| |
| |
| Foreword: Foot and Ankie Arthroscopy | |
| |
| |
| Perface: Arthroscopy of the Ankie and Foot | |
| |
| |
| Practical Aspects of Foot and Ankie Arthroscopy | |
| |
| |
| Arthroscopy of the foot and ankle, although sometimes technically challenging, is a useful tool for the foot and ankle surgeon. Burman in 1931 was the first to attempt arthoscopy of the ankle joint and surmised that it was not a suitable joint for arthroscopy because of its narrow intra-articular space. With the development of smaller-diameter arthroscopes and improvements in joint distraction techniques, Watanabe was the first to present a series of 28 ankle arthroscopes in 1972. At present, arthroscopy is used not only to evaluate and treat intra-articular abnormalities but also for endoscopic and tendoscopic procedures. | |
| |
| |
| Preoperative Evaluation and Testing for Arthroscopy | |
| |
| |
| Understanding when to proceed with an arthroscopy of the ankle and foot can at times be difficult. Proper preoperative planning will ensure that the correct surgical procedure is selected. Although most surgeons can determine the correct diagnosis and treatment options for the patient based on the subjective and objective examinations, advanced imaging and diagnostic injections are useful tools in difficult cases. | |
| |
| |
| Soft Tissue Pathology of the Ankle | |
| |
| |
| Derangements of the soft tissues within the ankle joint are associated with a wide variety of pathophysiology, and typically can be classified as secondary to traumatic injury, rheumatic disease, or congenital lesions. Patients often present with persistent pain, swelling, and limitations on function, usually focused on the anterior aspect of the joint. Evaluation should be guided by a detalied history and physical examination, followed by clinical, laboratory, and imaging studies as indicated. The pathophysiology, diagnosis, and management of these conditions will be the focus of this article. | |
| |
| |
| Arthroscopic Treatment of Ankle Osteochondral Lesions | |
| |
| |
| Arthroscopic treatment of osteochondral lesions (OCls) of the ankle is a popular first-line surgical option after conservative therapy has failed. MRI is the preferred imaging modality to evaluate OCLs and aid in surgical planning. Associated soft tissue pathology must be appreciated and addressed surgically, because associated synovitis and soft tissue impingement often contribute to symptoms. The diverse treatment modalities avaliable via arthroscopy often simplistic and straightforward solutions for bilogicallya nd mechanically complicated pathology. Marrow-stimulating techniques, particularly microfracture, have shown good to excellent results in most patients with small (<15mm) acute lesions, and have a low complication rate. | |
| |
| |
| Arthroscopic Treatment of Arterior Ankle Impingement | |
| |
| |
| Anterior ankle impingement is a common cause of chronic ankle pain in the athletic population. Its cause can be either soft tissue or osseous in nature. Arthroscopic debridement results in favorable and reproducible outcomes. However, in the population in which ankle instability or narrowing of the ankle joint occur, outcomes may be less favorable. | |
| |
| |
| Arthroscopic Ankle Arthrodesis | |
| |
| |
| Arthroscopic ankle arthrodesis provides the surgeon with an alternative to traditional open techniques. Arthroscopic ankle arthrodesis has demonstrated faster union rates, decreased complications, reduced post-operative pain, and shorter hospital stays. Adherence to sound surgical techinques, particularly with regar to joint preparation, is critical for success. Although total ankle replacement continues to grow in popularly, arthroscopic ankle arthrodesis remains a viable alternative for the management of end-stage arthritic ankle. | |
| |
| |
| Arthroscopically Assisted Treatment of Ankle Injuries | |
| |
| |
| Ankle arthroscopy is a valuable tool in the treatment of certain intra-articular fractures involving the ankle, as it provides the ability to address ostechondral injury and aids in the direct visualization for joint reduction through minimal intervention. It can sometimes be complimented by a more minimally invasive approach to fracture reduction and internal fixation. It should be noted that to perform arthroscopically assisted minimally invasive fracture approaches, the surgeon must have significant experience with traditional open techniques. | |
| |
| |
| Subtalar Joint Arthroscopy | |
| |
| |
| Subtalar joint arthroscopy can be performed on a wide array of pathology. The procedure has progressed from a diagnostic test to reconstructive procedure. Although it is not as popular as ankle arthroscopy, it is becoming more commonly discussed in the literature and is part of many arthroscopy courses. Better education along with improved instrumentation will allow more foor and ankle surgeons to treat pathology of the subtalar joint with arthroscopic techniques. This will lead to improved outcomes and lower complication rates in treating that pathology. | |
| |
| |
| Small joint Arthroscopy of the Foor | |
| |
| |
| The arthroscopic approach to small joints of the foot has made many advances in recent years, which can be directly related to the improvement of the surgical equipment. This improvement has led to more indication for the use of arthroscopy as well as minimizing the complications. Several articles recently have presented experiences in arthroscopic surgey in the small joints of the foot; however, its use is still relatively limited. Approaches to small joints of the foot involve the first metatarsophalangeal joint, tarsometatarsal joint, and Chopart joint, as well as the interphalangeal joint to the great toe and lesser toes. | |
| |
| |
| Tendoscopy of the Ankle | |
| |
| |
| In this article, the peroneus longus and brevis, posterior tibial, Achilles, and flexor hallucis longus tendon endoscopy are discussed individually. Tendoscopic indications and surgical techniques are highlighted. | |
| |
| |
| Current Concepts and Techniques in Foot and Ankle Surgery | |
| |
| |
| Antithrombotic Pharmacologic Prophylaxis Use During Conservative and Surgical Management of Foot and Ankle Disorders: A Systematic Review | |
| |
| |
| The use of antithrombotic pharmacologic prophylaxis during conservative or postoperative management of foot and ankle disorders in controversial. This article presents a systematic review of the incidence of deep venous thrombosis (DVT)/pulmonary embolus (PE) during management of foot and ankle disroders in patients who did or did not receive antithrombotic pharmacologic prophylaxis. Incidence of DVT/PE in both groups was low; however, more than half of the patients in both groups received some form of antithrombotic pharmacologic prophylaxis of varying duration, making it difficult to determine the true protective effect of antithrombotic pharmacologic prophylaxis. | |
| |
| |
| Pigmental Villonodular Synovitis of the Distal Tibiofibular Joint: A Case Report | |
| |
| |
| Pigmented villonodular synovitis (PVNS) is a proliferative disorder of the synovium. Monoarticular involvement is the more common process. This article presents a case of PVNS with rare location at the distal tibiofibular joint and discusses the current concepts of diagnosis and treatment of this disease. | |
| |
| |
| Index | |