Video Monitor
2.2.3 Printer
2.3 Light Source and Cable
2.4 Motorized Instrument
2.4.1 Energy System
2.4.2 The Soft Tissue Shaver
2.4.3 The Arthroscopic Burr
2.4.4 Footswitch Control
2.5 Irrigation Equipment and Suction System
2.6 Special Instrument
2.6.1 Arthroscopic Probe
2.6.2 Arthroscopic Osteotome
2.6.3 Arthroscopic Elevator
2.6.4 The Closed-Cup Curette
2.6.5 The Open Curette (Fig. 2.25)
2.6.6 The Chondro-Picks
2.6.7 The Grasper
2.6.8 The Straight Punch Forceps
2.6.9 MicroVector Drill Guide System
2.6.10 Basic Surgical Instruments
2.7 Noninvasive and Invasive Distraction
2.8 Other Accessory Equipment
2.8.1 The Thigh Tourniquet
2.8.2 Prevention of Deep Vein Thrombosis
Further Reading
3: Anterior Arthroscopy of the Ankle Joint: General Principles and Arthroscopic Examination
3.1 Introduction
3.2 Regional Anatomy of the Anterior Ankle Joint
3.3 Indications and Contraindications
3.3.1 Indications
3.3.2 Contraindications
3.4 Procedural Setup and Anesthesia
3.5 Anterior Portals/Incision
3.5.1 Anteromedial Portal
3.5.2 Anterolateral Portal
3.5.3 Anterocentral Portal
3.5.4 Accessory Anteromedial Portal
3.5.5 Accessory Anterolateral Portal
3.6 Establishing the Portals
3.7 Diagnostic Arthroscopic Examination
Further Reading
4: Posterior Arthroscopy of the Ankle and Subtalar Joint: General Principles and Arthroscopic Examination
4.1 Introduction
4.2 Regional Anatomy of the Posterior Ankle Joint
4.3 Indications and Contraindications
4.3.1 Indications
4.3.2 Contraindications
4.4 Anesthesia, Tourniquet, Position, and Distraction
4.5 Posterior Portals/Incision
4.5.1 Posterolateral Portal
4.5.2 Posteromedial Portal
4.5.3 Accessory Posterolateral Portal
4.5.4 Accessory Posteromedial Portal
4.6 Creating the Pathway
4.7 Diagnostic Arthroscopic Examination: Posterior Ankle Examination
Further Reading
5: Osteochondral Lesions of Talus
5.1 Introduction
5.2 Anatomy of the Articular Cartilage of the Talus
5.3 Symptoms, Physical Examination, and Radiographic Evaluation
5.3.1 Symptoms
5.3.2 Physical Examination
5.3.3 Radiographic Evaluation
5.4 Classification and Staging
5.5 Operative Treatment Options
5.6 Arthroscopic Debridement and Bone Marrow Stimulation
5.6.1 Indications and Contraindications
5.6.1.1 Indications
5.6.1.2 Contraindications
5.6.2 Anesthesia, Tourniquet, Position, and Distraction
5.6.3 Surgical Procedures
5.6.3.1 Portals/Incision
5.6.3.2 Creating the Pathway
5.6.3.3 Arthroscopic Debridement and Bone Marrow Stimulation
5.6.4 Skin Closure/Dressings
5.6.5 Postoperative Care
5.6.6 Complications
5.7 Osteochondral Allograft Transfer
5.7.1 Background of the Osteochondral Allograft Transfer
5.7.2 Incision and Approach
5.7.3 Surgical Technique (for Lesion Accessible Without Malleolar Osteotomy)
5.7.4 Skin Closure/Dressings
5.7.5 Postoperative Care
5.7.6 Complications
Further Reading
6: Osteochondral Lesions of the Tibial Plafond
6.1 Introduction
6.2 The Anatomy of the Distal Epiphyses of the Tibia
6.3 Symptoms, Physical Examination, and Radiographic Evaluation
6.3.1 Symptoms
6.3.2 Physical Examination
6.3.3 Radiographic Evaluation
6.4 Indications and Contraindications
6.4.1 Indications
6.4.2 Contraindications
6.5 Anesthesia, Tourniquet, Position, Distraction, and Instruments
6.6 Surgical Procedures
6.6.1 Portals/Incision
6.6.2 Creating the Pathway
6.6.3 Arthroscopic Debridement (Anterior Approach)
