Skip to main content

Posterior Compartment of the Ankle Joint: A Focus on Arthroscopic Treatment (ICL 17)

  • Chapter
  • First Online:

Abstract

Arthroscopic approach of the posterior ankle compartment has experienced great development since the beginning of the twenty-first century. The anatomical research of Pau Golano has been of paramount importance for the development of a “safe”, reliable and reproducible approach (particularly the two portals technique with the patient in prone position).

The herein presented text pays a tribute to the brilliant anatomical research performed by Pau Golano.

Moreover, since the description of the two-portal technique by Niek van Dijk in the year 2000, there has been growing experience in dealing with the arthroscopic anatomy of this zone which enabled subsequent expansion of indications.

Besides the “classical” indications (e.g. posterior impingement), there is recent growing experience in treating tendinopathies (e.g. Achilles insertional tendinopathies, FHL pathology or FHL transfer), arthroscopic-assisted fracture repair, Cedell fracture approach, subtalar and ankle posterior fusion or even tarsal tunnel syndrome treatment.

This work provides a comprehensive description of “key to success” tips and pearls for classical as well as innovative techniques around arthroscopic posterior approach of the ankle.

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Andrews JR, Previte WJ, Carson WG. Arthroscopy of the ankle: technique and normal anatomy. Foot Ankle. 1985;6(1):29–33.

    Article  CAS  PubMed  Google Scholar 

  2. Bartonicek J. Anatomy of the tibiofibular syndesmosis and its clinical relevance. Surg Radiol Anat: SRA. 2003;25(5–6):379–86. doi:10.1007/s00276-003-0156-4.

    Article  PubMed  Google Scholar 

  3. Beimers L, de Leeuw PA, van Dijk CN. A 3-portal approach for arthroscopic subtalar arthrodesis. Knee Surg Sports Traumatol Arthrosc: Off J ESSKA. 2009;17(7):830–4. doi:10.1007/s00167-009-0795-z.

    Article  Google Scholar 

  4. Bureau NJ, Cardinal E, Hobden R, Aubin B. Posterior ankle impingement syndrome: MR imaging findings in seven patients. Radiology. 2000;215(2):497–503. doi:10.1148/radiology.215.2.r00ma01497.

    Article  CAS  PubMed  Google Scholar 

  5. Burman MS. Arthroscopy of direct visualization of joints. An experimental cadaver study. J Bone Joint Surg. 1931;13:669–95.

    Google Scholar 

  6. Cedell CA. Rupture of the posterior talotibial ligament with the avulsion of a bone fragment from the talus. Acta Orthop Scand. 1974;45(3):454–61.

    Article  CAS  PubMed  Google Scholar 

  7. Collman DR, Kaas MH, Schuberth JM. Arthroscopic ankle arthrodesis: factors influencing union in 39 consecutive patients. Foot Ankle Int. 2006;27(12):1079–85.

    PubMed  Google Scholar 

  8. Correia SI, Pereira H, Silva-Correia J, Van Dijk CN, Espregueira-Mendes J, Oliveira JM, Reis RL. Current concepts: tissue engineering and regenerative medicine applications in the ankle joint. J R Soc Interface R Soc. 2014;11(92):20130784. doi:10.1098/rsif.2013.0784.

    Article  CAS  Google Scholar 

  9. Correia SI, Silva-Correia J, Pereira H, Canadas RF, Morais A, Frias AM, Sousa RA, van Dijk CN, Espregueira-Mendes J, Reis RL, Oliveira JM. Posterior talar process as a suitable cell source for treatment of cartilage and osteochondral defects of the talus. J Tissue Eng Regen Med. 2015. Epub ahead of print.

    Google Scholar 

  10. de Leeuw PAJ, Hendrickx RP, Sufkens SAS, van Dijk CN, Kerkhoffs GM. Midterm results of posterior arthroscopic ankle fusion. 2015. Submission KSSTA September 2015.

    Google Scholar 

  11. Den Hartog BD. Flexor hallucis longus transfer for chronic Achilles tendinosis. Foot Ankle Int. 2003;24(3):233–7.

    Google Scholar 

  12. Ferkel RD, Scranton Jr PE. Arthroscopy of the ankle and foot. J Bone Joint Surg Am. 1993;75(8):1233–42.

    CAS  PubMed  Google Scholar 

  13. Ferkel RD, Small HN, Gittins JE. Complications in foot and ankle arthroscopy. Clin Orthop Relat Res. 2001;391:89–104.

