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Technique of Arthroscopic Treatment of Impingement After Total Ankle Arthroplasty.

ABSTRACT: Rates of medial and/or lateral gutter impingement after total ankle replacement are not insignificant. If impingement should occur, it typically arises an average of 17 months after total ankle replacement. Our patient underwent treatment for right ankle medial gutter bony impingement with arthroscopic debridement 5 years after her initial total ankle replacement. Standard anteromedial and anterolateral portals and a 30° 2.7-mm-diameter arthroscope were used. An aggressive soft-tissue and bony resection was performed using a combination of curettes, a 3.5-mm shaver, a 5.5-mm unsheathed burr, a drill, and a radiofrequency ablator. This case shows that arthroscopic treatment is an effective and potentially advantageous alternative to open treatment of impingement after total ankle replacement. In addition, symptoms of impingement often improve in a short amount of time after arthroscopic debridement of the medial and/or lateral gutter.

SUBMITTER: Gross CE

PROVIDER: S-EPMC4912567 | biostudies-literature | 2016 Apr

REPOSITORIES: biostudies-literature

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Technique of Arthroscopic Treatment of Impingement After Total Ankle Arthroplasty.

Gross Christopher E CE Neumann Julie A JA Godin Jonathan A JA DeOrio James K JK

Arthroscopy techniques 20160307 2

Rates of medial and/or lateral gutter impingement after total ankle replacement are not insignificant. If impingement should occur, it typically arises an average of 17 months after total ankle replacement. Our patient underwent treatment for right ankle medial gutter bony impingement with arthroscopic debridement 5 years after her initial total ankle replacement. Standard anteromedial and anterolateral portals and a 30° 2.7-mm-diameter arthroscope were used. An aggressive soft-tissue and bony r ...[more]

PMID: 27354942

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Project description:Accurate positioning of the total ankle arthroplasty implant components with the absence of any hindfoot deformity does not preclude the development of bony impingement. In cases of ankle stiffness after total ankle arthroplasty, the usual limitation is in dorsiflexion. If triceps surae contracture is excluded or persistent restriction remains in ankle dorsiflexion after gastrocnemius recession or tendo-Achilles lengthening, posterior ankle capsulectomy, debridement of posterior ankle gutter, and release of the deep posterior deltoid ligament and the posterior talofibular ligament are indicated. In this Technical Note, the technical details of endoscopic posterior ankle decompression and release after total ankle arthroplasty are described. Technique Video Video 1 Endoscopic posterior ankle decompression and release after total ankle arthroplasty of the left ankle. The patient is in the prone position. Posteromedial portal is the viewing portal and posterolateral portal is the working portal. The flexor hallucis longus (FHL) tendon is exposed. The arthroscope is switched to the posterolateral portal and the posterolateral ankle capsule is resected with arthroscopic instruments via the posteromedial portal. The FHL tendon is pushed medially by the instruments to facilitate resection of the more medial posterior ankle capsule. The arthroscope is switched back to the posteromedial portal and the most lateral part of the posterior ankle capsule is resected with arthroscopic shaver and radiofrequency wand via the posterolateral portal. Then, the FHL tendon is looped with a vascular sling via the posterolateral portal and the tendon is retracted laterally. The medial part of the posterior ankle capsule is resected with arthroscopic instruments via the posteromedial portal. The fibrous tissue of the posteromedial ankle gutter is also resected. The arthroscope is switched to the posteromedial portal and the fibrous tissue of the posterolateral ankle gutter is resected. The scarred posterolateral ankle ligamentous structure and fibrous band is released from its calcaneal insertion. The arthroscope is switched back to the posterolateral portal and the scarred posteromedial ankle ligamentous structure and fibrous band is carefully cut by a No. 15 scalpel with the cutting blade facing laterally.

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Technique of Arthroscopic Treatment of Impingement After Total Ankle Arthroplasty.

Publications

Technique of Arthroscopic Treatment of Impingement After Total Ankle Arthroplasty.

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