Journal article
Optimizing Arthroscopy for Osteochondral Lesions of the Talus: The Effect of Ankle Positions and Distraction During Anterior and Posterior Arthroscopy in a Cadaveric Model
Arthroscopy, Vol.33(12), pp.2238-2245
12/2017
DOI: 10.1016/j.arthro.2017.06.027
PMID: 28807507
Abstract
To quantify arthroscopic accessibility of the talar dome with predefined ankle positions through anterior and posterior approaches.
Fourteen below-knee cadaver specimens underwent preoperative range of motion assessments. A 30° 2.7-mm arthroscopic camera was used to mark accessible areas at varying ankle positions. Accessible regions were quantified using a surface laser scanner and digital 3 × 3 grid. Statistical analyses were performed to detect differences in arthroscopic accessibility between different flexion angles and noninvasive distraction.
The mean arthroscopic accessibility of the talus was 58.5% and 49.8% for the anterior and posterior approaches, respectively (P < .001). During anterior arthroscopy, accessibility increased with up to 30° of plantarflexion (P < .001). There were no significant differences in accessibility between flexion groups for the posterior approach. There was significantly greater central zone accessibility for anterior arthroscopy (87.7%) when compared with posterior arthroscopy (74.3%; P = .002). Arthroscopic accessibility increased with increasing ankle distraction for both the anterior and posterior approaches (parameter estimates ± standard error): anterior = 6.5% ± 1.3%/mm of distraction, P < .001; and posterior = 7.0% ± 2.8%/mm, P = .026. Frequency analysis showed that the posterior third of the talus was completely inaccessible in 7 out of 14 of ankles during anterior arthroscopy. The anterior third of the talus during posterior arthroscopy was inaccessible in 11 out of 14 ankles during posterior arthroscopy.
Ankle plantarflexion up to 30° may be adequate for anterior arthroscopy for osteochondral lesions of the talus (OLTs). Noninvasive distraction also increases accessibility during both anterior and posterior arthroscopy. Anterior arthroscopy should be used for central third OLTs due to greater accessibility.
Ankle positioning is an important consideration for anterior arthroscopy. Surgical approach used should match with the location of the OLTs.
Details
- Title: Subtitle
- Optimizing Arthroscopy for Osteochondral Lesions of the Talus: The Effect of Ankle Positions and Distraction During Anterior and Posterior Arthroscopy in a Cadaveric Model
- Creators
- Phinit Phisitkul - Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, Iowa, U.S.ACraig C Akoh - Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, Iowa, U.S.A.. Electronic address: craig-akoh@uiowa.eduChamnanni Rungprai - Phramongkutklao Hospital and College of Medicine, Bangkok, ThailandAlexej Barg - Department of Orthopaedics, University of Utah, Salt Lake City, Utah, U.S.AAnnuziato Amendola - Duke University, Durham, North Carolina, U.S.AKevin Dibbern - Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, Iowa, U.S.ADonald Anderson - Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, Iowa, U.S.A
- Resource Type
- Journal article
- Publication Details
- Arthroscopy, Vol.33(12), pp.2238-2245
- DOI
- 10.1016/j.arthro.2017.06.027
- PMID
- 28807507
- NLM abbreviation
- Arthroscopy
- ISSN
- 0749-8063
- eISSN
- 1526-3231
- Publisher
- Elsevier; United States
- Language
- English
- Date published
- 12/2017
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Orthopedics and Rehabilitation; Industrial and Systems Engineering
- Record Identifier
- 9984040329002771
Metrics
14 Record Views