Surgical Procedure

We start the procedure with identification of the FHL.
Distally the subtalar joint is visualized.
The posterior talar process and subtalar joint.
The posterior talocalcaneal ligament is cut with a punch.
A blunt trocar is introduced through the medial portal to open up the subtalar joint.
An additional portal is made in the sinus tarsi through which the blunt trocar is introduced. This way, the posteromedial - and lateral portals can be used for the scope and instruments to remove the subtalar cartilage.
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Pearls & Pitfalls

General

For general pearls & pitfalls in hindfoot endoscopy, please click here. 

 

Pearls

The addition of an accessory portal at the level of the sinus tarsi provides safe access for introduction of a large diameter blunt trocar in order to open up the subtalar joint.

The direction of the blunt trocar in the sinus tarsi is almost parallel to the subtalar joint space. Therefore, it can be forced in a sidewards direction into the joint from laterally. The sideward movement prevents the trocar of making a false route into the subchondral bone.

Removal of all articular cartilage of the posterior subtalar joint using ring curettes can be performed by changing portals whenever needed.

Before insertion of the two screws it is important to check the alignment of the hindfoot.

Co-aptation of the posterior subtalar joint surfaces can be checked arthroscopically when tightening the screws.

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