Arthroscopic Techniques and Anatomy of the Foot and Ankle: A Surgical Atlas

Preface
Acknowledgments
Contents
Contributors
1: Gross Anatomy of the Ankle Joint for Arthroscopy
	1.1	 Skin and Landmarks
	1.2	 Ankle Joint
		1.2.1	 Ankle Mortise
		1.2.2	 The Inferior Syndesmosis
	1.3	 Anatomy of the Talus
	1.4	 Anatomy of the Subtalar Joint
	1.5	 The Capsule of the Ankle Joint
	1.6	 The Ligaments Around the Ankle Joint
		1.6.1	 Medial Ligament
		1.6.2	 Lateral Ligament
		1.6.3	 Posterior Intermalleolar Ligament
	1.7	 Deep Fascia Layer
		1.7.1	 Anterior Region
		1.7.2	 Posterior Superficial Compartment
		1.7.3	 Posterior Deep Compartment
		1.7.4	 Lateral Region
		1.7.5	 Medial Region
	1.8	 Superficial Nerves and Veins
		1.8.1	 Superficial Peroneal Nerve
		1.8.2	 Sural Nerve and Lesser Saphenous Vein
		1.8.3	 Saphenous Nerve
	Further Reading
2: Arthroscopy Instruments and Applications
	2.1	 Arthroscopic Equipment
		2.1.1	 Arthroscope
		2.1.2	 Trocar, Obturator, and Cannula
	2.2	 Camera, Video Monitor, and Printer
		2.2.1	 Camera Control Unit and Camera Head
		2.2.2	 Video Monitor
		2.2.3	 Printer
	2.3	 Light Source and Cable
	2.4	 Motorized Instrument
		2.4.1	 Energy System
		2.4.2	 The Soft Tissue Shaver
		2.4.3	 The Arthroscopic Burr
		2.4.4	 Footswitch Control
	2.5	 Irrigation Equipment and Suction System
	2.6	 Special Instrument
		2.6.1	 Arthroscopic Probe
		2.6.2	 Arthroscopic Osteotome
		2.6.3	 Arthroscopic Elevator
		2.6.4	 The Closed-Cup Curette
		2.6.5	 The Open Curette (Fig. 2.25)
		2.6.6	 The Chondro-Picks
		2.6.7	 The Grasper
		2.6.8	 The Straight Punch Forceps
		2.6.9	 MicroVector Drill Guide System
		2.6.10	 Basic Surgical Instruments
	2.7	 Noninvasive and Invasive Distraction
	2.8	 Other Accessory Equipment
		2.8.1	 The Thigh Tourniquet
		2.8.2	 Prevention of Deep Vein Thrombosis
	Further Reading
3: Anterior Arthroscopy of the Ankle Joint: General Principles and Arthroscopic Examination
	3.1	 Introduction
	3.2	 Regional Anatomy of the Anterior Ankle Joint
	3.3	 Indications and Contraindications
		3.3.1	 Indications
		3.3.2	 Contraindications
	3.4	 Procedural Setup and Anesthesia
	3.5	 Anterior Portals/Incision
		3.5.1	 Anteromedial Portal
		3.5.2	 Anterolateral Portal
		3.5.3	 Anterocentral Portal
		3.5.4	 Accessory Anteromedial Portal
		3.5.5	 Accessory Anterolateral Portal
	3.6	 Establishing the Portals
	3.7	 Diagnostic Arthroscopic Examination
	Further Reading
4: Posterior Arthroscopy of the Ankle and Subtalar Joint: General Principles and Arthroscopic Examination
	4.1	 Introduction
	4.2	 Regional Anatomy of the Posterior Ankle Joint
	4.3	 Indications and Contraindications
		4.3.1	 Indications
		4.3.2	 Contraindications
	4.4	 Anesthesia, Tourniquet, Position, and Distraction
	4.5	 Posterior Portals/Incision
		4.5.1	 Posterolateral Portal
		4.5.2	 Posteromedial Portal
		4.5.3	 Accessory Posterolateral Portal
		4.5.4	 Accessory Posteromedial Portal
	4.6	 Creating the Pathway
	4.7	 Diagnostic Arthroscopic Examination: Posterior Ankle Examination
	Further Reading
5: Osteochondral Lesions of Talus
	5.1	 Introduction