6.6.4 Arthroscopic Debridement (Posterior Approach)
6.6.5 Skin Closure/Dressings
6.7 Postoperative Care
6.8 Complications
Further Reading
7: Anterior Ankle Impingement
7.1 Introduction
7.2 Clinical Anatomy of the Anterior Ankle
7.3 Symptoms, Physical Examination, and Radiographic Evaluation
7.3.1 Symptoms
7.3.2 Physical Examination
7.3.3 Radiographic Evaluation
7.4 Indications and Contraindications for Surgical Intervention
7.4.1 Indications
7.4.2 Contraindications
7.5 Anesthesia, Tourniquet, Position, Distraction, and Instruments
7.6 Surgical Procedures for Anterior Ankle Impingement
7.6.1 Portals/Incision
7.6.2 Creating the Pathway
7.6.3 Ankle Impingement: Arthroscopic Debridement
7.6.4 Cam Impingement: Arthroscopic Debridement
7.6.5 Loose Bodies and Loose Body Removal Approaches
7.6.6 Bassett’s Ligament Impingement: Arthroscopic Debridement
7.6.7 Skin Closure/Dressings
7.7 Postoperative Care
7.8 Complications
Further Reading
8: Chronic Ankle Instability
8.1 Introduction
8.2 Anatomy of the Ankle Ligament and Mechanism of Injury
8.3 Symptoms, Physical Exam, and Radiographic Evaluation
8.3.1 Symptoms
8.3.2 Physical Exam
8.3.3 Radiographic Evaluation
8.4 Indications and Contraindications
8.4.1 Indications
8.4.2 Contraindications
8.5 Anesthesia, Tourniquet, Position, and Distraction
8.6 Surgical Procedures
8.6.1 Portals/Incisions
8.6.2 Creating the Pathway
8.6.3 Arthroscopic Debridement and Open Broström-Gould Procedure
8.6.4 Open Broström-Gould Procedure
8.6.5 All-Inside Arthroscopic ATFL Reconstruction
8.6.6 Skin Closure/Dressings
8.7 Postoperative Care
8.8 Complications
Further Reading
9: High Ankle Sprain (Syndesmotic Injury)
9.1 Introduction
9.2 Anatomy of the Syndesmosis
9.3 Symptoms, Physical Exam, and Radiographic Evaluation
9.3.1 Symptoms
9.3.2 Physical Examination
9.3.3 Radiographic Evaluation
9.4 Indications and Contraindications
9.4.1 Indications
9.4.2 Contraindications
9.5 Anesthesia, Tourniquet, Position, Distraction, and Instruments
9.6 Surgical Procedures
9.6.1 Portals/Incision
9.6.2 Creating the Pathway
9.6.3 Arthroscopic Debridement and Fixation
9.6.4 Skin Closure/Dressings
9.7 Postoperative Care
9.8 Complications
Further Reading
10: Arthroscopic-Assisted Treatment of Ankle Fracture
10.1 Introduction
10.2 Anatomy of the Ankle Joint
10.3 Indications and Contraindications
10.3.1 Indications
10.3.2 Contraindications
10.4 Anesthesia, Tourniquet, Position, Distraction, and Instruments
10.5 Surgical Procedures
10.5.1 Portals/Incision
10.5.2 Creating the Pathway
10.5.3 Arthroscopic Debridement and Open/Closed Reduction Internal Fixation
10.5.4 Skin Closure/Dressings
10.6 Postoperative Care
10.7 Complications
Further Reading
11: Arthroscopic Ankle Arthrodesis
11.1 Introduction
11.2 Anatomy of the Ankle Joint
11.3 Symptoms, Physical Exam, and Radiographic Evaluation
11.3.1 Symptoms
11.3.2 Physical Exam
11.3.3 Radiographic Evaluation
11.4 Indications and Contraindications
11.4.1 Indications
11.4.2 Contraindications
11.5 Anesthesia, Tourniquet, Position, Distraction, and Instruments
11.6 Surgical Procedures (Anterior Arthroscopic Arthrodesis with Screw Fixation)
11.6.1 Portals/Incision
11.6.2 Creating the Pathway
11.6.3 Arthroscopic Debridement
11.6.4 Tibiotalar Fixation
11.6.5 Skin Closure/Dressings
11.7 Postoperative Care
11.8 Complications
