Dataset Information

Endoscopic Intermetatarsal Ligament Decompression.

ABSTRACT: Morton neuroma is an entrapment of the intermetatarsal nerve by the deep intermetatarsal ligament. It is usually treated conservatively. Surgery is considered if there is recalcitrant pain that is resistant to conservative treatment. The surgical options include resection of the neuroma or decompression of the involved nerve. Decompression of the nerve by release of the intermetatarsal ligament can be performed by either an open or minimally invasive approach. We describe 2-portal endoscopic decompression of the intermetatarsal nerve. The ligament is released by a retrograde knife through the toe-web portal under arthroscopic guidance through the plantar portal.

SUBMITTER: Lui TH

PROVIDER: S-EPMC4887115 | biostudies-literature | 2015 Dec

REPOSITORIES: biostudies-literature

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Endoscopic Intermetatarsal Ligament Decompression.

Lui Tun Hing TH

Arthroscopy techniques 20151214 6

Morton neuroma is an entrapment of the intermetatarsal nerve by the deep intermetatarsal ligament. It is usually treated conservatively. Surgery is considered if there is recalcitrant pain that is resistant to conservative treatment. The surgical options include resection of the neuroma or decompression of the involved nerve. Decompression of the nerve by release of the intermetatarsal ligament can be performed by either an open or minimally invasive approach. We describe 2-portal endoscopic dec ...[more]

PMID: 27284515

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Project description:Hallux valgus is one of the most common foot and ankle conditions faced by orthopaedic surgeons. Surgical correction of hallux valgus is frequently indicated for symptomatic deformity. Recently, the endoscopic technique of hallux valgus correction has been reported, which is basically an endoscopic approach to the classic distal soft tissue procedure. In this technical note, the technical details of the modified endoscopic distal soft tissue procedure with medial metatarsosesamoid ligament and intermetatarsal ligament augmentation is described. In this modified technique, the intact intermetatarsal ligament, plantar capsule of the first metatarsophalangeal joint (including the sesamoid apparatus), and medial metatarsosesamoid ligament form a soft tissue envelop that can wrap around the first metatarsal head to stabilize the first metatarsal in the reduced position. Technique Video Video 1 Modified endoscopic lateral soft tissue procedure with medial metatarsosesamoid ligament and intermetatarsal ligament augmentation of the left foot. The patient is in the supine position with the legs spread. The plantar portal is the viewing portal, and the toe web portal is the working portal. The adductor hallucis and lateral capsuloligamentous complex are released. Endoscopic bunionectomy is performed with the proximal bunion portal used as the viewing portal and the distal bunion portal used as the working portal. Two meniscal repair needles are inserted via the dorsal incision to the lateral side of the medial sesamoid. These bring back two PDS suture loops. The suture loops serve as suture retrievers and bring the minitape to the lateral side of the medial sesamoid. The minitape is passed through a bone tunnel at the first metatarsal neck, wrapped around the second metatarsal neck, and returned to the proximal bunion portal. The intermetatarsal space is closed up and transfixed by a basal intermetatarsal screw. The minitape is tensioned and fixed to the bone tunnel by a SwiveLock anchor.

Project description:ImportanceCarpal tunnel release (CTR) technique may influence the likelihood of revision surgery. Prior studies of revision CTR following endoscopic CTR (ECTR) compared with open CTR (OCTR) have been limited by sample size and duration of follow-up.ObjectiveTo estimate the incidence of revision CTR following ECTR compared with OCTR in a national cohort.Design, setting, and participantsThis retrospective cohort study used data from the US Veterans Health Administration. Participants included all adults (age ≥18 years) undergoing at least 1 outpatient CTR from October 1, 1999, to May 20, 2021. Data were analyzed from May 21, 2021, to November 27, 2023.ExposureIndex CTR technique.Main outcomes and measuresThe primary outcome was time to revision CTR, defined as repeat ipsilateral CTR during the study period. Secondary outcomes were indications for revision, findings during revision, and additional procedures performed during revision.ResultsAmong 134 851 wrists from 103 455 patients (92 510 [89.4%] male; median [IQR] age, 62 [53-70] years) undergoing at least 1 CTR, 1809 wrists underwent at least 1 revision at a median (IQR) of 2.5 (1.0-3.8) years. In competing-risks analysis, the cumulative incidence of revision was 1.06% (95% CI, 0.99%-1.12%) at 5 years and 1.59% (95% CI, 1.51%-1.67%) at 10 years. ECTR was associated with increased hazard of revision CTR compared with OCTR (adjusted hazard ratio [aHR], 1.56; 95% CI, 1.34-1.81; P < .001). The risk difference for revision CTR associated with ECTR compared with OCTR was 0.57% (95% CI, 0.31%-0.84%) at 5 years (number needed to harm, 176) and 0.72% (95% CI, 0.36%-1.07%) at 10 years (number needed to harm, 139). Regardless of index CTR technique, the most common indication for revision was symptom recurrence (1062 wrists [58.7%]). A reconstituted transverse carpal ligament (TCL) was more common after ECTR compared with OCTR, whereas scarring of the overlying tissues and of the median nerve itself were more common following OCTR. Incomplete transverse-carpal-ligament release was observed in 251 of the wrists undergoing revision CTR (13.94%) and was more common among revisions following ECTR (odds ratio, 1.62; 95% CI, 1.11-2.37; P = .01).Conclusions and relevanceIn this cohort study of revision CTR in the Veterans Health Administration, ECTR was associated with increased risk of revision compared with OCTR, but the absolute risk was low regardless of technique. Intraoperative findings at revision varied significantly according to index CTR technique.

Dataset Information

Endoscopic Intermetatarsal Ligament Decompression.

Publications

Endoscopic Intermetatarsal Ligament Decompression.

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