Posterior Arthroscopic Subtalar Arthrodesis Research Articles

Posterior arthroscopic subtalar arthrodesis for symptomatic adult talocalcaneal coalition

Objective: To investigate the functional outcomes of posterior arthroscopic subtalar arthrodesis (PASTA) for adult patients presenting with symptomatic talocalcaneal coalition. Methods: The study was a retrospective case-series research.The data of 17 adult patients (17 feet) with symptomatic talocalcaneal coalitions,treated with PASTA from March 2018 to February 2022 in Xuzhou Central Hospital were collected.This procedure involved 10 males and 7 females,aged (42.4±7.5) years(range:31 to 58 years).There were 9 cases on the right side and 7 cases on the left side.According to the Rozansky classification,there were 4 cases of type Ⅰ,7 cases of type Ⅱ, 3 cases of type Ⅲ,3 cases of type Ⅳ.The following items such as wound healing and bony union of the subtalar joint were observed.Clinical assessment was performed using pain visual analogue scale (VAS),American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scores and 36-item short form health survey (SF-36) scores.The paired t test was used for data comparison. Results: The follow-up time was (24.8±6.9) months(range:12 to 40 months).There were no complications such as wound infection,deep vein thrombosis,nonunion,or screw breakage.One patient with preoperative spasm,relieved after the second surgical procedure (peroneal brevis tendon lengthening).The union time of the subtalar joint was (8.8±2.2) weeks(range:6 to 12 weeks).At the final follow-up,the VAS decreased from (6.4±1.3) to (1.3±0.9)(t=14.114,P<0.01), the AOFAS ankle-hindfoot score increased from (49.0±8.1) to (90.0±5.1)(t=38.782,P<0.01),and the SF-36 score increased from (50.8±9.5) to (91.0±4.9)(t=20.468,P<0.01). Conclusion: PASTA for adult patients presenting with symptomatic talocalcaneal coalition offers advantages of minimal trauma,fast recovery,and few complications,which is an effective method.

A comparison of outcomes of posterior arthroscopic subtalar arthrodesis with or without bone graft for treatment of subtalar arthritis

BackgroundIt remains unclear whether to perform a bone graft is necessary during posterior arthroscopic subtalar arthrodesis. The present research aimed to comparatively analyze the outcomes of arthroscopic subtalar arthrodesis through a 3-portal posterior approach with or without bone graft. MethodsA total of 93 patients with subtalar arthritis who underwent posterior arthroscopic subtalar arthrodesis were retrospectively examined. The patients were divided into two groups according to whether they received bone graft or not. The clinical outcomes were compared for analysis. ResultsAmong the 93 patients included, 53 received bone graft and 40 did not. The union rate and time to osseous fusion suggested no significant difference between the two groups. The improvement of clinical outcomes were comparable between the two groups at the final follow-up. ConclusionsIn the present study, bone graft could not effectively reduce the risk of nonunion and improve the outcome.

Calcaneus Fracture and Posterior Arthroscopic Primary Subtalar Arthrodesis (C-PASTA).

