Ankle Joint Arthroscopy. A Step-by-Step Guide

Preface
Presentation
Introduction
Contents
Part I: Anatomy of Ankle Joint
	1: Anatomy of the Ankle Joint and Hindfoot
		1.1	 Introduction
		1.2	 Ankle Ligaments
			1.2.1	 Tibiofibular or Syndesmotic Ligaments
				1.2.1.1	 Anterior Tibiofibular Ligament (ATiFL)
				1.2.1.2	 Interosseous Ligament
				1.2.1.3	 Posterior Tibiofibular Ligament (PTiFL)
				1.2.1.4	 Intermalleolar Ligament
			1.2.2	 Ligaments That Join the Leg Bones to the Foot Skeleton
			1.2.3	 Lateral Collateral Ligament
				1.2.3.1	 Anterior Talofibular Ligament (ATFL)
				1.2.3.2	 Calcaneofibular Ligament (CFL)
				1.2.3.3	 Posterior Talofibular Ligament (PTFL)
			1.2.4	 Medial Collateral Ligament (MCL)
		1.3	 Hindfoot
		References
	2: Gross Anatomy of the Subtalar Joint
		2.1	 Introduction
		2.2	 Subtalar Ankle Ligaments
			2.2.1	 Interosseous Talocalcaneal Ligament (ITCL)
			2.2.2	 Cervical Ligament
			2.2.3	 Spring Ligament Complex
			2.2.4	 Bifurcate Ligament
			2.2.5	 Inferior Extensor Retinaculum
		References
Part II: Basic Ankle Arthroscopy
	3: Instrumentation and Operative Setup for Anterior and Posterior Ankle Arthroscopy
		3.1	 Irrigation
		3.2	 Arthroscope
		3.3	 Light Source
		3.4	 Instruments
		3.5	 Distraction Instruments
			3.5.1	 Non-invasive Distraction
			3.5.2	 Invasive Distraction
		3.6	 Anterior Arthroscopy Using the Dorsiflexion Method
			3.6.1	 Portals
		3.7	 Posterior Arthroscopy
			3.7.1	 Portals
		3.8	 Lateral Approach to the Subtalar Joint
		References
	4: Diagnostic Arthroscopy for the Anterior/Posterior Ankle Joint
		4.1	 Diagnostic Arthroscopy for the Subtalar Joint
		References
Part III: Impingement of Anterior/Posterior Ankle and Subtalar Joint
	5: Bony Impingement: Aetiology, Classifications, Treatment, Arthroscopic Procedures, Pitfalls and Tricks
		5.1	 Anterior Bony Impingement
		5.2	 Classifications
			5.2.1	 Topographic Classification of Anterior Impingement
				5.2.1.1	 Anteromedial Impingement
				5.2.1.2	 Anterior Impingement (Fig. 5.1)
				5.2.1.3	 Anterolateral Impingement
			5.2.2	 Arthritis Classification According to van Dijk
		5.3	 Clinical and Diagnostic Investigations
		5.4	 Conservative
		5.5	 Arthroscopic Debridement: Step-by-Step Tricks to Avoid Pitfalls
			5.5.1	 Position
			5.5.2	 Arthroscopic Accesses
			5.5.3	 Removal of Osteophytes
		5.6	 Posterior Bony Impingement
		5.7	 Anatomical Substrate and Aetiopathogenesis
			5.7.1	 Overuse Impingement Syndromes
			5.7.2	 Traumatic Causes
			5.7.3	 Other Causes
		5.8	 Clinical and Diagnostic Investigations
			5.8.1	 Clinical Examination
				5.8.1.1	 Medical History
				5.8.1.2	 Objective Examination
			5.8.2	 Investigations (Fig. 5.5)
		5.9	 Conservative
			5.9.1	 Treatment
			5.9.2	 Surgical Treatment
			5.9.3	 Open Debridement
			5.9.4	 Arthroscopic Debridement
		5.10	 Arthroscopic Debridement: Step-by-Step Tricks to Avoid Pitfalls
			5.10.1	 Patient’s Position (Fig. 5.6)
			5.10.2	 Arthroscopic Portals and Principles of the Posterior Arthroscopic Technique
			5.10.3	 Os Trigonum Removal
				5.10.3.1	 Postoperative Treatment
