Skip to main content
Journal cover image

Optimizing Arthroscopy for Osteochondral Lesions of the Talus: The Effect of Ankle Positions and Distraction During Anterior and Posterior Arthroscopy in a Cadaveric Model.

Publication ,  Journal Article
Phisitkul, P; Akoh, CC; Rungprai, C; Barg, A; Amendola, A; Dibbern, K; Anderson, D
Published in: Arthroscopy
December 2017

PURPOSE: To quantify arthroscopic accessibility of the talar dome with predefined ankle positions through anterior and posterior approaches. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. CLINICAL RELEVANCE: Ankle positioning is an important consideration for anterior arthroscopy. Surgical approach used should match with the location of the OLTs.

Duke Scholars

Published In

Arthroscopy

DOI

EISSN

1526-3231

Publication Date

December 2017

Volume

33

Issue

12

Start / End Page

2238 / 2245

Location

United States

Related Subject Headings

  • Talus
  • Orthopedics
  • Middle Aged
  • Manipulation, Orthopedic
  • Male
  • Humans
  • Female
  • Cartilage
  • Cadaver
  • Arthroscopy
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Phisitkul, P., Akoh, C. C., Rungprai, C., Barg, A., Amendola, A., Dibbern, K., & Anderson, D. (2017). 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, 33(12), 2238–2245. https://doi.org/10.1016/j.arthro.2017.06.027
Phisitkul, Phinit, Craig C. Akoh, Chamnanni Rungprai, Alexej Barg, Annuziato Amendola, Kevin Dibbern, and Donald Anderson. “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 33, no. 12 (December 2017): 2238–45. https://doi.org/10.1016/j.arthro.2017.06.027.
Phisitkul, Phinit, et al. “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, no. 12, Dec. 2017, pp. 2238–45. Pubmed, doi:10.1016/j.arthro.2017.06.027.
Phisitkul P, Akoh CC, Rungprai C, Barg A, Amendola A, Dibbern K, Anderson D. 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. 2017 Dec;33(12):2238–2245.
Journal cover image

Published In

Arthroscopy

DOI

EISSN

1526-3231

Publication Date

December 2017

Volume

33

Issue

12

Start / End Page

2238 / 2245

Location

United States

Related Subject Headings

  • Talus
  • Orthopedics
  • Middle Aged
  • Manipulation, Orthopedic
  • Male
  • Humans
  • Female
  • Cartilage
  • Cadaver
  • Arthroscopy