The procedure begins with the patient in the prone position. The subtalar joint is visualized with a 1.9-mm flexible camera through a standard posterior arthroscopic approach. With the help of the C-arm, position in the subtalar joint space is confirmed. The joint space is debrided with use of a 4-0 shaver and then prepared for arthrodesis arthroscopically with use of an osteotome and a burr. Next, we inject allograft demineralized matrix-based bone putty under direct arthroscopic visualization to fill residual gaps or defects. The arthrodesis is performed under fluoroscopic guidance with use of 2 guidewires followed by 2 to 3 titanium compression screws. The first screw is inserted along the posteromedial calcaneus and into the talar dome medially. The second is placed laterally into the head-neck junction of the talus. The third screw is placed distal to proximal from the plantar anterior process to the talar head. Finally, images are obtained in multiple views to ensure proper screw placement, and the screws are tightened sequentially to ensure equal compression across the joint. Nonoperative treatment of calcaneal fractures includes cast immobilization with non-weight-bearing, although this treatment is typically reserved for nondisplaced, small extra-articular fractures6. Operative treatment of calcaneal fractures includes open reduction and internal fixation, which is traditionally performed via a sinus tarsi approach or extensile lateral approach. Primary subtalar arthrodesis has been utilized primarily for Sanders type-IV fractures6. Displaced intra-articular calcaneal fractures are associated with alarmingly high rates of posttraumatic arthritis (30% to 70% within 1 year of injury), and surgical outcomes are inversely proportional to the severity of the fracture pattern, with Sanders III and IV having the worst outcomes1. Treating these most severe fracture patterns with primary open subtalar arthrodesis has shown favorable results in terms of union rates, pain scores, and functional outcomes throughout the literature2,3. However, some authors have reported rates of revision as high as 60%4. Thus, the PASTA procedure has been established, resulting in significantly better time to union, return to work, activities of daily living, and sports activities compared with open techniques5. Thus, given the favorable results of primary open subtalar arthrodesis and the proven results with use of an arthroscopic technique in the non-acute setting, we propose that C-PASTA can serve as an alternative treatment option in the acute setting for patients with Sanders type-III and IV calcaneal fractures. We expect the outcomes of this procedure to mirror those found throughout the literature, which shows favorable results for open primary subtalar arthrodesis1-3. With use of an arthroscopic approach, we expect better time to union, return to work, activities of daily living, and sports activities than if the procedure were performed in an open fashion5. In addition, minimizing soft-tissue damage through an arthroscopic approach may decrease the risk of infection and stimulate postoperative healing, perhaps accounting for the more favorable postoperative recovery period compared with an open procedure. In the arthroscopic approach to the subtalar joint, identify the flexor hallucis longus, making sure to stay lateral to that tendon to remain in the "safe zone."Utilizing the TRIMANO device (Arthrex) to distract the ankle longitudinally in addition to a solid bump placed on the anterior aspect of the ankle allows for optimal subtalar joint visualization.Fish-scaling with an osteotome followed by bone grafting allows for a good fill between cancellous fragments to stimulate an optimal environment for fusion.Divergent screws should be placed and tightened sequentially to ensure equal compression across the joint. ADL's = activities of daily livingCT = computed tomographySCD = sequential compression deviceAP = anteroposteriorDVT = deep vein thrombosisBID = twice dailyVit = vitamin.

In Advanced Isolated Subtalar Arthritis, Posterior Arthroscopic Subtalar Arthrodesis Reduced Time to Union, But Not Union Rate, Compared with Open Subtalar Arthrodesis.

1Medstar Union Memorial Hospital, Baltimore, Maryland Disclosure: The Disclosure of Potential Conflicts of Interest form is provided with the online version of the article (https://links.lww.com/JBJS/H9).

Outcomes and Complications of Open vs Posterior Arthroscopic Subtalar Arthrodesis: A Prospective Randomized Controlled Multicenter Study.

Open subtalar arthrodesis is the standard treatment for subtalar arthritis. Posterior arthroscopic subtalar arthrodesis (PASTA) has recently gained increasing popularity due to a shorter recovery time and better cosmesis. However, studies comparing outcomes and complications between these 2 techniques are limited. In total, 56 patients with subtalar joint arthritis were prospectively randomized to 2 parallel groups to receive either PASTA (n = 28 patients) or open subtalar arthrodesis (n = 28 patients). The minimum follow-up period was 12 months. Primary outcome was union rate confirmed on postoperative computed tomography (CT) scan. Secondary outcomes were union time; visual analog scale (VAS), Short Form-36 (SF-36), and Foot and Ankle Ability Measure (FAAM) scores; tourniquet time; and complications. Union time (9.4 vs 12.8 weeks) and recovery time (time to return to activities of daily living [8.4 vs 10.8 weeks], work [10.6 vs 12.9 weeks], and sports [24.9 vs 32.7 weeks]) were significantly shorter with PASTA than with the open technique (P < .05 all). Both techniques led to significant improvements in all functional outcomes (FAAM, SF-36, and VAS scores; P < .01 all); however, there was no significant difference between the techniques in these outcomes (P > .05 all). Other outcomes, including tourniquet time (55.8 vs 67.2 min), union rate (96.3% vs 100%), and complication rate, were not significantly different between the techniques. Both open and PASTA techniques led to significant improvements in pain and function in patients with isolated subtalar joint arthritis. Although short-term functional outcomes and complication rates were not significantly different between the techniques, the PASTA technique was better at shortening the union and recovery times. Level I, prospective multicenter randomized controlled trial.

Outcomes of Posterior Arthroscopic Subtalar Arthrodesis for Medial Facet Talocalcaneal Coalition.