    Article  PubMed  Google Scholar 

  14. Folk JW, Starr AJ, Early JS. Early wound complications of operative treatment of calcaneus fractures: analysis of 190 fractures. J Orthop Trauma. 1999;13(5):369–72.

    Article  CAS  PubMed  Google Scholar 

  15. Friedman RL, Glisson RR, Nunley 2nd JA. A biomechanical comparative analysis of two techniques for tibiotalar arthrodesis. Foot Ankle Int. 1994;15(6):301–5.

    Article  CAS  PubMed  Google Scholar 

  16. Gasparetto F, Collo G, Pisanu G, Villella D, Drocco L, Cerlon R, Bonasia DE. Posterior ankle and subtalar arthroscopy: indications, technique, and results. Curr Rev Musculoskelet Med. 2012;5(2):164–70. doi:10.1007/s12178-012-9118-y.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Gavlik JM, Rammelt S, Zwipp H. The use of subtalar arthroscopy in open reduction and internal fixation of intra-articular calcaneal fractures. Injury. 2002;33(1):63–71.

    Article  PubMed  Google Scholar 

  18. Gkotsoulias EN, Simonson DC, Roukis TS. Outcomes and safety of endoscopic tarsal tunnel decompression: a systematic review. Foot Ankle Specialist. 2014;7(1):57–60. doi:10.1177/1938640013514267.

    Article  PubMed  Google Scholar 

  19. Golano P, Mariani PP, Rodriguez-Niedenfuhr M, Mariani PF, Ruano-Gil D. Arthroscopic anatomy of the posterior ankle ligaments. Arthrosc: J Arthrosc Relat Surg: Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc. 2002;18(4):353–8.

    Article  Google Scholar 

  20. Golano P, Vega J, de Leeuw PA, Malagelada F, Manzanares MC, Gotzens V, van Dijk CN. Anatomy of the ankle ligaments: a pictorial essay. Knee Surg Sports Traumatol Arthrosc: Off J ESSKA. 2010;18(5):557–69. doi:10.1007/s00167-010-1100-x.

    Article  Google Scholar 

  21. Golano P, Vega J, Perez-Carro L, Gotzens V. Ankle anatomy for the arthroscopist. Part I: the portals. Foot Ankle Clin. 2006;11(2):253–73. doi:10.1016/j.fcl.2006.03.005, v.

    Article  PubMed  Google Scholar 

  22. Gougoulias NE, Agathangelidis FG, Parsons SW. Arthroscopic ankle arthrodesis. Foot Ankle Int. 2007;28(6):695–706. doi:10.3113/FAI.2007.0695.

    Article  PubMed  Google Scholar 

  23. Guhl JF. Operative arthroscopy. Am J Sports Med. 1979;7(6):328–35.

    Article  CAS  PubMed  Google Scholar 

  24. Guhl JF. Foot and ankle arthroscopy. New York: Slack; 1993.

    Google Scholar 

  25. Hamilton WG, Geppert MJ, Thompson FM. Pain in the posterior aspect of the ankle in dancers. Differential diagnosis and operative treatment. J Bone Joint Surg Am. 1996;78(10):1491–500.

    CAS  PubMed  Google Scholar 

  26. Hedrick MR, McBryde AM. Posterior ankle impingement. Foot Ankle Int. 1994;15(1):2–8.

    Article  CAS  PubMed  Google Scholar 

  27. Hefti FL, Baumann JU, Morscher EW. Ankle joint fusion – determination of optimal position by gait analysis. Arch Orthop Trauma Surg Arch Orthop Unfall-Chirurgie. 1980;96(3):187–95.

    Article  CAS  Google Scholar 

  28. Hendrickx RP, de Leeuw PA, Golano P, van Dijk CN, Kerkhoffs GM. Safety and efficiency of posterior arthroscopic ankle arthrodesis. Knee Surg Sports Traumatol Arthrosc: Off J ESSKA. 2015;23(8):2420–6. doi:10.1007/s00167-014-3040-3.

    Article  Google Scholar 

  29. Hendrickx RP, Kerkhoffs GM, Stufkens SA, van Dijk CN, Marti RK. Ankle fusion using a 2-incision, 3-screw technique. Oper Orthop Traumatol. 2011;23(2):131–40. doi:10.1007/s00064-011-0015-0.

