Minimally Invasive Surgery of the Foot and Ankle (eBook)

Minimally Invasive Surgery of the Foot and Ankle 2
Copyright page 3
Preface 4
Contents 6
Contributors 10
Part I: Generalities 14
1: Minimally Invasive Foot Surgery: A Paradigm Shift 15
1.1General Principles Percutaneous Surgery of the Foot 17
1.2Planning 18
1.2.1Incision 18
1.2.2Angle of Approach 18
1.2.3Approach Path 19
1.3Percutaneous Surgery for Soft Tissue 19
1.3.1Subcutaneous Tenotomy 19
1.3.2Deep Tenotomy 20
1.3.3Tendon Lengthening 20
1.3.4Tendon Debridement 20
1.3.5Capsulotomy 21
1.4Percutaneous Bone Surgery 22
1.4.1Exostosectomy 22
1.4.2Osteotomies 23
References 23
2: Computer-Assisted Surgery (CAS) in Foot and Ankle Surgery 24
2.1Introduction 24
2.2Part 1: CAS Guided Retrograde Drilling in Talar Osteochondral Lesions (OCD) 24
2.2.1Clinical Example 25
2.2.2Results 25
2.2.3Discussion 28
2.3Part 2: CAS Guided Correction Arthrodeses at Foot and Ankle 32
2.3.1Methods 33
2.3.1.1Devices 33
2.3.1.2CAS-Procedure 33
2.3.1.3Additional Surgical Maneuvers 35
2.3.1.4Study Setting 36
2.3.1.5Results 37
2.3.1.6Discussion 39
References 41
3: Tendoscopy 45
3.1Introduction 45
3.2Tendoscopy of the Peroneal Tendons 45
3.2.1Introduction 45
3.2.2Surgical Technique 46
3.2.3Results 47
3.3Tendoscopy of the Posterior Tibial Tendon 50
3.3.1Introduction 50
3.3.2Surgical Technique 51
3.3.3Results 54
3.4Achilles Tendoscopy 55
3.4.1Introduction 55
3.4.2Surgical Technique 57
3.4.3Results 60
3.5Conclusions 60
References 61
Part II: Hallux 64
4: Arthroscopy of the First Metatarsophalangeal Joint 65
4.1Introduction 65
4.2Anatomy/Pathoanatomy 65
4.3Arthroscopic Technique 66
4.3.1Positioning 66
4.3.2Traction 66
4.3.3Instruments 66
4.3.4Portals 67
4.4Arthroscopic Examination 69
4.5Arthroscopic Synovectomy 70
4.5.1Technique 70
4.5.1.1Endoscopic Resection of Gouty Tophus Around the First Metatarso-phalangeal Joint 71
4.5.1.2Endoscopic Distal Soft Tissue Procedure for Hallux valgus Correction 73
4.6Arthroscopic Dorsal Cheilectomy for Dorsal Impingement Syndrome 73
4.7Osteoarthritis 74
4.8Chondral and Osteochondral Lesions 75
4.9Arthroscopic Sesamoidectomy for Sesamoid Pathology 76
4.10Arthroscopic Assisted Plantar Plate Tenodesis for First Metatarso-phalangeal Instability 77
4.10.1Technique 77
4.11Arthroscopic Release for First Metatarso-phalangeal Arthrofibrosis 78
4.11.1Technique 78
4.12Arthroscopic Assisted Reduction and Fixation of Intra-articular Fracture of the First Metatarsal Head 79
References 80
5: Minimally Invasive Management of Hallux Rigidus 82
5.1Introduction 82
5.2Pathogenesis 82
5.2.1Intrinsic Causes 82
5.2.2Extrinsic Causes 83
5.3Clinical 83
5.4Imaging and Further Investigations 84
5.4.1Surgery 85
5.4.2Instruments 86
5.4.3Anesthesia 86
5.4.4Cheilectomy 86
5.4.5Distal First Metatarsal Osteotomy 88
5.4.6Osteotomy of the Base of the Proximal Phalanx 90
5.4.7Postoperative Care 91
5.5Surgical Indications 93
5.5.1Cheilectomy 93
5.5.2Cheilectomy Plus Metatarsal Osteotomy and the Phalanx 93
5.5.3Metatarsophalangeal Arthrodesis 93
References 93
6: Percutaneous First Metatarso-Phalangeal Joint Fusion 95
6.1 Introduction 95
6.2 Operative Technique 95
6.3Post-Operative Care 99
6.4Indications: Results 100
6.5Discussion 100
6.6Conclusion 101
References 101
7: The Reverdin-Isham Procedure for the Correction of Hallux valgus 103
7.1Definition 103
7.2Etiology 104
7.3Classification 104
7.3.1Hallux Abductus Angle 104