Medial facet talocalcaneal coalition can be a painful condition. This study aimed to determine clinical and radiographic outcomes of posterior arthroscopic subtalar arthrodesis (PASTA) for adult patients presenting with symptomatic medial facet talocalcaneal coalition and normal hindfoot alignment, with a minimal follow-up of 18 months. Between June 2017 and July 2019, this procedure was performed on 8 feet (8 patients; mean age, 55 [42-70] years; mean BMI, 29.8 [24.4-45.0] kg/m2). Clinical assessment was performed using Visual Analog Scale for Pain (VAS-P), Foot and Ankle Outcome Score (FAOS) and the 36-Item Short-Form Health Survey (SF-36). Patient satisfaction was assessed at the last available follow-up as "very satisfied", "satisfied" or "unsatisfied". Radiographic analysis was performed using plain radiography, computed tomography (CT) scan and magnetic resonance imaging (MRI). The primary outcome was to determine both clinical and radiographic outcomes. The mean follow-up was 25.1 (18.2-34.2) months. The authors found statistically significant improvement on all clinical scores (VASP-P, FAOS and SF-36). They registered 6 "very satisfied" patients, 2 "satisfied" patients and no "unsatisfied" patient. Fusion of the subtalar joint was observed in all patients by 12 weeks and in 5 of them as soon as 8 weeks postoperatively (mean, 9.5 [8-12] weeks). There were no cases of delayed fusion or nonunion of the subtalar joint, superficial or deep infection, neurovascular damage, thromboembolic event, screw breakage, need for hardware removal or revision surgery. This study found that PASTA is a safe and reliable technique for adult patients presenting with symptomatic medial facet talocalcaneal coalition and normal hindfoot alignment, demonstrating and maintaining clinical improvement at an average follow-up of 2 years. Level IV, case series.

2020 IFFAS Award for Excellence Winner: Outcomes and Complications of Open versus Posterior Arthroscopic Subtalar Arthrodesis: A Prospective Randomized Controlled Multicenter Study

Category:HindfootIntroduction/Purpose:Open subtalar arthrodesis is a standard treatment for subtalar joint arthritis. Recently, posterior arthroscopic subtalar arthrodesis (PASTA) has been introduced and gained increasing popularity due to fasten recovery time and better cosmesis. However, there is limited current studies to report outcomes and complications between the two techniques. The purpose of this study is to compare outcomes and complications between open and PASTA techniques.Methods:A prospective, randomized collected data of 56 consecutive patients who were diagnosed with isolated subtalar arthritis and underwent either open (28 patients) or PASTA (28 patients) between 2016 and 2019 were enrolled in this study. The minimum follow-up time to be included in this study was 12 months. The primary outcome was union rate which was confirmed by post-operative CT scan. The secondary outcomes were union time, VAS, SF-36, FAAM, tourniquet times, and complications. A paired sample t-test was used to assess statistical differences between pre- and post-operative functional outcomes (VAS, SF-36, and FAAM) in the same group of both open and PASTA techniques while an independent t-test was used to compare functional outcomes (VAS, SF-36, and FAAM) between the two techniques. Results were significance at p < 0.05. Descriptive statistics were used for the demographic variables.Results:There were 56 patients (44 male and 12 female) with mean follow-up time was 17.7 months and 17.5 months for open and PASTA. The union time was significantly shorter in PASTA (9.4 vs 12.8 weeks, p<0.05). PASTA demonstrated significantly fasten recovery times (p<0.05 all) including time to return to ADL (8.4 vs 10.8 weeks), work (9.4 vs 12.8 weeks), and sports (9.4 vs 12.8 weeks). Both Open and PASTA techniques demonstrated significant improvement of all functional outcomes (FAAM, SF- 36, and VAS (p<0.01 all)); however, there was no significant difference between the two techniques. Other outcomes were not significant difference including tourniquet times (55.8 vs 67.2 minutes) and union rates (96.3 vs 100%) and complications.Conclusion:Both open and PASTA techniques demonstrated significant improvement of pain and function for treatment of patients with isolated subtalar joint arthritis. Although there was no significant difference of short-term of functional outcomes and complications, PASTA technique was better in term of shorten time to union and fasten time to return to sports.