		References
	6: Soft Tissue Impingement: Etiology and Classification, Treatment, Arthroscopic Procedures. Pitfalls, and Tricks
		6.1	 Introduction
		6.2	 Etiology and Classification
			6.2.1	 Anterolateral Impingement
			6.2.2	 Anteromedial Impingement
			6.2.3	 Anterior Impingement
			6.2.4	 Posterior Impingement
		6.3	 Pertinent Imaging
		6.4	 Arthroscopic Procedures
			6.4.1	 The Anterior Ankle Arthroscopy Procedure
			6.4.2	 The Posterior Ankle Endoscopy Procedure
		6.5	 Postoperative Protocol
		6.6	 Potential Complications
		6.7	 Pitfalls and Tricks
		References
Part IV: Chondral and Osteochondral Ankle Joint Defects
	7: Etiology, Classifications, Mechanism of Action
		7.1	 Introduction
		7.2	 Epidemiology
		7.3	 Etiology
		7.4	 Classification Systems
		7.5	 Mechanism of Action
		7.6	 Summary
		References
	8: Repair by Microfractures and Perforations
		8.1	 Introduction
		8.2	 Literature Overview
		8.3	 Indications
		8.4	 Surgical Technique
		8.5	 Rehabilitation
		8.6	 Considerations
		8.7	 Conclusions
		References
	9: Restoration by Autologous Osteochondral Transplantation
		9.1	 Introduction
		9.2	 Indications
		9.3	 Preoperative Preparation/Positioning
		9.4	 Operative Technique
			9.4.1	 Tibial Osteotomy
			9.4.2	 Preparation of the Recipient Site for the Insertion of the Osteochondral Graft
			9.4.3	 Harvesting Osteochondral Graft from the Ipsilateral Femoral Condyle
			9.4.4	 Insertion of Osteochondral Graft into the Recipient Site
			9.4.5	 Fixation of Osteotomy Fragment
		9.5	 Postoperative Management
		9.6	 Complications
		9.7	 Outcomes
		9.8	 Summary and Conclusions
		References
	10: The Use of Aci/Maci to Restore Osteochondral Defects in the Ankle
		10.1	 Introduction
		10.2	 Workup and Decision Making
		10.3	 Technique
			10.3.1	 Stage 1
			10.3.2	 Stage 2
		10.4	 Postoperative Care
		10.5	 Results
		10.6	 Second-Generation ACI
		10.7	 Matrix-Induced Autologous Chondrocyte Implantation (MACI)
		10.8	 Future Direction
		10.9	 Conclusion
		Appendix
		References
	11: Repair by Autologous Collagen-Induced Chondrogenesis (ACIC) Technique
		11.1	 Introduction
		11.2	 ACIC Treatment [12, 13]
		11.3	 Results
			11.3.1	 In Vitro Analysis Results
			11.3.2	 In Vivo Clinical Results
		11.4	 Discussion
		11.5	 Tips and Tricks
		References
	12: Restore by Mesenchymal Cells
		12.1	 Characteristics of Mesenchymal Cells (Bone Marrow-Derived Cell Transplantation)
		12.2	 Surgical Technique
			12.2.1	 Indications
			12.2.2	 Surgical Procedure
				12.2.2.1	 Platelet-Rich Fibrin Gel Production
				12.2.2.2	 Bone Marrow Aspiration (Video 12.1)
				12.2.2.3	 Bone Marrow Concentration (Video 12.2)
				12.2.2.4	 Surgical Procedure (Video 12.3)
		12.3	 Rehabilitation
			12.3.1	 Early Postoperative Phase: From 0 to 6 Weeks After Surgery
			12.3.2	 Late Postoperative Phase: From 6 Weeks to 4 Months After Surgery
			12.3.3	 Physical and Sport Activity Resumption: From 4 Months After Surgery on
		References
	13: The Use of Allograft
		13.1	 Osteochondral Transplant from Donor Talus (Allograft)
		13.2	 Surgical Technique