7.3.2Distal Articular Set Angle 104
7.3.3Proximal Articular Set Angle 105
7.3.4First Intermetatarsal Angle 105
7.3.5First Metatarso-Phalangeal Joint Position 105
7.4Classification of Hallux valgus 106
7.4.1Mild Hallux valgus 106
7.4.2Moderate Hallux valgus 106
7.4.3Severe Hallux valgus 106
7.5Reverdin-Isham Procedure 107
7.6Preoperative Criteria 109
7.7Operative Technique 109
7.8Minimally Invasive Technique 109
7.9Postoperative Management 110
7.10Postoperative Bandaging 111
7.11Advantages of the Reverdin-Isham Procedure 111
7.12Disadvantages of the Reverdin-Isham Procedure 113
7.13Summary 113
References 114
8: Arthroscopic Assisted Correction of Hallux valgus Deformity 115
8.1Introduction 115
8.2Technique of Endoscopic Distal Soft Tissue Procedure 115
8.2.1Lateral Soft Tissue Release 116
8.2.1.1Ligament Sacrifying Approach 116
8.2.1.2Ligament Preserving Approach 118
8.2.2Medial Exostectomy 119
8.2.3Reduction and Fixation of Intermetatarsal Angle 120
8.2.4Plication of the Medial Capsule 122
8.3Adjunct Procedures 122
8.3.1Derotation of the First Metatarsal 122
8.3.1.1Arthroscopic First Tarso-metatarsal (Lapidus) Arthrodesis 126
8.3.1.2Technique 126
8.3.2Endoscopic Assisted Lengthening of the Extensor Hallucis longus Tendon 127
8.3.2.1 Technique 127
References 128
9: Minimally Invasive Hallux valgus Correction 129
9.1Introduction 129
9.1.1Indications 130
9.2Surgical Technique 131
9.3Postoperative Care 132
9.4Discussion 133
References 135
10: Minimally Invasive Modified Wilson Osteotomy for the Treatment of Hallux valgus 138
10.1Introduction 138
10.2History 139
10.3Anesthesia 139
10.4Instrumentation 140
10.5Technique 142
10.6Remodeling the Medial Side of the First Metatarsal Head 147
10.7Additional Suggestions 153
References 158
Part III: Lesser Toes 159
11: Percutaneous Surgery for Static Metatarsalgia 160
11.1Introduction 160
11.2Operative Technique 160
11.3Post-Operative Care 163
11.4Indications: Results 164
11.5Discussion 164
References 164
12: Percutaneous Treatment of Static Metatarsalgia with Distal Metatarsal Mini-Invasive Osteotomy 166
12.1Introduction 166
12.2Aims and Principles 166
12.3Materials 168
12.4Surgical Technique 168
12.4.1Anaesthesia 168
12.4.2Patient Positioning 168
12.4.3Osteotomy 169
12.5Post-Operative Follow-Up 169
12.6Conclusion 172
References 172
13: Isham Hammertoe Procedures for the Correction of Lesser Digital Deformities 173
13.1Definition 173
13.2Etiology 174
13.3Classification 174
13.4Phalangeal Osteotomy Procedures 174
13.5Isham Hammertoe Procedures 175
13.6Non-Hammertoe Lesser Digit Deformities 178
13.6.1Operative Technique 180
13.6.2Post Operative Bandaging 181
13.7Summary 184
References 184
14: Minimally Invasive Management of Dorsiflexion Contracture at the Metatarsophalangeal Joint and Plantarflexion Contracture at the Proximal Interphalangeal Joint of the Fifth Toe 186
14.1Introduction 186
14.2Surgical Technique 186
14.3Postoperative Management 190
14.4Discussion 190
References 191
15: Arthroscopic Assisted Correction of Lesser Toe Deformity 192
15.1Introduction 192
15.1.1Technique of Plantar Plate Tenodesis 193
15.2Modified Plantar Plate Tenodesis 197
15.2.1Technique 197
References 198
16: Percutaneous Fixation of Proximal Fifth Metatarsal Fractures 199
16.1Introduction 199
16.2Surgical Indications 201
16.3Pre-operative Work-Up 202
16.4Surgical Technique 202
16.5 Post-operative Protocol 208
16.6 Complications 210