Treatment of Malunited Calcaneal Fracture With Posttraumatic Subtalar Osteoarthritis Using Lateral Endoscopic Calcaneoplasty With Posterior Arthroscopic Subtalar Arthrodesis

Malunion of calcaneal fractures is a common complication after improper nonoperative treatment. It may develop into posttraumatic subtalar osteoarthritis, lateral calcaneal wall prominence, and severe foot deformities. This Technical Note reports the technical aspects of lateral endoscopic calcaneoplasty with posterior arthroscopic subtalar arthrodesis for the treatment of malunited calcaneal fracture with lateral calcaneal wall prominence and posttraumatic subtalar osteoarthritis. This technique was chosen because it can reduce the risk of wound complication compared with a conventional lateral extensile approach. This Technical Note describes the use of the technique in a patient with prone position. This offers the advantages of easier access to the lateral surface of the calcaneus and posterior facet of the subtalar joint, and is less invasive to the soft tissue envelope on the lateral side of the foot. Moreover, the concomitant bone void area of the subtalar joint can be dealt with by an arthroscopic procedure.

Posterior Arthroscopic Subtalar Arthrodesis: Clinical and Radiologic Review of 19 Cases

Arthroscopic subtalar arthrodesis has recently gained popularity in the treatment of primary subtalar or post-traumatic arthritis, coalition, or inflammatory diseases with subtalar arthritis. The present study reports the clinical and radiologic results of 19 patients (19 feet) who underwent posterior arthroscopic subtalar arthrodesis using 2 posterior portals. A total of 19 posterior arthroscopic subtalar arthrodeses (minimum follow-up of 24 months) performed without a bone graft and with 2 parallel screws were prospectively evaluated. The fusion rate was 94% (mean time to fusion 9.8 weeks). Modified American Orthopaedic Foot and Ankle Society ankle-hindfoot scale score (maximum 94 points) improved significantly from 43 to 80 points and the visual analog scale for pain score improved from 7.6 to 1.2. The 12-item short-form physical and mental scores at the last follow-up point were 52.5 and 56.4, respectively. One (5.3%) patient underwent open repeat fusion for nonunion, 2 (10.5%) patients required a second procedure for implant removal, and 1 (5.3%) experienced reversible neuropraxia. In conclusion, posterior arthroscopic subtalar arthrodesis is a safe technique with a good union rate and a small number of complications in patients with no or very little hindfoot deformity.

Subtalar arthroscopic arthrodesis: Technique and outcomes.

The goal of this study was to describe the surgical technique and our results with arthroscopic posterior subtalar arthrodesis. Retrospective case series of 65 patients (38 men and 27 women) averaging 50 years of age (range 21-72 years) undergoing posterior arthroscopic subtalar arthrodesis using one or two percutaneous 6.5-7.3mm screws between May 2004 and February 2011, with a mean follow-up of 57.5 months (range 24-105 months). We achieved a 95.4% union rate after an average of 12.1 weeks (range 9 to 16 weeks). 12.3% of patients suffered complications, including superficial infection, nonunion and need for hardware removal. The AOFAS score improved from 51.5 points (19-61 points) preoperatively to 81.9 points (60-94 points) in the postoperative period. We describe the surgical technique for arthroscopic subtalar arthrodesis, which as proven to be a safe and reliable technique in our experience, with consistent improvements in AOFAS scores.

Posterior Arthroscopic Subtalar Arthrodesis.

Although subtalar joint arthrodesis may be achieved through open or arthroscopic approaches, we have found that posterior arthroscopic subtalar arthrodesis has technical advantages compared with other approaches. Clinically assess the foot and ankle with regard to remaining motion, previous scarring, and associated deformities, ensuring that no concomitant procedure will be needed in the supine position. Use spinal or general anesthesia. Place the posterolateral portal lateral to the Achilles tendon at the level of the tip of the lateral malleolus, according to the original technique described by van Dijk et al. Place the posteromedial portal medial to the Achilles tendon at the level of the tip of the lateral malleolus. With the help of the shaver, look for the landmarks of the posterior arthroscopy, going from the posterolateral part of the subtalar joint toward the flexor hallucis longus tendon, which is medially located, while exposing the tibiotalar joint. Sometimes an accessory portal, just anterior to the tip of the external malleolus, may be needed to achieve a distraction of the anterior part of the subtalar posterior facet. To perform this concomitant step, which generally is not necessary, use an arthroscopic forceps to insert a 5 by 20-mm autograft or allograft in the subtalar joint. Use two cannulated screws with a 7.3-mm diameter; we prefer stabilization screws to compression screws. Always clean out the posterior compartment of the ankle during the PASTA procedure, as is done during surgical treatment for posterior impingement syndrome, and note that both posterior impingement syndrome and subtalar degenerative changes may thereby be easily addressed through this procedure. A short posterior leg splint is worn for three to ten days, followed by another non-weight-bearing cast for another three weeks. Since the appearance of the original article, a total of forty-one unilateral subtalar joints in twenty-five men and sixteen women, seen between May 2007 and December 2012, with isolated subtalar arthritis or talocalcaneal coalition without any other major hindfoot arthritis were treated by posterior arthroscopic subtalar arthrodesis, and all subtalar joints except for two were considered radiographically fused at the first attempt after an average of 6.7 weeks (range, six to ten weeks).IndicationsContraindicationsPitfalls & Challenges.

