Arthroscopy of the subtalar joint

Area of Science:

• Orthopedic Surgery
• Anatomy

Background:

• Arthroscopic surgery of the foot and ankle requires precise portal placement.
• Understanding the anatomical relationships of portals to neurovascular structures is crucial for safety.

Purpose of the Study:

• To determine the optimal position and safety of anterior, posterior, and middle arthroscopic portals.
• To assess the proximity of these portals to lateral foot and ankle neurovascular structures and tendons.
• To demonstrate arthroscopic access to posterior subtalar joint components.

Main Methods:

• 15 cadaveric foot and ankle specimens were used.
• Specimens were divided into three groups, each utilizing a different combination of anterior, posterior, and middle portals for arthroscopy and instrumentation.
• Anatomical dissection was performed to correlate portal placement with surrounding neurovascular structures.

Main Results:

• The posterior portal placement placed the sural nerve and small saphenous vein at risk.
• The anterior portal carried a minor risk to the dorsal intermediate cutaneous branch of the superficial peroneal nerve.
• The middle portal demonstrated no risk to surrounding structures.
• Group I (anterior arthroscope, posterior curette) offered the best access to the posterior subtalar facet.
• Group II (posterior arthroscope, anterior curette) provided good visualization but poor instrumentation access.
• Group III (anterior arthroscope, middle curette) provided optimal access to the sinus tarsi.
• No portal combination allowed visualization or instrumentation of the middle or anterior subtalar facets.

Conclusions:

• The middle portal is the safest option for foot and ankle arthroscopy.
• Portal selection should consider the specific surgical target within the subtalar joint.
• Careful planning is necessary to avoid neurovascular injury during posterior and anterior portal use.