		13.3	 Arthroscopic Technique
		13.4	 Open Techniques
			13.4.1	 Surgical Approach
			13.4.2	 Tricks and Tips of Osteotomy of the Medial Malleolus
			13.4.3	 Preparing the Lesion
			13.4.4	 Preparing the Allograft
				13.4.4.1	 Small ‘Contained’ Lesions
				13.4.4.2	 Marginal Lesions Involving the Shoulder or Larger in Size (>10 mm)
			13.4.5	 Transplant Fixation
			13.4.6	 Post-op Treatment
		13.5	 Results in Literature
		References
Part V: Instability of Ankle and Subtalar Joint
	14: Classification, Treatment, and Arthroscopic Procedures
		14.1	 Introduction
		14.2	 Classification
		14.3	 Treatment
			14.3.1	 Patient Evaluation
		14.4	 Arthroscopic Procedures
		14.5	 Conclusion
		References
	15: Instability of Ankle and Subtalar Joint
		References
	16: All Inside Broström Arthroscopic Procedure
		16.1	 Background
		16.2	 Indication
		16.3	 Surgical Technique
		16.4	 Conclusions
		References
	17: Capsular Plications Repair
		17.1	 Introduction
		17.2	 Surgical Technique
		17.3	 Discussion
		17.4	 Conclusions
		References
	18: Radiofrequency Repair
		18.1	 Surgical Technique
		18.2	 Rehabilitation Protocol
		References
	19: Ligaments Anatomic Repair
		19.1	 Introduction
			19.1.1	 Indications
		19.2	 Surgical Technique
			19.2.1	 Equipment
				19.2.1.1	 Patient Positioning
				19.2.1.2	 Portal Design
		19.3	 Step-by-Step Description of the Technique(s)
			19.3.1	 Graft Harvesting
			19.3.2	 Step 1
			19.3.3	 Step 2
			19.3.4	 Step 3
			19.3.5	 Step 4
			19.3.6	 Step 5
		19.4	 Post-operative Care
		References
	20: Syndesmotic Joint Instability Arthroscopic Repair
		20.1	 Anatomy and Biomechanical Background
		20.2	 Classification
		20.3	 Diagnosis
		20.4	 Treatment
		References
Part VI: Upper and Lower Ankle Arthritis
	21: Ankle Arthritis: Etiology and Classifications
		21.1	 Introduction
		21.2	 Etiology
			21.2.1	 Posttraumatic Changes
		21.3	 Classifications
		21.4	 Conclusion
		References
	22: Ankle Joint Debridement
		22.1	 Introduction
		22.2	 Clinical Examination
		22.3	 Surgical Treatment: Ankle Debridement
		22.4	 Postoperative Rehabilitation
		22.5	 Complications
		22.6	 Conclusion
		References
	23: Ankle Fusion by Screws
		23.1	 Introduction
		23.2	 Indications and Limits
		23.3	 Surgical Technique
			23.3.1	 Patient Positioning
			23.3.2	 Surgical Instrumentations
			23.3.3	 Surgical Approach and Procedure
			23.3.4	 Fixation
			23.3.5	 Postoperative
		23.4	 Results
		23.5	 Conclusions
		References
	24: Arthroscopic Assisted Ankle Fusion by Retrograde Intramedullary Nail
		24.1	 Indications
		24.2	 Surgical Procedure
		24.3	 Discussion
		24.4	 Conclusions
		References
	25: Subtalar Joint Arthritis: Treatment and Arthroscopic Lateral Procedure
		25.1	 Introduction
		25.2	 Preoperative Preparation/Positioning
		25.3	 Operative Technique
			25.3.1	 Portal Placement
			25.3.2	 Joint Preparation
			25.3.3	 Screw Placement
		25.4	 Postoperative Management
		25.5	 Complications
		25.6	 Outcomes
		25.7	 Summary and Conclusions
		References
	26: Arthroscopic Subtalar Arthrodesis by Posterior Approach
		26.1	 Indications
		26.2	 Contraindication