Results of Arthroscopic Subtalar Arthrodesis for Adult-Acquired Flatfoot Deformity vs Posttraumatic Arthritis

The goal of this study was to compare results with arthroscopic posterior subtalar arthrodesis between patients treated for adult-acquired flatfoot deformity (AAFD) due to posterior tibial tendon dysfunction and patients with posttraumatic subtalar arthritis. Retrospective case series of 61 consecutive patients (group 1: posttraumatic arthritis, n = 37; group 2: AAFD, n = 24) averaging 49 years of age (range, 21-72 years) undergoing posterior arthroscopic subtalar arthrodesis via 1 or 2 percutaneous 6.5- to 7.3-mm screws, with a mean follow-up of 57.5 months (range, 24-105 months). Fusion was defined as the appearance of bony trabeculae across the subtalar joint on standard x-rays, along with clinical signs of union. Patients with posttraumatic arthritis (group 1) were more predominantly male and younger than patients treated for AAFD (group 2). Overall, we achieved a 95.1% radiologic union rate after an average of 11.7 weeks. Complications appeared in 14.8% of patients. Union rate and complications did not differ significantly between groups. American Orthopaedic Foot & Ankle Society (AOFAS) scores improved significantly for both patient groups, although patients with AAFD showed significantly larger improvement and higher postoperative AOFAS scores, even after adjusting for age and sex (mean improvement in AOFAS scores: 27.0 ± 9.1 points for the posttraumatic arthritis group vs 34.9 ± 7.4 points for the AAFD group; P < .001). Arthroscopic subtalar arthrodesis was a safe and reliable technique, with consistent improvement in AOFAS scores throughout different patient subgroups, as well as comparable time to union and complication rates. Improvements were larger for patients treated for AAFD, even after adjusting for age and sex. Level III, retrospective case series.

Computer Tomography assessment of the fusion rate after posterior arthroscopic subtalar arthrodesis

The purpose of this study was to assess the fusion rate on CT examinations and to correlate clinically the functional result with the degree of bone fusion in the subtalar joint after posterior arthroscopic subtalar arthrodesis (PASTA). Fourteen cases, from 36 to 84 years old, were retrospectively followed-up for a minimum of one year (range 12-92 months). A CT scan had been systematically performed at the six-month follow-up visit. The CT scans were examined in sagittal 2-mm-thick reformatted slices, measuring the length of the joint surface and the length of the fused portion of the joint space on each image. At six months, the average fusion ratio was 39±19% (range 0-69%). Fusion defined by a fusion ratio superior or equal to 33% on the CT scan was observed in 11 cases. One patient had a delayed union and required a revision of fixation. One patient had a bilateral nonunion. Mean average AOFAS score improved from 51±10 to 77±9 at last follow-up. Compared to open procedures, the posterior arthroscopic fusion seems to offer a promising alternative. However, our results suggest that the fusion rate following PASTA is not as favourable as reported in previous studies. Factors such as adequate compression and stable fixation provided by the screws together with the surgeons' experience with this demanding technique are of the utmost importance. A 33% CT fusion ratio threshold could accurately discriminate between clinical stability and instability.

