Foot and Ankle Arthroscopy, An Issue of Clinics in Podiatric Medicine and Surgery

Lawrence G. Rubin

Description

Topics will include: Instrumentation and Practical Aspects of Foot and Ankle Arthroscopy;Arthroscopic Treatment of Soft Tissue Lesions;Arthroscopic Treatment of Ankle Osteochondral Defects Arthroscopic Treatment of Anterior Ankle Impingement;Arthroscopic Ankle Arthrodesis;Arthroscopy of Smaller Joints in the Foot ;Arthroscopic Applications for the Foot and Ankle Trauma.

Sujets

• Medical
• Médecine
• Podiatry

Informations

• Publié par: Saunders
• Date de parution: 28 juillet 2011
• Nombre de lectures: 0
• EAN13: 9781455712557
• Langue: English
• Poids de l'ouvrage: 3 Mo

Extrait

Clinics in Podiatric Medicine and Surgery , Vol. 28, No. 3, July 2011
ISSN: 0891-8422
doi: 10.1016/S0891-8422(11)00057-7

Contributors
Clinics in Podiatric Medicine and Surgery
Foot and Ankle Arthroscopy
Laurence G. Rubin, DPM, FACFAS
Thomas Zgonis, DPM, FACFAS
ISSN  0891-8422
Volume 28 • Number 3 • July 2011

Contents
Cover
Contributors
Forthcoming Issues
Foot and Ankle Arthroscopy
Arthroscopy of the Ankle and Foot
Practical Aspects of Foot and Ankle Arthroscopy
Preoperative Evaluation and Testing for Arthroscopy
Soft Tissue Pathology of the Ankle
Arthroscopic Treatment of Ankle Osteochondral Lesions
Arthroscopic Treatment of Anterior Ankle Impingement
Arthroscopic Ankle Arthrodesis
Arthroscopically Assisted Treatment of Ankle Injuries
Subtalar Joint Arthroscopy
Small Joint Arthroscopy of the Foot
Tendoscopy of the Ankle
Antithrombotic Pharmacologic Prophylaxis Use During Conservative and Surgical Management of Foot and Ankle Disorders: A Systematic Review
Pigmented Villonodular Synovitis of the Distal Tibiofibular Joint: A Case Report
Index
Clinics in Podiatric Medicine and Surgery , Vol. 28, No. 3, July 2011
ISSN: 0891-8422
doi: 10.1016/S0891-8422(11)00059-0

Forthcoming Issues
Clinics in Podiatric Medicine and Surgery , Vol. 28, No. 3, July 2011
ISSN: 0891-8422
doi: 10.1016/j.cpm.2011.06.002

Foreword
Foot and Ankle Arthroscopy

Thomas Zgonis, DPM
Division of Podiatric Medicine and Surgery, Department of Orthopaedic Surgery, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive–MSC 7776, San Antonio, TX 78229, USA
E-mail address: [e-mail]

Thomas Zgonis, DPM, Consulting Editor
Arthroscopy in foot and ankle surgery has gained popularity in the last decade since the advent of new techniques, improved instrumentation, and safer means of ankle distraction. The notion of performing minimally invasive surgery utilizing arthroscopic techniques improves recovery time while decreasing the complications that are typically associated with extensile incisions and open procedures. Foot and ankle arthroscopy encompasses a broad category of indications for the treatment of both soft tissue and joint pathology. Its evolution has progressed from the initial treatment of sports-related injuries to the management of osteochondral talar defects, ankle impingement syndromes, and ankle instability. Its latest indications also include the capability of achieving an in situ ankle arthrodesis and of being used as an adjunct procedure for complex fracture repair.
The selected guest editor and invited authors have a vast experience in this field and have provided us with an excellent portrait of when to consider arthroscopy while explaining in detail novel techniques that are being tried. I congratulate the authors on their excellent work as I am confident that this edition will educate our readers in the most current surgical treatments for which foot and ankle arthroscopy can be beneficial.
Clinics in Podiatric Medicine and Surgery , Vol. 28, No. 3, July 2011
ISSN: 0891-8422
doi: 10.1016/j.cpm.2011.06.001

Preface
Arthroscopy of the Ankle and Foot

Laurence G. Rubin, DPM
Private Practice, 3808 Hackamore Lane, Richmond, VA 23233, USA
E-mail address: [e-mail]