		26.3	 Operative Technique
		26.4	 Advantages of Arthroscopic Technique over Open Surgery
		26.5	 Potential Dangers of the Technique
		References
Part VII: Ankle Tendinopathies
	27: Flexor Hallucis Longus Tendinopathy
		27.1	 Surgical Technique Step-by-Step
			27.1.1	 Landmarks and Portals
		27.2	 Traps and Tricks
		References
	28: Peroneal Tendons Tendinopathy
		28.1	 Introduction
		28.2	 Anatomy and Function
		28.3	 Patient History, Clinical Examination and Diagnostics
		28.4	 Tendoscopic Technique
		28.5	 Complications
		28.6	 Pearls
		28.7	 Pitfalls
		28.8	 Conclusions
		References
	29: Tibialis Posterior Tendinopathy
		29.1	 Introduction
		29.2	 Indications
		29.3	 Anatomy and Function
		29.4	 Patient History, Clinical Examination and Diagnostics
		29.5	 Tendoscopic Technique
		29.6	 Outcomes and Possible Complications
		29.7	 Pearls
		29.8	 Pitfalls
		29.9	 Conclusions
		References
	30: Haglund Disease
		30.1	 Treatment
			30.1.1	 Conservative Treatment
			30.1.2	 Surgical Treatment
				30.1.2.1	 Endoscopic Calcaneoplasty
					Surgical Technique Step-by-Step
					Skin Markers and Portals
					How Much Bone Must We Remove?
		30.2	 Traps and Tricks
		References
	31: Tendinopathy of the Achilles Tendon
		31.1	 Introduction
		31.2	 Anatomy of Tendon
		31.3	 Terminology
			31.3.1	 Historical Perspective
				31.3.1.1	 Midportion Achilles Tendinopathy
				31.3.1.2	 Pathology Around the Achilles Tendon Insertion
			31.3.2	 Proposed Terminology
				31.3.2.1	 Midportion Achilles Tendinopathy
				31.3.2.2	 Achilles Paratendinopathy
				31.3.2.3	 Insertional Achilles Tendinopathy
				31.3.2.4	 Retrocalcaneal Bursitis
				31.3.2.5	 Superficial Calcaneal Bursitis
		31.4	 Etiology of Tendinopathy
			31.4.1	 Intrinsic Factors
			31.4.2	 Extrinsic Factors
		31.5	 Histology of Achilles Tendinopathy
		31.6	 Clinical Aspects
		31.7	 Imaging
		31.8	 Conclusions
		References
Part VIII: Plantar Fascia
	32: Endoscopic Treatment of Plantar Fasciitis
		32.1	 Introduction
		32.2	 Anatomic Aspects
		32.3	 Findings and Physical Examination
		32.4	 Management and Treatment
		32.5	 Endoscopic Procedure
		References
Part IX: Great Toe Disorders
	33: Etiology, Classifications, and Treatment by Arthroscopic Procedures
		33.1	 Introduction
		33.2	 Indications, Etiology, and Classification
			33.2.1	 Major Indications
			33.2.2	 Controversial Counterindications
			33.2.3	 Absolute Counterindications
		33.3	 Anatomy
		33.4	 Physical Examination
		33.5	 Imaging
		33.6	 Portals
		33.7	 Equipment
		33.8	 Preoperative Preparation and Operative Technique
			33.8.1	 Osteochondral Lesions
			33.8.2	 Hallux Rigidus
			33.8.3	 Synovitis, Loose Bodies, and Sesamoiditis
		33.9	 Postoperative Management
		33.10	 Complications
		33.11	 Pitfalls and Tricks
		References
Part X: Rehabilitation
	34: Rehabilitation Following Ankle Arthroscopy
		34.1	 Introduction
		34.2	 Rationale of Rehabilitation Following AA
		34.3	 Improving Joint Stability and Proprioception
		34.4	 Improving Muscle Strength
		34.5	 Improving Range of Motion
		34.6	 Conclusions
		References