Further Reading
12: Posterior Approach for Osteochondral Lesions of the Talus
12.1 Introduction
12.2 Clinical Anatomy of the Talus
12.3 Symptoms, Physical Exam, and Radiographic Evaluation
12.3.1 Symptoms
12.3.2 Physical Exam
12.3.3 Radiographic Evaluation
12.4 Indications and Contraindications
12.4.1 Indications
12.4.2 Contraindications
12.5 Anesthesia, Tourniquet, Position, and Distraction
12.6 Surgical Procedures
12.6.1 Portals/Incision
12.6.2 Creating the Pathway
12.6.3 Arthroscopic Examination and Debridement
12.6.4 Bone Marrow Stimulation (BMS)
12.6.5 Skin Closure/Dressings
12.7 Postoperative Care
12.8 Complications
Further Reading
13: Posterior Ankle Impingement: Os Trigonum Syndrome
13.1 Introduction
13.2 Clinical Anatomy of the Posterior Process of the Talus
13.3 Symptoms, Physical Examination, and Radiographic Evaluation
13.3.1 Symptoms
13.3.2 Physical Exam
13.3.3 Radiographic Evaluation
13.4 Indications and Contraindications
13.4.1 Indications
13.4.2 Contraindications
13.4.3 Anesthesia, Tourniquet, Position, Distraction, and Instruments
13.5 Surgical Procedures
13.5.1 Portals/Incision
13.5.2 Creating the Pathway
13.5.3 Arthroscopic Debridement
13.5.4 Skin Closure/Dressings
13.6 Postoperative Care
13.7 Complications
Further Reading
14: Posterior Impingement: FHL Tendinopathy
14.1 Introduction
14.2 Anatomy of FHL Tendon
14.3 Symptoms, Physical Exam, and Radiographic Evaluation
14.3.1 Symptoms
14.3.2 Physical Exam
14.3.3 Radiographic Evaluation
14.3.4 Treatment Options
14.4 Arthroscopic Surgical Indications and Contraindications
14.4.1 Indications
14.4.2 Contraindications
14.5 Position, Anesthesia, Tourniquet, and Distraction
14.6 Surgical Procedures
14.6.1 Portals/Incision
14.6.2 Arthroscopic Visualization
14.6.3 Arthroscopic Release
14.6.4 Skin Closure/Dressings
14.7 Postoperative Care
14.8 Complications
Further Reading
15: Arthroscopic Subtalar Joint Arthrodesis: Posterior Approach
15.1 Introduction
15.2 Clinical Anatomy of the Subtalar Joint
15.3 Symptoms, Physical Exam, and Radiographic Evaluation
15.3.1 Symptoms
15.3.2 Physical Exam
15.3.3 Radiographic Evaluation
15.4 Indications and Contraindications
15.4.1 Indications
15.4.2 Contraindications
15.5 Anesthesia, Tourniquet, Position, and Distraction
15.6 Surgical Procedures
15.6.1 Portals/Incision
15.6.2 Arthroscopic Portals
15.6.3 Arthroscopic Debridement
15.6.4 Subtalar Fixation
15.6.5 Skin Closure/Dressings
15.7 Postoperative Care
15.8 Complications
Further Reading
16: Arthroscopic Subtalar Joint: Lateral Approach
16.1 Introduction
16.2 Anatomy of the Subtalar Joint (Lateral Side)
16.3 Symptoms, Physical Exam, and Radiographic Evaluation
16.4 Indications and Contraindications
16.5 Anesthesia, Tourniquet, Position, and Distraction
16.6 Surgical Procedures
16.6.1 Portals/Incision
16.6.2 Creating the Pathway
16.7 Arthroscopy for Subtalar Arthrodesis
16.7.1 Arthroscopic Debridement
16.7.2 Fixation
16.7.3 Postoperative Care
16.8 Subtalar Arthroscopy for Sinus Tarsi Syndrome
16.8.1 The Portals
16.8.2 Arthroscopic Debridement
16.8.3 Postoperative Care
16.9 Complications
Further Reading
17: Haglund’s Deformity and Retrocalcaneal Bursitis
17.1 Introduction
17.2 Anatomy of the Insertion of Achilles Tendon and the Retrocalcaneal Bursa
17.3 Symptoms, Physical Exam, and Radiographic Evaluation
17.3.1 Symptoms
17.3.2 Physical Exam