	5.2	 Anatomy of the Articular Cartilage of the Talus
	5.3	 Symptoms, Physical Examination, and Radiographic Evaluation
		5.3.1	 Symptoms
		5.3.2	 Physical Examination
		5.3.3	 Radiographic Evaluation
	5.4	 Classification and Staging
	5.5	 Operative Treatment Options
	5.6	 Arthroscopic Debridement and Bone Marrow Stimulation
		5.6.1	 Indications and Contraindications
			5.6.1.1	 Indications
			5.6.1.2	 Contraindications
		5.6.2	 Anesthesia, Tourniquet, Position, and Distraction
		5.6.3	 Surgical Procedures
			5.6.3.1	 Portals/Incision
			5.6.3.2	 Creating the Pathway
			5.6.3.3	 Arthroscopic Debridement and Bone Marrow Stimulation
		5.6.4	 Skin Closure/Dressings
		5.6.5	 Postoperative Care
		5.6.6	 Complications
	5.7	 Osteochondral Allograft Transfer
		5.7.1	 Background of the Osteochondral Allograft Transfer
		5.7.2	 Incision and Approach
		5.7.3	 Surgical Technique (for Lesion Accessible Without Malleolar Osteotomy)
		5.7.4	 Skin Closure/Dressings
		5.7.5	 Postoperative Care
		5.7.6	 Complications
	Further Reading
6: Osteochondral Lesions of the Tibial Plafond
	6.1	 Introduction
	6.2	 The Anatomy of the Distal Epiphyses of the Tibia
	6.3	 Symptoms, Physical Examination, and Radiographic Evaluation
		6.3.1	 Symptoms
		6.3.2	 Physical Examination
		6.3.3	 Radiographic Evaluation
	6.4	 Indications and Contraindications
		6.4.1	 Indications
		6.4.2	 Contraindications
	6.5	 Anesthesia, Tourniquet, Position, Distraction, and Instruments
	6.6	 Surgical Procedures
		6.6.1	 Portals/Incision
		6.6.2	 Creating the Pathway
		6.6.3	 Arthroscopic Debridement (Anterior Approach)
		6.6.4	 Arthroscopic Debridement (Posterior Approach)
		6.6.5	 Skin Closure/Dressings
	6.7	 Postoperative Care
	6.8	 Complications
	Further Reading
7: Anterior Ankle Impingement
	7.1	 Introduction
	7.2	 Clinical Anatomy of the Anterior Ankle
	7.3	 Symptoms, Physical Examination, and Radiographic Evaluation
		7.3.1	 Symptoms
		7.3.2	 Physical Examination
		7.3.3	 Radiographic Evaluation
	7.4	 Indications and Contraindications for Surgical Intervention
		7.4.1	 Indications
		7.4.2	 Contraindications
	7.5	 Anesthesia, Tourniquet, Position, Distraction, and Instruments
	7.6	 Surgical Procedures for Anterior Ankle Impingement
		7.6.1	 Portals/Incision
		7.6.2	 Creating the Pathway
		7.6.3	 Ankle Impingement: Arthroscopic Debridement
		7.6.4	 Cam Impingement: Arthroscopic Debridement
		7.6.5	 Loose Bodies and Loose Body Removal Approaches
		7.6.6	 Bassett’s Ligament Impingement: Arthroscopic Debridement
		7.6.7	 Skin Closure/Dressings
	7.7	 Postoperative Care
	7.8	 Complications
	Further Reading
8: Chronic Ankle Instability
	8.1	 Introduction
	8.2	 Anatomy of the Ankle Ligament and Mechanism of Injury
	8.3	 Symptoms, Physical Exam, and Radiographic Evaluation
		8.3.1	 Symptoms
		8.3.2	 Physical Exam
		8.3.3	 Radiographic Evaluation
	8.4	 Indications and Contraindications
		8.4.1	 Indications
		8.4.2	 Contraindications
	8.5	 Anesthesia, Tourniquet, Position, and Distraction
	8.6	 Surgical Procedures
		8.6.1	 Portals/Incisions
		8.6.2	 Creating the Pathway
