Arthroscopic Decompression for Medial Ankle Impingement After Total Ankle Arthroplasty.
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ABSTRACT:
SUBMITTER: Lam HY
PROVIDER: S-EPMC8185646 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description: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.
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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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Project description:Ankle replacements appear to offer a good alternative to fusion for most arthritic conditions. Use of mobile bearings has significantly improved results of ankle replacement. Ankle replacements still have a significant minor-complication rate which does not seem to affect the long-term outcome. Medial impingement as a complication has been reported with popular designs. We reviewed the senior author's first five years of Buechel-Pappas ankle replacements looking at AOFAS scores, VAS scores, patient satisfaction, learning curve of the surgeon and complications. Eight patients out of a total of 34 reported symptoms of medial impingement at follow-up. Four patients underwent revision surgery for this. Ankle replacements have a significant proportion of minor complications, one of which is medial impingement. Whether this is due to implant design, residual arthritis in medial recess or soft-tissue pathology is uncertain but revision surgery may be required.
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Project description:Arthroscopic release of the iliopsoas tendon for iliopsoas impingement (IPI) after total hip arthroplasty (THA) at the lesser trochanter gives good results. However, where IPI then recurs, due to adhesions between the healing iliopsoas tendon and the surrounding soft tissue, and nonoperative measures have failed, a revision THA procedure is usually considered. We propose a technique of arthroscopic visualization of the recurrent IPI and a subsequent psoas tenotomy at the level of the hip joint using an outside-in capsulotomy approach. This secondary tenotomy, located proximally directly at the level of the recurrent impingement, allows relief of the painful symptoms without compromising the muscle function of the iliopsoas and precludes the need for a complex THA revision.
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Project description:Posterior ankle endoscopy is a safe and effective approach for treatment of posterior ankle impingement. This is usually performed with the patient in prone position. The purpose of this technical note is to describe an arthroscopic approach of decompression of posterior ankle impingement with the patient in supine position. This is indicated if there is posterior ankle impingement together with other ankle pathology requiring anterior ankle arthroscopy. This approach allows treatment of both anterior ankle and posterior ankle pathology with the patient in the supine position. Concomitant anterior ankle arthroscopy can be performed with the usual orientation without the need of change of patient's position.
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