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Anthony Perera - One of the best experts on this subject based on the ideXlab platform.
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lateral hind foot endoscopic anterolateral posterolateral leap Subtalar Arthrodesis an effective minimally invasive technique to achieve Subtalar fusion and deformity correction
Arthroscopy techniques, 2021Co-Authors: Anthony Perera, Vikram Kandhari, Tali Portalbanker, Stephane GuillodAbstract:Arthrodesis surgery aims to provide relief for chronic joint pain and correct limb alignment by achieving a stable union between articulating bones. The key factors to achieving sound Arthrodesis is adequate debridement of arthritic cartilage and creating well-apposed bleeding subchondral bone surfaces without compromising the surrounding soft tissue envelope. Arthroscopic Subtalar Arthrodesis is technically demanding but provides better visualization of the articular surfaces and is safer for the surrounding soft tissues compared to the open approach. Early published reports of the arthroscopic Subtalar Arthrodesis from the lateral sinus tarsi approach and posterior approach have shown promising results with high rates of union and less wound healing complications. However, there are concerns about access to all facets of Subtalar joint, nerve injury, and deformity correction. In this technique, the article authors describe the lateral endoscopic anterolateral/posterolateral (LEAP) approach for Subtalar Arthrodesis to improve visualization and access to all facets of the Subtalar joint to ensure adequate preparation of apposing surfaces, sound union, and facilitate deformity correction of hind-foot. Strategic portal placement also avoids injury to sural nerve. This is a safe and effective minimally invasive technique for Subtalar Arthrodesis.
Stephane Guillod - One of the best experts on this subject based on the ideXlab platform.
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lateral hind foot endoscopic anterolateral posterolateral leap Subtalar Arthrodesis an effective minimally invasive technique to achieve Subtalar fusion and deformity correction
Arthroscopy techniques, 2021Co-Authors: Anthony Perera, Vikram Kandhari, Tali Portalbanker, Stephane GuillodAbstract:Arthrodesis surgery aims to provide relief for chronic joint pain and correct limb alignment by achieving a stable union between articulating bones. The key factors to achieving sound Arthrodesis is adequate debridement of arthritic cartilage and creating well-apposed bleeding subchondral bone surfaces without compromising the surrounding soft tissue envelope. Arthroscopic Subtalar Arthrodesis is technically demanding but provides better visualization of the articular surfaces and is safer for the surrounding soft tissues compared to the open approach. Early published reports of the arthroscopic Subtalar Arthrodesis from the lateral sinus tarsi approach and posterior approach have shown promising results with high rates of union and less wound healing complications. However, there are concerns about access to all facets of Subtalar joint, nerve injury, and deformity correction. In this technique, the article authors describe the lateral endoscopic anterolateral/posterolateral (LEAP) approach for Subtalar Arthrodesis to improve visualization and access to all facets of the Subtalar joint to ensure adequate preparation of apposing surfaces, sound union, and facilitate deformity correction of hind-foot. Strategic portal placement also avoids injury to sural nerve. This is a safe and effective minimally invasive technique for Subtalar Arthrodesis.
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Lateral Hind-Foot Endoscopic Anterolateral/Posterolateral (LEAP) Subtalar Arthrodesis: An Effective Minimally Invasive Technique to Achieve Subtalar Fusion and Deformity Correction
'Elsevier BV', 2021Co-Authors: Anthony Perera, M.b.ch.b. F.r.c.s.(orth), Vikram Kandhari, M.b.b.s., M.s. D.n.b. K. M.r.c.s., Tali Portal-banker, Stephane GuillodAbstract:Arthrodesis surgery aims to provide relief for chronic joint pain and correct limb alignment by achieving a stable union between articulating bones. The key factors to achieving sound Arthrodesis is adequate debridement of arthritic cartilage and creating well-apposed bleeding subchondral bone surfaces without compromising the surrounding soft tissue envelope. Arthroscopic Subtalar Arthrodesis is technically demanding but provides better visualization of the articular surfaces and is safer for the surrounding soft tissues compared to the open approach. Early published reports of the arthroscopic Subtalar Arthrodesis from the lateral sinus tarsi approach and posterior approach have shown promising results with high rates of union and less wound healing complications. However, there are concerns about access to all facets of Subtalar joint, nerve injury, and deformity correction. In this technique, the article authors describe the lateral endoscopic anterolateral/posterolateral (LEAP) approach for Subtalar Arthrodesis to improve visualization and access to all facets of the Subtalar joint to ensure adequate preparation of apposing surfaces, sound union, and facilitate deformity correction of hind-foot. Strategic portal placement also avoids injury to sural nerve. This is a safe and effective minimally invasive technique for Subtalar Arthrodesis
Annunziato Amendola - One of the best experts on this subject based on the ideXlab platform.
