Subtalar Arthroscopy: Lateral Approach
Lateral approach subtalar arthroscopy confers diagnostic and potentially therapeutic value in treating subtalar trauma, arthrofibrosis, impingement, and cartilage pathology. 1 The orthopedic literature suggests that establishing a definitive diagnosis of subtalar pathology, based on physical exam and detailed imaging studies, improves the likelihood of successful outcome with subtalar arthroscopy. 2-4 Lateral approach subtalar arthroscopy affords satisfactory access to the majority of the talocalcaneal mechanism, including the major articular surfaces, the lateral (talocalcaneal-fibular) gutter, the anterior structures within the sinus tarsi, and the posterior subtalar structures. 1,5 Subtalar access is optimized and complications minimized with careful placement of the 3 standard portals used in lateral approach subtalar arthroscopy 4: the anterior portal at the distal sinus tarsi, the middle portal immediately anterior to the tip of the fibula and centered over the sinus tarsi, and the posterior portal slightly proximal and posterior to the fibular tip. The authors recommend using small joint arthroscopy equipment. By switching the small joint arthroscope and instruments among the 3 portals, arthrofibrosis and impingement may be comprehensively debrided and all current arthroscopy cartilage repair procedures may be performed. Provided that subtalar arthroscopy confirms definitive diagnosis and pathology is treated appropriately using an arthroscopic technique, a postoperative protocol that includes physical therapy typically leads to a relatively rapid return to satisfactory function.