		8.6.3	 Arthroscopic Debridement and Open Broström-Gould Procedure
		8.6.4	 Open Broström-Gould Procedure
		8.6.5	 All-Inside Arthroscopic ATFL Reconstruction
		8.6.6	 Skin Closure/Dressings
	8.7	 Postoperative Care
	8.8	 Complications
	Further Reading
9: High Ankle Sprain (Syndesmotic Injury)
	9.1	 Introduction
	9.2	 Anatomy of the Syndesmosis
	9.3	 Symptoms, Physical Exam, and Radiographic Evaluation
		9.3.1	 Symptoms
		9.3.2	 Physical Examination
		9.3.3	 Radiographic Evaluation
	9.4	 Indications and Contraindications
		9.4.1	 Indications
		9.4.2	 Contraindications
	9.5	 Anesthesia, Tourniquet, Position, Distraction, and Instruments
	9.6	 Surgical Procedures
		9.6.1	 Portals/Incision
		9.6.2	 Creating the Pathway
		9.6.3	 Arthroscopic Debridement and Fixation
		9.6.4	 Skin Closure/Dressings
	9.7	 Postoperative Care
	9.8	 Complications
	Further Reading
10: Arthroscopic-Assisted Treatment of Ankle Fracture
	10.1	 Introduction
	10.2	 Anatomy of the Ankle Joint
	10.3	 Indications and Contraindications
		10.3.1	 Indications
		10.3.2	 Contraindications
	10.4	 Anesthesia, Tourniquet, Position, Distraction, and Instruments
	10.5	 Surgical Procedures
		10.5.1	 Portals/Incision
		10.5.2	 Creating the Pathway
		10.5.3	 Arthroscopic Debridement and Open/Closed Reduction Internal Fixation
		10.5.4	 Skin Closure/Dressings
	10.6	 Postoperative Care
	10.7	 Complications
	Further Reading
11: Arthroscopic Ankle Arthrodesis
	11.1	 Introduction
	11.2	 Anatomy of the Ankle Joint
	11.3	 Symptoms, Physical Exam, and Radiographic Evaluation
		11.3.1	 Symptoms
		11.3.2	 Physical Exam
		11.3.3	 Radiographic Evaluation
	11.4	 Indications and Contraindications
		11.4.1	 Indications
		11.4.2	 Contraindications
	11.5	 Anesthesia, Tourniquet, Position, Distraction, and Instruments
	11.6	 Surgical Procedures (Anterior Arthroscopic Arthrodesis with Screw Fixation)
		11.6.1	 Portals/Incision
		11.6.2	 Creating the Pathway
		11.6.3	 Arthroscopic Debridement
		11.6.4	 Tibiotalar Fixation
		11.6.5	 Skin Closure/Dressings
	11.7	 Postoperative Care
	11.8	 Complications
	Further Reading
12: Posterior Approach for Osteochondral Lesions of the Talus
	12.1	 Introduction
	12.2	 Clinical Anatomy of the Talus
	12.3	 Symptoms, Physical Exam, and Radiographic Evaluation
		12.3.1	 Symptoms
		12.3.2	 Physical Exam
		12.3.3	 Radiographic Evaluation
	12.4	 Indications and Contraindications
		12.4.1	 Indications
		12.4.2	 Contraindications
	12.5	 Anesthesia, Tourniquet, Position, and Distraction
	12.6	 Surgical Procedures
		12.6.1	 Portals/Incision
		12.6.2	 Creating the Pathway
		12.6.3	 Arthroscopic Examination and Debridement
		12.6.4	 Bone Marrow Stimulation (BMS)
		12.6.5	 Skin Closure/Dressings
	12.7	 Postoperative Care
	12.8	 Complications
	Further Reading
13: Posterior Ankle Impingement: Os Trigonum Syndrome
	13.1	 Introduction
	13.2	 Clinical Anatomy of the Posterior Process of the Talus
	13.3	 Symptoms, Physical Examination, and Radiographic Evaluation
		13.3.1	 Symptoms
		13.3.2	 Physical Exam
		13.3.3	 Radiographic Evaluation
	13.4	 Indications and Contraindications
		13.4.1	 Indications
		13.4.2	 Contraindications
		13.4.3	 Anesthesia, Tourniquet, Position, Distraction, and Instruments
	13.5	 Surgical Procedures
		13.5.1	 Portals/Incision
		13.5.2	 Creating the Pathway
		13.5.3	 Arthroscopic Debridement
		13.5.4	 Skin Closure/Dressings
	13.6	 Postoperative Care
	13.7	 Complications
	Further Reading
14: Posterior Impingement: FHL Tendinopathy
	14.1	 Introduction
	14.2	 Anatomy of FHL Tendon
	14.3	 Symptoms, Physical Exam, and Radiographic Evaluation
		14.3.1	 Symptoms
		14.3.2	 Physical Exam
		14.3.3	 Radiographic Evaluation
		14.3.4	 Treatment Options
	14.4	 Arthroscopic Surgical Indications and Contraindications
		14.4.1	 Indications
		14.4.2	 Contraindications
	14.5	 Position, Anesthesia, Tourniquet, and Distraction
	14.6	 Surgical Procedures
		14.6.1	 Portals/Incision
		14.6.2	 Arthroscopic Visualization
		14.6.3	 Arthroscopic Release
		14.6.4	 Skin Closure/Dressings
	14.7	 Postoperative Care
	14.8	 Complications
	Further Reading
15: Arthroscopic Subtalar Joint Arthrodesis: Posterior Approach
	15.1	 Introduction
	15.2	 Clinical Anatomy of the Subtalar Joint
	15.3	 Symptoms, Physical Exam, and Radiographic Evaluation
		15.3.1	 Symptoms
		15.3.2	 Physical Exam
		15.3.3	 Radiographic Evaluation
	15.4	 Indications and Contraindications
		15.4.1	 Indications
		15.4.2	 Contraindications
	15.5	 Anesthesia, Tourniquet, Position, and Distraction
	15.6	 Surgical Procedures
		15.6.1	 Portals/Incision
		15.6.2	 Arthroscopic Portals
		15.6.3	 Arthroscopic Debridement
		15.6.4	 Subtalar Fixation
		15.6.5	 Skin Closure/Dressings
	15.7	 Postoperative Care
	15.8	 Complications
	Further Reading
16: Arthroscopic Subtalar Joint: Lateral Approach
	16.1	 Introduction
	16.2	 Anatomy of the Subtalar Joint (Lateral Side)
	16.3	 Symptoms, Physical Exam, and Radiographic Evaluation
	16.4	 Indications and Contraindications
	16.5	 Anesthesia, Tourniquet, Position, and Distraction
	16.6	 Surgical Procedures
		16.6.1	 Portals/Incision
		16.6.2	 Creating the Pathway
	16.7	 Arthroscopy for Subtalar Arthrodesis
		16.7.1	 Arthroscopic Debridement
		16.7.2	 Fixation
		16.7.3	 Postoperative Care
	16.8	 Subtalar Arthroscopy for Sinus Tarsi Syndrome
		16.8.1	 The Portals
		16.8.2	 Arthroscopic Debridement
		16.8.3	 Postoperative Care
	16.9	 Complications
	Further Reading
17: Haglund’s Deformity and Retrocalcaneal Bursitis
	17.1	 Introduction
	17.2	 Anatomy of the Insertion of Achilles Tendon and the Retrocalcaneal Bursa
	17.3	 Symptoms, Physical Exam, and Radiographic Evaluation
		17.3.1	 Symptoms
		17.3.2	 Physical Exam
		17.3.3	 Radiographic Evaluation
	17.4	 Indications and Contraindications
		17.4.1	 Indications
		17.4.2	 Contraindications
	17.5	 Anesthesia, Tourniquet, Position, Distraction, and Instruments
	17.6	 Surgical Procedures
		17.6.1	 Portals/Incision
		17.6.2	 Creating the Pathway
		17.6.3	 Arthroscopic Debridement: Remove the Posterior Tubercle of Calcaneus
		17.6.4	 Skin Closure/Dressings
	17.7	 Haglund’s Deformity with Gout Achilles Tendonitis
		17.7.1	 The History of This Case
		17.7.2	 Creating the Pathway and Debridement of Retrocalcaneal Bursa
		17.7.3	 Debridement of Haglund’s Deformity and Gouty Lesions
		17.7.4	 Skin Closure/Dressings
	17.8	 Postoperative Care
	17.9	 Complications
	Further Reading
18: Peroneal Tendon Disorders
	18.1	 Introduction
	18.2	 Anatomy of Peroneal Tendon and Retinaculum
	18.3	 Symptoms, Physical Exam, and Radiographic Evaluation
		18.3.1	 Symptoms
		18.3.2	 Physical Exam
		18.3.3	 Radiographic Evaluation
	18.4	 Surgical Indications and Contraindications
		18.4.1	 Indications
		18.4.2	 Contraindications
	18.5	 Position, Anesthesia, and Tourniquet
	18.6	 Surgical Procedures
		18.6.1	 Portals/Incision
		18.6.2	 Creating the Pathway
		18.6.3	 Arthroscopic Debridement
		18.6.4	 Endoscopic Retromalleolar Groove Deepening
		18.6.5	 Skin Closure/Dressings
	18.7	 Postoperative Care
	18.8	 Complications
	Further Reading
19: Endoscopic Gastrocnemius Recession
	19.1	 Introduction
	19.2	 Clinical Anatomy of the Triceps Surae and Achilles Tendon
	19.3	 Symptoms, Physical Exam, and Radiographic Evaluation
		19.3.1	 Symptoms
		19.3.2	 Physical Exam
		19.3.3	 Radiographic Evaluation
	19.4	 Indications and Contraindications
		19.4.1	 Indications
		19.4.2	 Contraindications
	19.5	 Position, Anesthesia, Tourniquet, and Instruments
	19.6	 Surgical Procedure: Endoscopic Gastrocnemius Recession
		19.6.1	 Portals/Incision
		19.6.2	 Clearing the Cannula and Ensuring Correct Plane
		19.6.3	 Release the Gastrocnemius Aponeurosis
		19.6.4	 Skin Closure/Dressings
	19.7	 Surgical Procedure: Endoscopic Baumann Procedure
		19.7.1	 Portals/Incision
		19.7.2	 Creating the Pathway
		19.7.3	 Release the Gastrocnemius Muscle Fascia
		19.7.4	 Skin Closure/Dressings
	19.8	 Postoperative Care
	Further Reading
20: Endoscopic Plantar Fascia Release
	20.1	 Introduction
	20.2	 Anatomy of Plantar Fascia
	20.3	 Symptoms, Physical Exam, and Radiographic Evaluation
		20.3.1	 Symptoms
		20.3.2	 Physical Exam
		20.3.3	 Differential Diagnosis
		20.3.4	 Radiographic Evaluation
		20.3.5	 Nonoperative Treatment Options
	20.4	 Surgical Indications and Contraindications
		20.4.1	 Indications
		20.4.2	 Contraindications
		20.4.3	 Position, Anesthesia, Tourniquet, and Instrumentation
	20.5	 Surgical Procedures
		20.5.1	 Portal Landmarks
		20.5.2	 Creating the Pathway
		20.5.3	 Identification of the Plantar Fascia
		20.5.4	 Release the Plantar Fascia
		20.5.5	 Skin Closure/Dressings
	20.6	 Postoperative Care
	20.7	 Complications
	Further Reading
21: Hallux Metatarsophalangeal (MTP) Joint Arthroscopy
	21.1	 Introduction
	21.2	 Gross Anatomy of the First MTP Joint
	21.3	 Indications and Contraindications
		21.3.1	 Indications
		21.3.2	 Contraindications
	21.4	 Preoperative Evaluation
	21.5	 Position, Anesthesia, Tourniquet, Distraction, and Instruments
	21.6	 Surgical Procedures
		21.6.1	 Portals/Incision
		21.6.2	 Creating the Pathway
		21.6.3	 Arthroscopic Examination of MTP Joint
	21.7	 Special Techniques for Hallux Rigidus
	21.8	 Special Techniques for Synovitis: Synovectomy
	21.9	 Complications
	Further Reading
Index