    Article  CAS  PubMed  Google Scholar 

  30. Higgins TF, Baumgaertner MR. Diagnosis and treatment of fractures of the talus: a comprehensive review of the literature. Foot Ankle Int. 1999;20(9):595–605.

    Article  CAS  PubMed  Google Scholar 

  31. Holt ES, Hansen ST, Mayo KA, Sangeorzan BJ. Ankle arthrodesis using internal screw fixation. Clin Orthop Relat Res. 1991;268:21–8.

    PubMed  Google Scholar 

  32. Kang S, Thordarson DB, Charlton TP. Insertional Achilles tendinitis and Haglund’s deformity. Foot Ankle Int. 2012;33(6):487–91. doi:10.3113/FAI.2012.0487.

    Article  PubMed  Google Scholar 

  33. Kerkhoffs GM, Hendrickx RP, Mallee WH, de Leeuw PA, van Dijk CN. Ankle arthrodesis: posterior arthroscopic approach. OKOJ. 2014. http://orthoportal.aaos.org/.

  34. Krishna Sayana M, Maffulli N. Insertional Achilles tendinopathy. Foot Ankle Clin. 2005;10(2):309–20. doi:10.1016/j.fcl.2005.01.010.

    Article  PubMed  Google Scholar 

  35. Lauge-Pedersen H, Aspenberg P, Ryd L, Tanner KE. Arch-shaped versus flat arthrodesis of the ankle joint: strength measurements using synthetic cancellous bone. Proc Inst Mech Eng H J Eng Med. 2002;216(1):43–9.

    Article  CAS  Google Scholar 

  36. Lim S, Yeap E, Lim Y, Yazid M. Outcome of calcaneoplasty in insertional achilles tendinopathy. Malays Orthop J. 2012;6(SupplA):28–34. doi:10.5704/MOJ.1211.007.

    PubMed  PubMed Central  Google Scholar 

  37. Mann RA, Rongstad KM. Arthrodesis of the ankle: a critical analysis. Foot Ankle Int. 1998;19(1):3–9.

    Article  CAS  PubMed  Google Scholar 

  38. Maquirriain J. Posterior ankle impingement syndrome. J Am Acad Orthop Surg. 2005;13(6):365–71.

    Article  PubMed  Google Scholar 

  39. McDougall A. The os trigonum. J Bone Joint Surg Br. 1955;37-B(2):257–65.

    CAS  PubMed  Google Scholar 

  40. Milner CE, Soames RW. Anatomical variations of the anterior talofibular ligament of the human ankle joint. J Anat. 1997;191(Pt 3):457–8.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Mouhsine E, Crevoisier X, Leyvraz PF, Akiki A, Dutoit M, Garofalo R. Post-traumatic overload or acute syndrome of the os trigonum: a possible cause of posterior ankle impingement. Knee Surg Sports Traumatol Arthrosc: Off J ESSKA. 2004;12(3):250–3. doi:10.1007/s00167-003-0465-5.

    Article  CAS  Google Scholar 

  42. Myerson MS, Quill G. Ankle arthrodesis. A comparison of an arthroscopic and an open method of treatment. Clin Orthop Relat Res. 1991;268:84–95.

    PubMed  Google Scholar 

  43. Neumaier Probst E, Maas R, Meenen NM. Isolated fracture of the posterolateral tibial lip (Volkmann’s triangle). Acta Radiol. 1997;38(3):359–62.

    Article  CAS  PubMed  Google Scholar 

  44. Nielsen KK, Linde F, Jensen NC. The outcome of arthroscopic and open surgery ankle arthrodesis: a comparative retrospective study on 107 patients. Foot Ankle Surg: Off J Eur Soc Foot Ankle Surg. 2008;14(3):153–7. doi:10.1016/j.fas.2008.01.003.

    Article  Google Scholar 

  45. O’Brien TS, Hart TS, Shereff MJ, Stone J, Johnson J. Open versus arthroscopic ankle arthrodesis: a comparative study. Foot Ankle Int. 1999;20(6):368–74.

    Article  PubMed  Google Scholar 

  46. Oh CS, Won HS, Hur MS, Chung IH, Kim S, Suh JS, Sung KS. Anatomic variations and MRI of the intermalleolar ligament. AJR Am J Roentgenol. 2006;186(4):943–7. doi:10.2214/AJR.04.1784.

