Subtalar Arthroscopy

Abstract

The subtalar joint plays an important role in the movement of the ankle and foot. The complex anatomy of the subtalar joint makes it difficult for surgeons to evaluate the entire joint even with extensile approach. The arthroscopy of posterior subtalar joint was first described by Parisien in 1985. The development of good quality small-diameter arthroscopes and refined arthroscopic techniques has contributed to the improvement of the subtalar arthroscopy. The reported advantages of the subtalar arthroscopy include faster postoperative recovery and decreased postoperative pain.The subtalar arthroscopy can be applied as a diagnostic and therapeutic tool. The diagnostic indications are persistent pain, swelling, stiffness, or locking of the subtalar area resistant to conservative treatment. Therapeutic indications include debridement of sinus tarsi syndrome and chondromalacia, excision of subtalar impingement lesions and osteophytes, lysis of adhesions with post-traumatic arthrofibrosis, synovectomy, removal of loose bodies, removal of a symptomatic os trigonum, calcaneal fracture assessment and reduction, and arthroscopic arthrodesis of the subtalar joint.The subtalar arthroscopy can be done in supine position using thigh holder or in lateral decubitus position. The arthroscope generally used is a 2.7-mm 30 degrees short arthroscope. Noninvasive distraction with a strap around the hindfoot can be helpful. Usually anterolateral, middle, and posterolateral portals are utilized for inspection and instrumentation within the subtalar joint. After insertion of the arthroscope, thorough inspection of the joint can be done using 13-point examination techniques. Two-portal posterior subtalar arthroscopy in prone position can be performed as well with 4.0-mm 30 degrees arthroscope, depending on the type and location of the subtalar pathology. The joint capsule and the adjacent fatty tissue should be partially resected for better visualization.The subtalar arthroscopy is a technically demanding procedure, which requires proper instrumentation and careful operative technique. Possible complications after subtalar arthroscopy are nerve damage and persistent wound drainage.In conclusion, the ankle arthroscopy is a safe adjunctive procedure for the treatment of ankle fractures. It can be performed as well for the evaluation and management of syndesmotic injury, and for persistent pain following the definitive treatment of ankle fractures.