Laurence G. Rubin, DPM, Guest Editor
Arthroscopy of the ankle and foot is one of the more innovative forms of arthroscopic surgery of the human body. In its infancy, it was a more direct, but awkward diagnostic tool. It has become a mainstay in the field of foot and ankle surgery, and it continues to progress on an ongoing basis. Arthroscopic ankle fusions are becoming more commonplace and we are now able reduce fractures with less invasive techniques using arthroscopy. Similarly, arthroscopy of the foot is now becoming more established. Surgeons are routinely performing arthroscopic procedures of the subtalar and the first metatarsal phalangeal joints. The continued improvements of the medical equipment, along with the advancement in techniques and education in our profession, will lead to further development of this field of surgery.
I had the privilege of training with Harold Vogler, who coauthored the first article on ankle arthroscopy in our literature, and John Stienstra, a true pioneer in the field of ankle arthroscopy. It was their mentoring that encouraged me to develop my skills as an arthroscopist. During my tenure over the last thirteen years as a faculty member of the American College of Foot and Ankle Surgeons course in arthroscopy of the ankle and foot, I was able to share the podium with some of the most experienced and technically proficient foot and ankle surgeons in the country. It was those individuals that I asked to author articles for this edition. I would like to thank them for generously donating their time and expertise.
The authors of this Clinics in Podiatric Medicine and Surgery edition were asked to take the reader from the basics of equipment and technique to some of the most current procedures being performed today. Some of the authors were asked to give their incomparable experience in the more traditional pathologic conditions that foot and ankle surgeons are likely to encounter, while others were teamed up to provide a vast array of experience from multiple points of view. I hope that this edition provides the reader with a thorough and informative Arthroscopy of the Ankle and Foot edition of Clinics in Podiatric Medicine and Surgery .
Clinics in Podiatric Medicine and Surgery , Vol. 28, No. 3, July 2011
ISSN: 0891-8422
doi: 10.1016/j.cpm.2011.05.001

Practical Aspects of Foot and Ankle Arthroscopy

Meagan M. Jennings, DPM * , Samantha E. Bark, DPM ,
Department of Podiatry, Palo Alto Medical Foundation, 701 East El Camino Real, Mountain View, CA 94040, USA
* Corresponding author.
E-mail address: [e-mail]

Abstract
Arthroscopy of the foot and ankle, although sometimes technically challenging, is a useful tool for the foot and ankle surgeon. Burman in 1931 was the first to attempt arthoscopy of the ankle joint and surmised that it was not a suitable joint for arthroscopy because of its narrow intra-articular space. With the development of smaller-diameter arthroscopes and improvements in joint distraction techniques, Watanabe was the first to present a series of 28 ankle arthroscopes in 1972. At present, arthroscopy is used not only to evaluate and treat intra-articular abnormalities but also for endoscopic and tendoscopic procedures.

Keywords
• Arthroscopy • Foot • Ankle
Arthroscopy of the foot and ankle, although sometimes technically challenging, is a useful tool for the foot and ankle surgeon. Burman 1 was the first to attempt arthroscopy of the ankle joint in 1931 and surmised that it was not a suitable joint for arthroscopy because of its narrow intra-articular space. With the development of smaller-diameter arthroscopes and improvements in joint distraction techniques, Watanabe 2 was the first to present a series of 28 ankle arthroscopes in 1972.
At present, arthroscopy is a valuable skill for the foot and ankle surgeon and is used not only to evaluate and treat intra-articular abnormalities but also for endoscopic and tendoscopic procedures.

Instrumentation
Requirements for arthroscopy are a light source, camera and monitor, arthroscope, and ingress of fluid. The arthroscope is essentially a telescope in a cannula that protects the scope and allows for controlled ingress and egress of fluid. The light source attaches to the scope and illuminates the joint using fiberoptic bundles. The bundles are coupled with a rod-lens system that carries reflected light images from the interior of the joint through the camera, and the image of the interior of the joint is projected on the monitor.
The arthroscope ranges in size from smaller than 1.5 mm in diameter to 7.3 mm; the larger the diameter of the scope, the larger the viewing surface, which increases exponentially (surface area = πr 2 ). A 4-mm-diameter scope is typically used for ankle arthroscopy ( Fig. 1 ). The advent of wide-angled scopes has allowed the development of ankle and small joint arthroscopy. Traditional arthroscopes have the lens angled at 90° to the long axis of the scope. However, the smaller-diameter scopes are cut at 30° and 70° to the long axis of the scope, giving a larger viewing surface and improved visibility in these small spaces. The 30° and 70° scopes have different viewing fields. The 30° scope allows the arthroscopist a field of vision in line with the scope and 30° to the periphery, whereas the 70° scope allows a field of vision 70° to the periphery but not directly ahead ( Fig. 2 ).

Fig. 1 The 4.0- and 2.7-mm arthroscopes are the most commonly used in foot and ankle arthroscopy.

Fig. 2 The 70° versus 30° arthroscope fields of view.

Hand Instruments
A variety of instruments have been made for arthroscopy. For ankle arthroscopy, instruments with a diameter less than 5 mm are ideal, and for smaller foot joints, a diameter less than 3 mm is ideal. The typical nonmotorized hand instruments available are probes, graspers, curettes, knives, osteotomes, gouges, punches, rongeurs, and magnetized rods ( Figs. 3 - 7 ). Probes are often marked as a measuring device in 1- to 2-mm increments and als