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do patient positioning and portal placement for arthroscopic Subtalar Arthrodesis matter
Orthopaedic Journal of Sports Medicine, 2019Co-Authors: Alan G Shamrock, Annunziato Amendola, Natalie A Glass, Keith Shamrock, Chris Cychosz, Christopher N Carender, Kyle R DuchmanAbstract:Background:Arthroscopic Subtalar Arthrodesis was first described over 2 decades ago and originally performed in the lateral decubitus or supine position using anterolateral and posterolateral porta...
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outcomes and complications after open versus posterior arthroscopic Subtalar Arthrodesis in 121 patients
Journal of Bone and Joint Surgery American Volume, 2016Co-Authors: Chamnanni Rungprai, Charles L Saltzman, Phinit Phisitkul, John E Femino, Kevin D Martin, Annunziato AmendolaAbstract:Background: Subtalar Arthrodesis is a standard treatment for Subtalar arthritis. Both open and arthroscopic techniques have been described and are commonly used. The cases of a consecutive series of 121 patients treated with either open or posterior arthroscopic techniques are presented with functional outcomes and complications. Materials: A retrospective chart review with prospectively collected data was performed for 121 consecutive patients (129 feet) who underwent Subtalar Arthrodesis with open (60 feet in 57 patients) or arthroscopic (69 feet in 64 patients) techniques between 2001 and 2014. The technique was selected on the basis of the deformity and surgeon preference. The primary outcomes were the visual analog scale (VAS) for pain, Short Form (SF)-36, Foot Function Index (FFI), and Angus and Cowell rating scores. Secondary outcomes included hindfoot alignment, operative time, length of hospital stay, fusion rate, time to return to work, ability to perform sports and activities of daily living, and complications. Results: Both groups demonstrated significant improvement in VAS, SF-36, FFI, and Angus and Cowell rating scale scores. The mean operative time, VAS score, Angus and Cowell rating score, and coronal plane hindfoot alignment were similar between the groups. There were no significant differences within the groups with respect to union rate and time to union among the various sizes of screws and types of bone graft. Sural nerve complications and a painful surgical scar were more frequent in the open group, whereas hardware-related symptoms were more frequent in the arthroscopically treated group. Conclusions: Subtalar Arthrodesis performed with open and arthroscopically assisted techniques demonstrated significant improvement in terms of pain and function as measured with the VAS, FFI, and SF-36. While the time to union and to return to work, activities of daily living, and sports activities were significantly shorter for the arthroscopic Arthrodesis group, the union rates and complications overall were not significantly different. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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a posterior 3 portal arthroscopic approach for isolated Subtalar Arthrodesis
Arthroscopy, 2008Co-Authors: Keunbae Lee, Charles L Saltzman, Jinsoo Suh, Lisa Wasserman, Annunziato AmendolaAbstract:Arthroscopic Subtalar Arthrodesis was developed to improve on open methods of fusion. A posterior 3-portal arthroscopic approach with the patient in the prone position provides a new and optimal method for isolated Subtalar Arthrodesis. It facilitates safe access to the posterior talocalcaneal facet. The posterolateral portal was established using blunt dissection. The 3-mm, 30° arthroscope was inserted, the posterolateral portal was made, and synovectomy carried out. A large 4-mm arthroscope was used to improve fluid flow. The third portal was then established approximately 1 cm proximal and 1 cm posterior to the tip of the lateral malleolus. This portal was used for distraction by inserting a large blunt trocar into the joint. Most of the procedure was performed with the arthroscope in the posterolateral portal and the instruments posteromedial. Allograft was inserted through the posterolateral portal. Fixation was achieved using 2 cannulated 6.5- or 7.3-mm cancellous screws, inserted under fluoroscopic control. Postoperatively, patients were assigned to non-weight bearing cast immobilization with crutch ambulation for 6 weeks, followed by gradual weight bearing until radiographs showed union. Preliminary results have shown high patient satisfaction, an excellent fusion rate, and less postoperative morbidity than with open Subtalar Arthrodesis.