References 210
Part IV: Hindfoot 213
17: Minimally Invasive Realignment Surgery of the Charcot Foot 214
17.1Introduction 214
17.2Preoperative Evaluation 215
17.3Surgical Planning 215
17.4Minimally Invasive Charcot Foot Reconstruction 216
17.5Surgical Technique for Gradual Correction 217
17.6Results 218
17.7Conclusion 220
17.8Acknowledgements 221
References 221
18: Arthroscopic Triple Arthrodesis 222
18.1Introduction 222
18.2Description of Technique 222
18.3Deformity Correction 225
18.3.1Arthroscopic Lateral Subtalar Release 225
18.3.1.1Technique 225
18.3.2“Closing Wedge” Procedure 226
18.3.3Anterior Subtalar Arthroscopy 227
18.3.3.1Technique 227
18.3.4Extra-Articular Procedure: Percutaneous Tendon Release or Transfer or Percutaneous Osteotomy 228
References 228
19: Percutaneus Calcaneal Displacement Osteotomy 229
19.1Introduction 229
19.2Indications 230
19.3Considerations for Preoperative Planning 231
19.4Surgical Technique 231
19.5Procedure 232
19.6Pitfalls and Bailouts 237
19.7Outcomes 237
19.8Summary 240
References 240
20: Tendoscopy of the Flexor Hallucis Longus Tendon 243
20.1Introduction 243
20.2Description of Technique 244
20.3Zone 2 FHL Tendoscopy 246
20.4Application of Zone 2 Tendoscopy 246
References 250
21: Open Reduction and Internal Fixation of Calcaneal Fractures Through a Combined Medial and Lateral Approach Using a Small Incision Technique 251
21.1Introduction 251
21.2The Fracture 251
21.3Past Medical History 255
21.4Physical Examination 255
21.5Radiographic Evaluation 255
21.6Timing to Surgery 259
21.7The Principles of Reduction 260
21.8Reduction and Internal Fixation 260
21.9Post-operative Care 270
21.10Experience 271
21.11Discussion 272
References 274
22: Endoscopic Plantar Fasciotomy 275
22.1Introduction 275
22.2Technique 276
References 286
23: Arthroscopic Os Trigonum Excision 287
23.1Introduction 287
23.2Clinical Examination 288
23.3Imaging 288
23.4Indication 289
23.5Contraindication 291
23.6Surgical Technique 291
23.7Postoperative Care 291
23.8Results and Complications 293
23.9Discussion 294
23.10Conclusion 295
References 296
24: Endoscopic Calcaneoplasty 297
24.1Introduction 297
24.2Diagnosis 298
24.3Management 299
24.4Endoscopic Treatment 299
24.4.1Indication 299
24.4.2Surgical Technique 301
24.4.3Post-operative Management 302
24.4.4Patient Outcome 306
24.5Discussion 307
24.6Conclusion 309
References 309
Part V: Ankle 312
25: Postero-medial Approach in the Supine Position for Posterior Ankle Endoscopy 313
25.1Introduction 313
25.2Surgical Technique 314
25.3Discussion 317
References 318
26: Ankle Equinus and Endoscopic Gastrocnemius Recession 319
References 333
27: Athroscopic Arthrodesis of the Ankle 336
27.1Abstract 336
27.2History 336
27.3Indications and Contra-indications 337
27.4Examination and Assessment 341
27.5Equipment 341
27.5.1Distraction 342
27.5.2Camera System 342
27.5.3Fixation 342
27.6Anesthesia and Positioning 342
27.7Operative Technique 343
27.8Post-operative Management 346
27.9Results, Complications and Problems 347
27.10Conclusion 349
References 349
28: Percutaneous Osteosynthesis of Distal Tibial Fractures Using Locking Plates 351
28.1 Introduction 351
28.2 Surgical Technique 351
28.3 Rehabilitation Protocol 354
References 355
29: Percutaneous Supramalleolar Osteotomy Using the Ilizarov/ Taylor Spatial Frame 356
29.1 Introduction 356
29.2 Clinical Indications 357
29.2.1 Malunion of Tibia Fracture 357
