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Posterior Ankle and Hindfoot Arthroscopy
Florian Nickisch, MD1; Alexej Barg, MD1; Charles L. Saltzman, MD1; Timothy C. Beals, MD1; Davide E. Bonasia, MD2; Phinit Phisitkul, MD2; John E. Femino, MD2; Annunziato Amendola, MD2
1 Department of Orthopaedics, University of Utah Orthopaedic Center, 590 Wakara Way, Salt Lake City, UT 84108
2 Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242. E-mail address for A. Amendola: ned-amendola@uiowa.edu
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Based on an original article: J Bone Joint Surg Am. 2012 Mar 7;94(5):439-46.

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
JBJS Essential Surgical Techniques, 2012 Aug 08;2(3):e15 1-12. doi: 10.2106/JBJS.ST.L.00003
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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).

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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