17.3.3 Radiographic Evaluation
17.4 Indications and Contraindications
17.4.1 Indications
17.4.2 Contraindications
17.5 Anesthesia, Tourniquet, Position, Distraction, and Instruments
17.6 Surgical Procedures
17.6.1 Portals/Incision
17.6.2 Creating the Pathway
17.6.3 Arthroscopic Debridement: Remove the Posterior Tubercle of Calcaneus
17.6.4 Skin Closure/Dressings
17.7 Haglund’s Deformity with Gout Achilles Tendonitis
17.7.1 The History of This Case
17.7.2 Creating the Pathway and Debridement of Retrocalcaneal Bursa
17.7.3 Debridement of Haglund’s Deformity and Gouty Lesions
17.7.4 Skin Closure/Dressings
17.8 Postoperative Care
17.9 Complications
Further Reading
18: Peroneal Tendon Disorders
18.1 Introduction
18.2 Anatomy of Peroneal Tendon and Retinaculum
18.3 Symptoms, Physical Exam, and Radiographic Evaluation
18.3.1 Symptoms
18.3.2 Physical Exam
18.3.3 Radiographic Evaluation
18.4 Surgical Indications and Contraindications
18.4.1 Indications
18.4.2 Contraindications
18.5 Position, Anesthesia, and Tourniquet
18.6 Surgical Procedures
18.6.1 Portals/Incision
18.6.2 Creating the Pathway
18.6.3 Arthroscopic Debridement
18.6.4 Endoscopic Retromalleolar Groove Deepening
18.6.5 Skin Closure/Dressings
18.7 Postoperative Care
18.8 Complications
Further Reading
19: Endoscopic Gastrocnemius Recession
19.1 Introduction
19.2 Clinical Anatomy of the Triceps Surae and Achilles Tendon
19.3 Symptoms, Physical Exam, and Radiographic Evaluation
19.3.1 Symptoms
19.3.2 Physical Exam
19.3.3 Radiographic Evaluation
19.4 Indications and Contraindications
19.4.1 Indications
19.4.2 Contraindications
19.5 Position, Anesthesia, Tourniquet, and Instruments
19.6 Surgical Procedure: Endoscopic Gastrocnemius Recession
19.6.1 Portals/Incision
19.6.2 Clearing the Cannula and Ensuring Correct Plane
19.6.3 Release the Gastrocnemius Aponeurosis
19.6.4 Skin Closure/Dressings
19.7 Surgical Procedure: Endoscopic Baumann Procedure
19.7.1 Portals/Incision
19.7.2 Creating the Pathway
19.7.3 Release the Gastrocnemius Muscle Fascia
19.7.4 Skin Closure/Dressings
19.8 Postoperative Care
Further Reading
20: Endoscopic Plantar Fascia Release
20.1 Introduction
20.2 Anatomy of Plantar Fascia
20.3 Symptoms, Physical Exam, and Radiographic Evaluation
20.3.1 Symptoms
20.3.2 Physical Exam
20.3.3 Differential Diagnosis
20.3.4 Radiographic Evaluation
20.3.5 Nonoperative Treatment Options
20.4 Surgical Indications and Contraindications
20.4.1 Indications
20.4.2 Contraindications
20.4.3 Position, Anesthesia, Tourniquet, and Instrumentation
20.5 Surgical Procedures
20.5.1 Portal Landmarks
20.5.2 Creating the Pathway
20.5.3 Identification of the Plantar Fascia
20.5.4 Release the Plantar Fascia
20.5.5 Skin Closure/Dressings
20.6 Postoperative Care
20.7 Complications
Further Reading
21: Hallux Metatarsophalangeal (MTP) Joint Arthroscopy
21.1 Introduction
21.2 Gross Anatomy of the First MTP Joint
21.3 Indications and Contraindications
21.3.1 Indications
21.3.2 Contraindications
21.4 Preoperative Evaluation
21.5 Position, Anesthesia, Tourniquet, Distraction, and Instruments
21.6 Surgical Procedures
21.6.1 Portals/Incision
21.6.2 Creating the Pathway
21.6.3 Arthroscopic Examination of MTP Joint
21.7 Special Techniques for Hallux Rigidus
21.8 Special Techniques for Synovitis: Synovectomy
21.9 Complications
Further Reading
Index