Posterior ankle and hindfoot arthroscopy, performed with use of posteromedial and posterolateral portals with the patient in the prone position, has become an important diagnostic and therapeutic procedure for various intra-articular and extra-articular disorders.
Step 1: Position the Patient Prone
If you are planning to use fluoroscopy for surgery and wire distraction, position the patient prone, flex the contralateral knee, and wrap the contralateral leg to a padded holder.
Step 2: Apply Distraction If Necessary
Invasive distraction is used primarily to improve access to the ankle and subtalar joints.
Step 3: Place the Posterolateral and Posteromedial Portals Under Fluoroscopic Guidance
Using a mini-c-arm fluoroscopy unit to guide portal placement, place the posterolateral and posteromedial portals just lateral and medial to the Achilles tendon.
Step 4: Perform the Intra-Articular and/or Extra-Articular Procedure
Specific procedures include posterior arthroscopic arthrodesis of the subtalar joint, ankle arthrodesis, and excision of the os trigonum with tenolysis of the flexor hallucis longus tendon.
Step 5: Close the Arthroscopy Portals
Close the skin incision with nonabsorbable nylon sutures, and apply a sterile bulky dressing.
Step 6: Postoperative Care
Postoperatively, a plaster splint or walking boot with the foot in neutral is used for the first five to seven days.
Posterior ankle and hindfoot arthroscopy was performed in 189 ankles (186 consecutive patients with a mean age of 37.1 years).
What to Watch For
Pitfalls & Challenges