Posterior arthroscopic subtalar arthrodesis: Ten cases at one-year follow-up

Isolated subtalar arthrodesis is the treatment of choice for several conditions-mostly subtalar arthritis, tarsal coalition and posterior tibial tendon dysfunction-unresponsive to conservative treatment. Arthroscopic procedures are an interesting recent alternative, less invasive than conventional open techniques. Posterior arthroscopy, in prone position, could be more advantageous than the conventional lateral and/or anterior approach. Ten cases, from 20 to 59-years-old, were prospectively followed up for minimum of one-year (range 12 to 31 months). Arthritis and tarsal coalition were the most common indications. Fusion was observed in all cases at a maximum of nine weeks. Mean average AOFAS score improved from 47 to 78. No complications were noted related to the technique. Only two patients, operated for a symptomatic subtalar coalition, complained of some residual pain due to a lateral submalleolar impingement. Interest of preservation of vascular talar supply and bone grafting are discussed. The good results using this innovative technique are encouraging. Long-term randomized studies remain necessary to confirm the reliability of the procedure in these different indications, and the type of bone graft to favour, if really needed. Level IV therapeutic study.

Arthroscopic Subtalar Arthrodesis Using a Posterior 2-Portal Approach in the Prone Position

The purpose of this study was to evaluate the results of posterior arthroscopic subtalar arthrodesis (ASTA) by use of a posterior 2-portal approach in the prone position and to describe the surgical technique. Between September 2004 and December 2006, posterior ASTA was performed in 16 patients (all men) with post-traumatic subtalar arthritis after an intra-articular fracture of the calcaneus. The mean age was 44 years (range, 20 to 64 years). The mean follow-up period was 30 months (range, 20 to 46 months). According to the Sanders classification of calcaneal fractures, 2 patients had type IIA fractures, 3 had type IIIB fractures, 6 had type IIIAC fractures, and 5 had type IIIBC fractures. The technique involved using posteromedial and posterolateral portals in the prone position, posterior talocalcaneal facet debridement, and percutaneous posterior fixation with 2 cannulated screws. Clinical results were evaluated by use of the ankle-hindfoot scale of the American Orthopaedic Foot & Ankle Society (AOFAS), the Angus and Cowell scoring system, and postoperative complications. To assess union rate and time to union, radiographic evaluations were also performed. The mean modified AOFAS score (maximum, 94 points) improved from 35 points (range, 24 to 45 points) preoperatively to 84 points (range, 71 to 94 points) at final follow-up. According to the Angus and Cowell criteria, 13 patients had a good rating, 2 had a fair rating, and 1 had a poor rating because of nonunion. The union rate was 94% at a mean of 11 weeks, and nonunion occurred in 1 case. No other postoperative complications occurred. ASTA in the prone position through a posterior 2-portal approach provided safe access and superior visualization of the posterior talocalcaneal facet and easy fixation of posterior screws. This technique also provided good clinical outcomes (good results in 81% of patients according to the Angus and Cowell scoring system and a mean modified AOFAS score of 84 points) and a 94% union rate at a mean of 11 weeks.

Technique and Early Experience with Posterior Arthroscopic Subtalar Arthrodesis

Subtalar arthrodesis is a reliable procedure for pain relief and improved function in patients with isolated subtalar arthritis. Arthroscopic subtalar arthrodesis (ASTA) was designed to improve upon traditional methods by using a minimally invasive technique. However, posterior arthroscopic subtalar arthrodesis (PASTA) has not been described. The purpose of the present study was to investigate the early results of PASTA. A retrospective review of 11 feet in 10 patients (one bilateral) that had PASTA was conducted. Inclusion criteria were isolated subtalar arthritis with no or minimal deformity and no significant bone loss. Exclusion criteria included patients requiring adjunctive open procedures or who had significant deformity. The technique involved prone positioning, two posterolateral portals and one posteromedial portal, posterior talocalcaneal facet debridement, percutaneous cancellous allografting and internal screw fixation. Outcome measures included patient satisfaction, the modified American Orthopaedic Foot and Ankle Society (AOFAS) score, union rate, time to union, and postoperative complications. All patients were discharged the day of surgery or stayed one night in the hospital. Eight patients were very satisfied, one satisfied, and one patient not satisfied with the results of their surgery. The average modified AOFAS score (maximum 94 points) improved from 36 points preoperatively to 86 points postoperatively. Ten joints fused by 10 weeks postoperatively, and one patient developed a nonunion. No other postoperative complications occurred. For surgeons familiar with posterior ankle or subtalar arthroscopy, PASTA offers superior exposure of the posterior talocalcaneal facet, high patient satisfaction, an excellent fusion rate, and less postoperative morbidity for patients with subtalar arthritis.