title: Talonavicular arthroscopy for osteochondral lesions: technique and case series.
abstract: BACKGROUND
  Traditional treatment of talonavicular osteochondral lesions (OCLs) requires an open procedure. Arthroscopic microfracture of talonavicular OCLs may provide a viable, minimally invasive approach. The purpose of this study was to describe an arthroscopic approach for treatment of talonavicular OCLs, describe the proximity of arthroscopic portals to important structures in cadaver specimens, and report magnetic resonance imaging (MRI) findings and clinical outcomes of this technique.
  
  
  METHODS
  Five cadaver specimens were dissected so proximity of portals to adjacent tendons and neurovascular structures could be assessed. Subsequently, 3 athletic patients with OCLs of the talonavicular joint were treated with arthroscopic debridement and microfracture. Patient records and imaging studies were retrospectively reviewed.
  
  
  RESULTS
  In the cadaver specimens, the mean distance between the neurovascular bundle and the medial border of the extensor hallucis longus (EHL) was 9.0 (range, 8 to 10) mm. The saphenous nerve was located a mean of 6.8 (range, 6 to 7) mm from the medial border of the tibialis anterior tendon. Therefore, portals were placed just medial to the EHL and tibialis anterior tendon to avoid the neurovascular bundle and saphenous nerve, respectively. In all patients, access, identification of the OCL, debridement, and microfracture were successfully performed. All patients demonstrated improvements in Foot and Ankle Outcome Scores and Short Form-12 scores and began gradual return to activity within 12 weeks following the operation. No significant complications occurred. MRI indicated signal consistent with reparative fibrocartilage in all patients.
  
  
  CONCLUSIONS
  Talonavicular arthroscopy allowed visualization, curettage, synovectomy, loose body removal, and microfracture of OCLs that would have otherwise required an open approach. At early follow-up, all patients had returned to their previous activity levels. Arthroscopy of the talonavicular joint was a viable approach for microfracture of OCLs.
  
  
  METHODS
  Level IV, case series.
authors: Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA.
authors: Keir A
authors: KA
authors: Ross
authors: Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA.
authors: Christine M
authors: CM
authors: Seaworth
authors: Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA.
authors: Niall A
authors: NA
authors: Smyth
authors: Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA.
authors: Jeffrey S
authors: JS
authors: Ling
authors: Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA.
authors: Stephanie C
authors: SC
authors: Sayres
authors: Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA KennedyJ@hss.edu.
authors: John G
authors: JG
authors: Kennedy
mesh_terms: D000293:Adolescent; D000328:Adult; D054544:Arthroplasty, Subchondral; D001182:Arthroscopy / Q000379:methods*; D001265:Athletic Injuries / Q000601:surgery; D002102:Cadaver; D002358:Cartilage, Articular / Q000293:injuries / Q000601:surgery*; D003646:Debridement; D005260:Female; D005267:Femoral Nerve / Q000033:anatomy & histology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000033:anatomy & histology; D012189:Retrospective Studies; D013640:Tarsal Joints / Q000033:anatomy & histology / Q000293:injuries / Q000601:surgery*; D013710:Tendons / Q000033:anatomy & histology
keywords: articular cartilage; bone marrow stimulation; microfracture; midfoot; navicular; outcomes; talus