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Posterior Arthroscopic Tibiotalar Arthrodesis: Anatomic Feasibility Study
Louis Malekpour1, Said Rahali1, Damien Potage1
1Surgeon, Department of Orthopaedics Surgery and Traumatology, Rouen University Hospital, Rouen, France.
Summary
Posterior arthroscopic tibiotalar fusion is feasible but has limitations. The talar dome cartilage is difficult to fully prepare, especially the anterior portion, potentially impacting outcomes.
Area of Science:
- Orthopedic Surgery
- Arthroscopy
- Anatomy
Background:
- Anterior arthroscopic tibiotalar arthrodesis is established.
- Posterior approaches are used for specific indications like soft tissue issues or combined subtalar fusion.
Purpose of the Study:
- Assess feasibility of posterior arthroscopic tibiotalar fusion.
- Determine optimal arthroscopy entry points.
- Evaluate cartilage preparation quality and complication risks.
Main Methods:
- Anatomic study on 10 cadaver specimens.
- Mapped 22 zones of the tibiotalar mortise.
- Utilized medial and lateral para-Achilles approaches with a 4-mm arthroscope.
- Employed motorized burr, curette, and osteotome for chondral resection.
Main Results:
- Complete tibial plafond preparation achieved in all specimens.
- Talar dome preparation was complete in only 20%; posterior two-thirds in 80%.
- Anterior talar dome accessibility was limited.
- Over 50% of malleolar groove area prepared.
- One medial malleolar fracture and one posterior fibular artery lesion occurred.
Conclusions:
- Posterior arthroscopic tibiotalar fusion is feasible, particularly for combined subtalar fusion.
- Limitations include difficulty in fully preparing anterior talar dome cartilage.
- Contraindicated in frontal hindfoot deformity or tibiotalar equinus.
- Requires complementary approaches for associated subtalar fusion.