Footnotes - Winter 2024 - 26

Research Article Summary:
Lateral Arthroscopic Subtalar Arthrodesis for
Talocalcaneal Coalition: Surgical Technique
By Andrea Delgado, BUSPM Class of 2026
The talocalcaneal coalition ranks as the second most common
tarsal coalition, and when patients present with pain,
treatment is often necessary. Conservative measures may be
attempted initially, but surgical intervention becomes crucial
if conservative approaches fail. Surgical options include
resection of the talocalcaneal coalition for cases with less than
50% subtalar joint involvement in patients with normal tarsal
joints. Patients with degenerative lesions of tarsal joints may
require a triple arthrodesis. Subtalar arthrodesis is performed
when the talocalcaneal coalition involves more than 50% of
subtalar articulation and/or exhibits subtalar arthritis. This
technical note aims to describe the arthroscopic resection of
the talocalcaneal coalition and talocalcaneal arthrodesis during
the same procedure, utilizing a two-lateral-portal technique.
Surgical Equipment: The procedure involves the use
of a standard 4-mm arthroscope, shavers (3.5 or 5 mm in
diameter), and spherical or oval burrs (5 mm in diameter).
Burrs, curettes, chisels, and awls are employed for coalition and
cartilage resection, as well as subchondral bone preparation.
Cannulated screws are used for arthrodesis fixation under
fluoroscopy.
Installation: Preoperative antibioprophylaxis is administered
with the patient in lateral decubitus under general or
locoregional anesthesia. The foot is forced into varus to open
up the sinus tarsi and the lateral part of the subtalar joint. Two
portals are created: a lateral portal 1 cm anterior to the tip of
the lateral malleolus for the arthroscope and an anterolateral
portal 1 cm inferior and 2 cm anterior to the tip of the lateral
malleolus.
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Surgical Procedure: The working area is progressively
created with the shaver from distal to proximal. Talocalcaneal
coalition resection is performed from dorsal to caudal, lateral
to medial, and distal to proximal. The resection is guided by
the oblique nature of middle facet coalitions. After complete
removal of cartilage and coalition, a square-tipped awl is
used to create holes down to cancellous bone on articular
surfaces for bone fusion. Fixation involves the insertion of two
cannulated screws from the posterior heel to the talus, ensuring
hindfoot position maintenance. Two pins perpendicular to the
posterior talar surface from the calcaneal tuberosity to the talus
aid in compression at the arthrodesis site.
Postoperative Management: The procedure allows for
a one-day surgery with immediate use of a walking boot for
4 to 6 weeks and full weight-bearing as tolerated. Analgesics
and nonsteroidal anti-inflammatory drugs are prescribed for
the early postoperative period, with thromboprophylaxis for
4 weeks. Clinical and radiologic evaluations are conducted at
specific intervals postoperatively.
Advantages and Conclusion: Lateral subtalar arthroscopy
demonstrates favorable results with low complication rates
and excellent visualization of the entire subtalar articulation.
The procedure facilitates quick bone fusion, leading to a faster
recovery. However, preoperative assessment of the posterior
facet articular surface involvement is crucial for patient
selection. This surgical approach efficiently addresses a painful
condition, providing adequate exposure without excessive
vessel retraction, ultimately emphasizing a swift and successful
recovery for patients.
WINTER 2024
Footnotes - Winter 2024

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