    Article  PubMed  Google Scholar 

  47. Parisien JS, Vangsness T. Arthroscopy of the subtalar joint: an experimental approach. Arthrosc: J Arthrosc Relat Surg: Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc. 1985;1(1):53–7.

    Article  CAS  Google Scholar 

  48. Peace KA, Hillier JC, Hulme A, Healy JC. MRI features of posterior ankle impingement syndrome in ballet dancers: a review of 25 cases. Clin Radiol. 2004;59(11):1025–33. doi:10.1016/j.crad.2004.02.010.

    Article  CAS  PubMed  Google Scholar 

  49. Phisitkul P, Tochigi Y, Saltzman CL, Amendola A. Arthroscopic visualization of the posterior subtalar joint in the prone position: a cadaver study. Arthrosc: J Arthrosc Relat Surg: Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc. 2006;22(5):511–5. doi:10.1016/j.arthro.2005.12.034.

    Article  Google Scholar 

  50. Raikin SM. Arthrodesis of the ankle: arthroscopic, mini-open, and open techniques. Foot Ankle Clin. 2003;8(2):347–59.

    Article  PubMed  Google Scholar 

  51. Rammelt S, Amlang M, Barthel S, Gavlik JM, Zwipp H. Percutaneous treatment of less severe intraarticular calcaneal fractures. Clin Orthop Relat Res. 2010;468(4):983–90. doi:10.1007/s11999-009-0964-x.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Robinson P, White LM. Soft-tissue and osseous impingement syndromes of the ankle: role of imaging in diagnosis and treatment. Radiographics. 2002;22(6):1457–69.

    Article  PubMed  Google Scholar 

  53. Sarrafian SK. Anatomy of the foot and ankle. Descriptive, topographic, functional. 2nd ed. Philadelphia: Lippincott; 1993.

    Google Scholar 

  54. Scholten PE, Sierevelt IN, van Dijk CN. Hindfoot endoscopy for posterior ankle impingement. J Bone Joint Surg Am. 2008;90(12):2665–72. doi:10.2106/JBJS.F.00188.

    Article  CAS  PubMed  Google Scholar 

  55. Schuberth JM, Cobb MD, Talarico RH. Minimally invasive arthroscopic-assisted reduction with percutaneous fixation in the management of intra-articular calcaneal fractures: a review of 24 cases. J foot Ankle Surg: Off Publ Am Coll Foot Ankle Surg. 2009;48(3):315–22. doi:10.1053/j.jfas.2009.01.002.

    Article  Google Scholar 

  56. Scranton Jr PE, McDermott JE. Anterior tibiotalar spurs: a comparison of open versus arthroscopic debridement. Foot Ankle. 1992;13(3):125–9.

    Article  PubMed  Google Scholar 

  57. Sitte W, Lampert C, Baumann P. Osteosynthesis of talar body shear fractures assisted by hindfoot and subtalar arthroscopy: technique tip. Foot Ankle Int. 2012;33(1):74–8. doi:10.3113/FAI.2012.0074.

    Article  PubMed  Google Scholar 

  58. Stufkens SAS, Leeuw PA, Dijk CN. Is there still a place for a diagnostic ankle arthroscopy? Eur Musculoskelet Rev. 2009;4:86–94.

    Google Scholar 

  59. Suttinark P, Suebpongsiri P. Clinical outcomes of flexor hallucis longus transfer for the treatment of Achilles tendinosis rupture. J Med Assoc Thail Chotmaihet Thangphaet. 2009;92 Suppl 6:S226–31.

    Google Scholar 

  60. Tasto JP. Subtalar arthroscopy. In: Mcginty JB, Burkhart S, Jackson RW, editors. Operative arthroscopy. 3rd ed. New York: Lippincott Williams & Wilkins; 2003. p. 944–52.

    Google Scholar 

  61. Taylor DC, Englehardt DL, Bassett 3rd FH. Syndesmosis sprains of the ankle. The influence of heterotopic ossification. Am J Sports Med. 1992;20(2):146–50.

    Article  CAS  PubMed  Google Scholar 

  62. Tuijthof GJ, Beimers L, Kerkhoffs GM, Dankelman J, Dijk CN. Overview of subtalar arthrodesis techniques: options, pitfalls and solutions. Foot Ankle Surg: Off J Eur Soc Foot Ankle Surg. 2010;16(3):107–16. doi:10.1016/j.fas.2009.07.002.