29.2.2 Stiff Nonunion 360
29.2.2.1 Malunion of Ankle Fusion 361
29.2.3 Intra-articular Ankle Deformity 364
29.2.4 Ankle and Foot Deformity 364
29.2.5 Growth Arrest Deformity 367
29.2.6 Congenital and Developmental Deformity 367
29.2.6.1 Neuromuscular 367
29.2.6.2 Fibrous Dysplasia and Ollier’s Disease 367
29.2.6.3Achondroplasia 367
29.3 Preoperative Assessment 369
29.3.1 Clinical Evaluation 369
29.3.2 Radiographic Assessment 372
29.3.3 Surgical Planning 372
29.4 Treatment Principles 373
29.4.1 Features of the Ilizarov Method 373
29.4.2 Acute Versus Gradual Correction 374
29.5 Surgical Technique 375
29.5.1 Wire and Pin Configuration 375
29.5.2 Taylor Spatial Frame 376
29.5.2.1 Terminology 376
29.5.2.2 Deformity Parameters 380
29.5.2.3 Mounting Parameters 380
29.5.2.4 Structure at Risk (SAR) 380
29.5.3 Fibula Osteotomy 380
29.5.4 Supramalleolar Tibial Osteotomy 381
29.5.5 Extension Across Ankle 381
29.5.6 Proximal Tibial Osteotomy 381
29.6 Postoperative Care 381
29.6.1 General 381
29.6.2 Deformity Correction 383
29.6.3 Pain Management 384
29.6.4 Pin Care 384
29.6.5 Rehabilitation 384
29.6.6 Frame Removal 384
29.7 Complications 385
29.7.1 Pin Infection 385
29.7.2 Premature Consolidation 385
29.7.3 Patient Related 385
29.7.4 Nonunion 386
29.7.5 Nerve Injury 386
29.7.6 Deep Vein Thrombosis (DVT) 386
29.7.7 Septic Arthritis 386
29.7.8 Other 387
References 387
30: Minimally Invasive Management of Syndesmotic Injuries 389
30.1 Introduction 389
30.2 Clinical and Imaging Examination 390
30.3 Management Indications 392
30.4 Operative Management 392
30.4.1 Tightrope™ System (Arthrex, Naples) 392
30.4.2 Acute Syndesmotic Lesions (< 2 Weeks Posttraumatic)
30.4.3 Chronic Syndesmotic Lesions 395
30.5 Postoperative Management 395
30.6 Clinical Results 395
References 396
Part VI: The Achilles Tendon 399
31: Endoscopic Assisted Percutaneous Achilles Tendon Repair 400
31.1 The Technique of Endoscopy Assisted Percutaneous Repair 400
References 407
32: Percutaneous Repair of Acute Achilles Tendon Ruptures 410
32.1 Introduction 410
32.2 Surgical Technique 411
32.3 Postoperative Regimen 412
32.4 Discussion 413
References 414
33: Minimally Invasive Semitendinosus Tendon Graft Augmentation for Reconstruction of Chronic Tears of the Achilles Tendon 416
33.1 Introduction 416
33.2 Surgical Technique 417
33.3 Postoperative Management 419
33.4 Discussion 420
33.5 Competing Interests 421
References 421
34: Minimally Invasive Achilles Tendon Reconstruction Using the Peroneus Brevis Tendon Graft 422
34.1 Introduction 422
34.2 Surgical Technique 423
34.3 Postoperative Management 426
34.4 Discussion 426
34.5 Competing Interests 427
References 427
35: Free Hamstrings Tendon Transfer and Interference Screw Fixation for Less Invasive Reconstruction of Chronic Avulsions of the Achilles Tendon 429
35.1Introduction 429
35.2Surgical Technique 430
35.3Postoperative Regimen 432
35.4Discussion 433
References 433
36: Percutaneous Longitudinal Tenotomies for Chronic Achilles Tendinopathy 436
36.1Introduction 436
36.2Surgical Technique 437
36.3Multiple Percutaneous Longitudinal Tenotomies 437
36.4Ultrasound Guided Percutaneous Tenotomy 438
36.5Post-operative Management 441
36.6Discussion 441
References 442
37: Minimally Invasive Stripping for Chronic Achilles Tendinopathy 443
37.1Introduction 443
37.2Surgical Technique 444
37.3Postoperative Regimen 446
37.4Discussion 446
References 446
Index 448