title: Arthroscopic Talar Dome Access Using a Standard Versus Wire-Based Traction Method for Ankle Joint Distraction.
abstract: To evaluate the accessibility of the talar dome through anterior and posterior portals for ankle arthroscopy with the standard noninvasive distraction versus wire-based longitudinal distraction using a tensioned wire placed transversely through the calcaneal tuberosity.
  
  
  
  Seven matched pairs of thigh-to-foot specimens underwent ankle arthroscopy with 1 of 2 methods of distraction: a standard noninvasive strapping technique or a calcaneal tuberosity wire-based technique. The order of the arthroscopic approach and use of a distraction method was randomly determined. The areas accessed from both 2-portal anterior and 2-portal posterior approaches were determined by using a molded translucent grid.
  
  
  
  The mean talar surface accessible by anterior ankle arthroscopy was comparable with noninvasive versus calcaneal wire distraction with 57.8% ± 17.2% (range, 32.9% to 75.7%) versus 61.5% ± 15.2% (range, 38.5% to 79.1%) of the talar dome, respectively (P = .590). The use of calcaneal wire distraction significantly improved posterior talar dome accessibility compared with noninvasive distraction, with 56.4% ± 20.0% (range, 14.4% to 78.0%) versus 39.8% ± 14.9% (range, 20.0% to 57.6%) of the talar dome, respectively (P = .031).
  
  
  
  Under the conditions studied, our cadaveric model showed equivalent talar dome access with 2-portal anterior arthroscopy of calcaneal wire-based distraction versus noninvasive strap distraction, but improved access for 2-portal posterior arthroscopy with calcaneal wire-based distraction versus noninvasive strap distraction.
  
  
  
  The posterior 40% of the talar dome is difficult to access via anterior ankle arthroscopy. Posterior calcaneal tuberosity wire-based longitudinal distraction improved arthroscopic access to the centro-posterior talar dome with a posterior arthroscopic approach.
authors.affiliation: Department of Orthopaedics, University of Utah, Salt Lake City, Utah, U.S.A.; Orthopaedic Research Laboratory, Department of Orthopaedics, University of Utah, Salt Lake City, Utah, U.S.A.
authors.forename: Alexej
authors.initials: A
authors.lastname: Barg
authors.affiliation: Department of Orthopaedics, University of Utah, Salt Lake City, Utah, U.S.A.. Electronic address: charles.saltzman@hsc.utah.edu.
authors.forename: Charles L
authors.initials: CL
authors.lastname: Saltzman
authors.affiliation: Department of Orthopaedics, University of Utah, Salt Lake City, Utah, U.S.A.
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Beals
authors.affiliation: Orthopaedic Research Laboratory, Department of Orthopaedics, University of Utah, Salt Lake City, Utah, U.S.A.
authors.forename: Kent N
authors.initials: KN
authors.lastname: Bachus
authors.affiliation: Department of Orthopaedic Surgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, U.S.A.
authors.forename: Brad D
authors.initials: BD
authors.lastname: Blankenhorn
authors.affiliation: Department of Orthopaedics, University of Utah, Salt Lake City, Utah, U.S.A.. Electronic address: florian.nickisch@hsc.utah.edu.
authors.forename: Florian
authors.initials: F
authors.lastname: Nickisch
mesh_terms: D000328:Adult; D000843:Ankle Joint / Q000502:physiology* / Q000601:surgery*; D001182:Arthroscopy; D002102:Cadaver; D005260:Female; D006801:Humans; D008297:Male; D008349:Manipulation, Orthopedic / Q000379:methods*; D008875:Middle Aged