    Article  Google Scholar 

  63. Valderrabano V, Leumann A, Rasch H, Egelhof T, Hintermann B, Pagenstert G. Knee-to-ankle mosaicplasty for the treatment of osteochondral lesions of the ankle joint. Am J Sports Med. 2009;37 Suppl 1:105S–11. doi:10.1177/0363546509351481.

    Article  PubMed  Google Scholar 

  64. van Dijk CN. Hindfoot endoscopy. Foot Ankle Clin. 2006;11(2):391–414. doi:10.1016/j.fcl.2006.03.002, vii.

    Article  PubMed  Google Scholar 

  65. van Dijk CN. Ankle arthroscopy: techniques developed by the Amsterdam Foot and Ankle School. Berlin: Springer; 2014.

    Book  Google Scholar 

  66. van Dijk CN, de Leeuw PA, Scholten PE. Hindfoot endoscopy for posterior ankle impingement. Surgical technique. J Bone Joint Surg Am. 2009;91 Suppl 2:287–98. doi:10.2106/JBJS.I.00445.

    PubMed  Google Scholar 

  67. van Dijk CN, Scholte D. Arthroscopy of the ankle joint. Arthrosc: J Arthrosc Relat Surg: Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc. 1997;13(1):90–6.

    Article  Google Scholar 

  68. van Dijk CN, Scholten PE, Krips R. A 2-portal endoscopic approach for diagnosis and treatment of posterior ankle pathology. Arthrosc: J Arthrosc Relat Surg: Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc. 2000;16(8):871–6. doi:10.1053/jars.2000.19430.

    Article  Google Scholar 

  69. van Dijk CN, van Bergen CJ. Advancements in ankle arthroscopy. J Am Acad Orthop Surg. 2008;16(11):635–46.

    Article  PubMed  Google Scholar 

  70. van Dijk CN, van Sterkenburg MN, Wiegerinck JI, Karlsson J, Maffulli N. Terminology for Achilles tendon related disorders. Knee Surg Sports Traumatol Arthrosc: Off J ESSKA. 2011;19(5):835–41. doi:10.1007/s00167-010-1374-z.

    Article  Google Scholar 

  71. van Dijk CN, Verhagen RA, Tol JL. Arthroscopy for problems after ankle fracture. J Bone Joint Surg Br. 1997;79(2):280–4.

    Article  PubMed  Google Scholar 

  72. Vazquez AA, Lauge-Pedersen H, Lidgren L, Taylor M. Finite element analysis of the initial stability of ankle arthrodesis with internal fixation: flat cut versus intact joint contours. Clin Biomech (Bristol, Avon). 2003;18(3):244–53.

    Article  Google Scholar 

  73. Watanabe M. Selfoc-arthroscope (Watanabe no. 24 arthroscope). Monograph. Tokyo; 1972.

    Google Scholar 

  74. Witt BL, Hyer CF. Achilles tendon reattachment after surgical treatment of insertional tendinosis using the suture bridge technique: a case series. J Foot Ankle Surg: Off Publ Am Coll Foot Ankle Surg. 2012;51(4):487–93. doi:10.1053/j.jfas.2012.03.006.

    Article  Google Scholar 

  75. Woon CY, Chong KW, Yeo W, Eng-Meng Yeo N, Wong MK. Subtalar arthroscopy and fluoroscopy in percutaneous fixation of intra-articular calcaneal fractures: the best of both worlds. J Trauma. 2011;71(4):917–25. doi:10.1097/TA.0b013e318202f1d0.

    Article  PubMed  Google Scholar 

  76. Yassin M, Garti A, Weissbrot M, Heller E, Robinson D. Treatment of anterior tarsal tunnel syndrome through an endoscopic or open technique. Foot (Edinb). 2015;25(3):148–51. doi:10.1016/j.foot.2015.05.007.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Daniel Haverkamp .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2016 ESSKA

About this chapter

Cite this chapter

Haverkamp, D. et al. (2016). Posterior Compartment of the Ankle Joint: A Focus on Arthroscopic Treatment (ICL 17). In: Becker, R., Kerkhoffs, G., E. Gelber, P., Denti, M., Seil, R. (eds) ESSKA Instructional Course Lecture Book . Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-49114-0_15

Download citation

  • DOI: https://doi.org/10.1007/978-3-662-49114-0_15

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-49113-3

  • Online ISBN: 978-3-662-49114-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics