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Effect of Ankle Position and Noninvasive Distraction on Arthroscopic Accessibility of the Distal Tibial Plafond.

Publication ,  Journal Article
Akoh, CC; Dibbern, K; Amendola, A; Sittapairoj, T; Anderson, DD; Phisitkul, P
Published in: Foot Ankle Int
October 2017

BACKGROUND: Osteochondral lesions of the tibial plafond (OLTPs) can lead to chronic ankle pain and disability. It is not known how limited ankle motion or joint distraction affects arthroscopic accessibility of these lesions. The purpose of this study was to determine the effects of different fixed flexion angles and distraction on accessibility of the distal tibial articular surface during anterior and posterior arthroscopy. METHODS: Fourteen below-knee cadaver specimens underwent anterior and posterior ankle arthroscopy using a 30-degree 2.7-mm arthroscopic camera. Intra-articular working space was measured with a precision of 1 mm using sizing rods. The accessible areas at the plafond were marked under direct visualization at varying fixed ankle flexion positions. Arthroscopic accessibilities were normalized as percent area using a surface laser scan. Statistical analyses were performed to assess the relationship between preoperative ankle range of motion, amount of distraction, arthroscopic approach, and arthroscopic plafond visualization. RESULTS: There was significantly greater accessibility during posterior arthroscopy (73.5%) compared with anterior arthroscopy (51.2%) in the neutral ankle position ( P = .007). There was no difference in accessibility for anterior arthroscopy with increasing level of plantarflexion ( P > .05). Increasing dorsiflexion during posterior arthroscopy significantly reduced ankle accessibility ( P = .028). There was a significant increase in accessibility through the anterior and posterior approach with increasing amount of intra-articular working space (parameter estimates ± SE): anterior = 14.2 ± 3.34 ( P < .01) and posterior = 10.6 ± 3.7 ( P < .05). Frequency data showed that the posterior third of the plafond was completely inaccessible in 33% of ankles during anterior arthroscopy. The frequency of inaccessible anterior plafond during posterior arthroscopy was 12%. CONCLUSION: Intra-articular working space and arthroscopic accessibility were greater during posterior arthroscopy compared with anterior arthroscopy. Improved accessibility of OLTPs may be achieved from posterior arthroscopy. Arthroscopic accessibility was heavily dependent on the amount of intraoperative joint working space achieved and not on ankle position. CLINICAL RELEVANCE: OLTPs are often encountered in tandem with talar lesions, and safely achieving intra-articular working space through noninvasive distraction greatly improved arthroscopic accessibility.

Duke Scholars

Published In

Foot Ankle Int

DOI

EISSN

1944-7876

Publication Date

October 2017

Volume

38

Issue

10

Start / End Page

1152 / 1159

Location

United States

Related Subject Headings

  • Tibia
  • Sensitivity and Specificity
  • Risk Factors
  • Osteogenesis, Distraction
  • Orthopedics
  • Middle Aged
  • Male
  • Humans
  • Female
  • Cadaver
 

Citation

APA
Chicago
ICMJE
MLA
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Akoh, C. C., Dibbern, K., Amendola, A., Sittapairoj, T., Anderson, D. D., & Phisitkul, P. (2017). Effect of Ankle Position and Noninvasive Distraction on Arthroscopic Accessibility of the Distal Tibial Plafond. Foot Ankle Int, 38(10), 1152–1159. https://doi.org/10.1177/1071100717717264
Akoh, Craig C., Kevin Dibbern, Annuziato Amendola, Tinnart Sittapairoj, Donald D. Anderson, and Phinit Phisitkul. “Effect of Ankle Position and Noninvasive Distraction on Arthroscopic Accessibility of the Distal Tibial Plafond.Foot Ankle Int 38, no. 10 (October 2017): 1152–59. https://doi.org/10.1177/1071100717717264.
Akoh CC, Dibbern K, Amendola A, Sittapairoj T, Anderson DD, Phisitkul P. Effect of Ankle Position and Noninvasive Distraction on Arthroscopic Accessibility of the Distal Tibial Plafond. Foot Ankle Int. 2017 Oct;38(10):1152–9.
Akoh, Craig C., et al. “Effect of Ankle Position and Noninvasive Distraction on Arthroscopic Accessibility of the Distal Tibial Plafond.Foot Ankle Int, vol. 38, no. 10, Oct. 2017, pp. 1152–59. Pubmed, doi:10.1177/1071100717717264.
Akoh CC, Dibbern K, Amendola A, Sittapairoj T, Anderson DD, Phisitkul P. Effect of Ankle Position and Noninvasive Distraction on Arthroscopic Accessibility of the Distal Tibial Plafond. Foot Ankle Int. 2017 Oct;38(10):1152–1159.
Journal cover image

Published In

Foot Ankle Int

DOI

EISSN

1944-7876

Publication Date

October 2017

Volume

38

Issue

10

Start / End Page

1152 / 1159

Location

United States

Related Subject Headings

  • Tibia
  • Sensitivity and Specificity
  • Risk Factors
  • Osteogenesis, Distraction
  • Orthopedics
  • Middle Aged
  • Male
  • Humans
  • Female
  • Cadaver