Arthroscopic subtalar arthrodesis is a safe and reproducible surgical technique in intractable subtalar pain or instability secondary to post-traumatic, rheumatic arthritis, or talocalcaneal coalitions. Other less frequent indications are primary osteoarthritis and gross instability. In neuropathic pathologies and chronic posterior tibial tendon ruptures, it can be taken into account only if subtalar pathology is not associated with deformities in other neighboring joints that need surgical fusion. Combined ankle and subtalar arthroscopic arthrodesis have been recently described with the patient in a prone position.
This technique can be performed with lateral or posterior approach. The arthroscopic posterior approach through the two classical posteromedial and posterolateral portals is combined with an anterolateral portal used at first for distraction of the joint, subsequently to debride the cartilage of the anterior area of the joint. The arthroscopic subtalar arthrodesis in the prone position offers some advantages over other types of surgery performed in the lateral position (open or arthroscopic), like the correct intraoperative evaluation of the hindfoot alignment and the easiness of placement of the screws.
Contraindications may include the presence of great deformities, infections, hardware after calcaneal or talar fractures, osteophytes precluding a work chamber, eccentric talus, severe malunion, failure of previous arthrodesis, bone defect requiring large grafting, associated midfoot deformity, and need of more than 10° of correction of the alignment of the hindfoot in valgus or in varus.
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Subtalar Arthroscopic Arthrodesis by Posterior Approach (MP4 983393 kb)
Tasto JP. Arthroscopic ankle and subtalar arthrodesis. In: Chow JCY, editor. Advanced arthroscopy. New York, NY: Springer; 2001. p. 623–33.CrossRefGoogle Scholar
Bevernage BD, Deleu PA, Maldague P, et al. Technique and early experience with posterior arthroscopic tibiotalocalcaneal arthrodesis. Orthop Traumatol Surg Res Jun. 2010;96(4):469–75.CrossRefGoogle Scholar
Glanzmann MC, Sanhueza-Hernandez R. Arthroscopic subtalar arthrodesis for symptomatic osteoarthritis of the hindfoot: a prospective study of 41 cases. Foot Ankle Int. 2007;28(1):2–7.CrossRefGoogle Scholar
Roster B, Kreulen C, Giza E. Subtalar joint arthrodesis: open and arthroscopic indications and surgical techniques. Foot Ankle Clin. 2015;20(2):319–34.CrossRefGoogle Scholar
Van Dijk CN, Scholten PE, Krips R. A 2-portal endoscopic approach for diagnosis and treatment of posterior ankle pathology. Arthroscopy. 2000;16:871–6.CrossRefGoogle Scholar
Beimers L, de Leeuw PA, van Dijk CN. A 3-portal approach for arthroscopic subtalar arthrodesis. Knee Surg Sports Traumatol Arthrosc. 2009;17(7):830–4.CrossRefGoogle Scholar
Stegeman M, Louwerens JW, van der Woude JT, et al. Outcome after operative fusion of the tarsal joints: a systematic review. J Foot Ankle Surg. 2015;54(4):636–45.CrossRefGoogle Scholar
Amendola A, Lee KB, Saltzman CL, et al. Technique and early experience with posterior arthroscopic subtalar arthrodesis. Foot Ankle Int. 2007;28:298–302.CrossRefGoogle Scholar
Lijoi F, Lughi M, Baccarani G. Posterior arthroscopic approach to the ankle: an anatomic study. Arthroscopy. 2003;19(1):62–7.CrossRefGoogle Scholar