title: Arthroscopic subtalar arthrodesis: the posterior approach in the prone position.
abstract: Arthroscopic subtalar arthrodesis, as reported by Tasto, is done in the lateral decubitus position, and the portal sites are lateral. This report describes a new alternative method in which the patient is in the prone position and a posterior 2-portal approach is used, as described by van Dijk et al. The initial debridement and synovectomy are performed with 4- and 5-mm resectors. Debridement and decortication are done posterior to the interosseous ligament because only the posterior facet is fused. Denudation of the articular surfaces is performed with curettes, as well as 4.5- and 5.5-mm burs, to remove 2 mm of subchondral bone. Stabilization in 5 degrees of hindfoot valgus is accomplished with 2 percutaneous cannulated headless screws from the non-weight-bearing portion of the calcaneal tuberosity directed to a point 5 to 10 mm posterior to the anterior margin of the posterior facet. The advantages of this alternative treatment are better intra-articular visualization, more thorough preparation of the fusion site, and minimal bone removal of the lateral side with better control of the arthrodesis position and with less chance of malunion, as well as the possibility to perform a concomitant surgical fusion or debridement of the ankle joint during the same operative procedure with no need for additional portals or orientation.
authors.affiliation: Servicio Traumatología y Cirugía Ortopédica, Hospital Universitario Marqués de Valdecilla y Centro Médico Lealtad, Santander, Spain. lpcarro@mundivia.es
authors.forename: Luis Perez
authors.initials: LP
authors.lastname: Carro
authors.forename: Pau
authors.initials: P
authors.lastname: Golanó
authors.forename: Jordi
authors.initials: J
authors.lastname: Vega
mesh_terms: D000328:Adult; D001174:Arthrodesis / Q000379:methods*; D001182:Arthroscopy / Q000379:methods*; D005260:Female; D006801:Humans; D007592:Joint Diseases / Q000175:diagnosis / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D016059:Range of Motion, Articular / Q000502:physiology*; D020127:Recovery of Function; D018570:Risk Assessment; D012494:Sampling Studies; D013380:Subtalar Joint / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome