In Which Position Do We Perform Arthroscopy of the Hindfoot—Supine or Prone?

Abstract

Over the last twenty-five years, hindfoot arthroscopy has evolved from a diagnostic tool to a therapeutic modality used to treat many intra-articular disorders1,2. This procedure has always been performed with the patient in the supine position, utilizing the anteromedial, anterolateral, and posterolateral portals. The posteromedial portal was avoided because of difficult access and concerns about injury to the neurovascular structures. In the mid-1990s, van Dijk, Amendola, and others introduced the concept of posterior hindfoot arthroscopy (PHA) performed with the patient in the prone position3,4. This was stimulated by renewed interest in arthroscopically treating posterior ankle impingement, including removal of the os trigonum or Stieda process and other pathology. Since that time, there have been a number of reports on PHA, including its safety, indications, and results. As expertise with this procedure has improved, the indications for PHA have increased and include debridement and microfracture of osteochondral lesions of the talus, excision of the os trigonum, release of the flexor hallucis longus tendon, subtalar arthrodesis, and treatment of posttraumatic arthrofibrosis, calcaneal fractures, and Achilles tendon disorders5. However, …