Technical Note
A 2-portal endoscopic approach for diagnosis and treatment of posterior ankle pathology*

https://doi.org/10.1053/jars.2000.19430Get rights and content

Abstract

Summary: We describe a 2-portal endoscopic approach of the hindfoot with the patient in the prone position. By means of this approach, it is possible to visualize and treat a variety of posterior ankle problems. Not only can pathology of the posterior ankle joint and subtalar joint be visualized and treated, but also periarticular pathology, such as calcifications or scar tissue, can be diagnosed and treated. We describe a professional ballet dancer with chronic flexor hallucis longus tendinitis and a posterior ankle impingement syndrome caused by an os trigonum of both ankles. The patient was successfully treated by removing the os trigonum and releasing the flexor hallucis longus tendon. She resumed her professional activities within 2 months after endoscopic treatment.

Arthroscopy: The Journal of Arthroscopic and Related surgery, Vol 16, No 8 (November-December), 2000: pp 871–876

Section snippets

Operative technique

The patient is placed in prone position. A tourniquet is applied and a small support is placed under the lower leg, making it possible to move the ankle freely. The posterolateral portal is made at the level or slightly above the tip of the lateral malleolus, just lateral to the Achilles tendon. After making a vertical stab incision, the subcutaneous layer is split by a mosquito clamp. The mosquito clamp is directed anteriorly, pointing in the direction of the interdigital webspace between the

Discussion

Posterior ankle impingement syndrome; os trigonum syndrome; tendinitis of the FHL, posterior tibial tendon, or peroneal tendons; post-traumatic calcifications; bony avulsions; osteochondral defects; ankle and subtalar arthrosis; synovitis; loose bodies and their combinations can all be the cause of posterior ankle pain.5 It is difficult to distinguish these various causes of posterior ankle pain by medical history and clinical examination alone. Radiologic and scintigraphic diagnostics and/or a

References (6)

  • RD Ferkel et al.

    Progress in ankle arthroscopy

    Clin Orthop Rel Res

    (1989)
There are more references available in the full text version of this article.

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*

Address correspondence and reprint requests to C. Niek van Dijk, M.D., Ph.D., Academic Medical Center, Department of Orthopaedic Surgery, PO Box 22700, 1100 DE Amsterdam, The Netherlands. E-mail: [email protected]

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