Sacro-iliac joint arthroscopy for arthrodesis after traumatic dislocation. Cadaver and clinical feasibility study.
BACKGROUND
Sacro-iliac arthrodesis usually requires an extended posterior approach, which is associated with a number of dreaded complications. Here, we assessed the feasibility of arthroscopic exploration of the dislocated sacro-iliac joint.


METHODS
In the first step of our study, we used ligament section to induce loss of sacro-iliac joint coaptation in a cadaver. We then studied 5 patients with Tile C pelvic ring injuries. Arthroscopy was used to clear the joint of fibrous tissue and to roughen the bone to subchondral level in order to induce sacro-iliac arthrodesis. In addition, posterior fixation was performed using a hinge system or an ilio-sacral screw.


RESULTS
The cadaver study confirmed the feasibility of sacro-iliac arthroscopy after disruption of the strong posterior inter-osseous ligament. In the clinical part of the study in 5 patients with Tile C pelvic ring injuries, arthroscopy allowed direct visualisation extending to the anterior part of the joint space. A power burr and synovial knife were introduced to remove the interposed fibrous tissue and to roughen the bone to subchondral level in order to induce joint fusion. In addition, percutaneous or open posterior fixation was performed in all 5 patients. No infectious complications were recorded.


CONCLUSIONS
An arthroscope cannot be introduced into the normal sacro-iliac joint. In contrast, after traumatic sacro-iliac dislocation, arthroscopy can be used to evaluate the intra-articular injuries and to roughen the bone to subchondral level.
Service de chirurgie orthopédique, CHU de Rouen, Université de Rouen, 1, rue de Germont, 76031 Rouen cedex, France. Electronic address: mouradouldslimane@yahoo.fr.
M
M
Ould-Slimane
Service de chirurgie orthopédique, CHU de Rouen, Université de Rouen, 1, rue de Germont, 76031 Rouen cedex, France.
E
E
Foulongne
Service de chirurgie pédiatrique, CHU de Rouen, Université de Rouen, 1, rue de Germont, 76031 Rouen cedex, France.
J
J
Leroux
Service de chirurgie orthopédique, CHU de Rouen, Université de Rouen, 1, rue de Germont, 76031 Rouen cedex, France.
S
S
Bertiaux
Service de chirurgie orthopédique, Hôpital Beaujon, AP-HP, Université Paris VII, 100, boulevard du Général-Leclerc, 92110 Clichy, France.
T
T
Lenoir
Service de chirurgie orthopédique, Hôpital Beaujon, AP-HP, Université Paris VII, 100, boulevard du Général-Leclerc, 92110 Clichy, France.
P
P
Guigui
Service de chirurgie orthopédique, Hôpital Beaujon, AP-HP, Université Paris VII, 100, boulevard du Général-Leclerc, 92110 Clichy, France.
E
E
Hoffmann
D000328:Adult; D000368:Aged; D001174:Arthrodesis / Q000379:methods*; D001182:Arthroscopy; D002102:Cadaver; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D004204:Joint Dislocations / Q000601:surgery*; D008297:Male; D012446:Sacroiliac Joint / Q000293:injuries* / Q000601:surgery*
Arthrodesis; Arthroscopy; Non-union; Sacro-iliac joint