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technique and early experience with posterior arthroscopic Subtalar Arthrodesis
Foot & Ankle International, 2007Co-Authors: Annunziato Amendola, Keunbae Lee, Charles L Saltzman, Jinsoo SuhAbstract:Background: Subtalar Arthrodesis is a reliable procedure for pain relief and improved function in patients with isolated Subtalar arthritis. Arthroscopic Subtalar Arthrodesis (ASTA) was designed to...
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Subtalar Arthrodesis using interposition iliac crest bone graft after calcaneal fracture
Foot & Ankle International, 1996Co-Authors: Annunziato Amendola, P LammensAbstract:Fifteen consecutive patients with hindfoot pain after calcaneal fracture underwent Subtalar Arthrodesis using interposition iliac crest bone graft. Outcome and correction of calcaneal collapse were assessed before and after surgery with clinical examination, visual analogue scores, and standard x-rays while weightbearing. Eleven of the 15 patients were satisfied with the procedure. There were four failures due to transverse tarsal joint arthritis, overcorrection, and reflex sympathetic dystrophy. Radiographic examination revealed restoration of heel height, with 100% union rate of the Arthrodesis. The described technique allows Arthrodesis and correction of calcaneal collapse after calcaneal fracture.
Mark E. Easley - One of the best experts on this subject based on the ideXlab platform.
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isolated Subtalar Arthrodesis for avascular necrosis of the talus
Journal of surgical orthopaedic advances, 2019Co-Authors: Travis J. Dekker, Mark E. Easley, Manuel J. Pellegrini, James K. Deorio, James A. Nunley, Adam Schiff, Samuel B. AdamsAbstract:Isolated Subtalar Arthrodesis has been attempted in talar avascular necrosis (AVN) patients to preserve the tibiotalar joint and potential revascularization. This article reports the efficacy of isolated Subtalar Arthrodesis in the setting of AVN. A retrospective review of Subtalar arthrodeses was performed on a cohort of 12 patients with talar AVN who underwent Subtalar Arthrodesis. The primary outcome was radiographic fusion with secondary outcomes of subsequent procedures, recurrent pain, and perioperative complications. Radiographic fusion of Subtalar Arthrodesis occurred in 12 of 12 patients. Five of six patients with traumatic etiology went on to have secondary procedures. One of six patients with atraumatic etiology underwent a secondary procedure for advancement of tibiotalar arthritis. In the setting of atraumatic talar AVN, this small cohort demonstrates that isolated Subtalar Arthrodesis is a safe and reliable procedure with high fusion rates and low need for secondary procedures. (Journal of Surgical Orthopaedic Advances 28(2):132-136, 2019).
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torsional stiffness after Subtalar Arthrodesis using second generation headless compression screws biomechanical comparison of 2 screw and 3 screw fixation
Clinical Biomechanics, 2017Co-Authors: Markus Riedl, Richard R Glisson, Takumi Matsumoto, Stefan G Hofstaetter, Mark E. EasleyAbstract:Abstract Background Subtalar joint Arthrodesis is a common operative treatment for symptomatic Subtalar arthrosis. Because excessive relative motion between the talus and calcaneus can delay or prohibit fusion, fixation should be optimized, particularly in patients at risk for Subtalar Arthrodesis nonunion. Tapered, fully-threaded, variable pitch screws are gaining popularity for this application, but the mechanical properties of joints fixed with these screws have not been characterized completely. We quantified the torsion resistance of 2-screw and 3-screw Subtalar joint fixation using this type of screw. Methods Ten pairs of cadaveric Subtalar joints were prepared for Arthrodesis and fixed using Acutrak 2–7.5 screws. One specimen from each pair was fixed with two diverging posterior screws, and the contralateral joint was fixed using two posterior screws and a third screw directed through the anterior calcaneus into the talar neck. Internal and external torsional loads were applied and joint rotation and torsional stiffness were measured at two torque levels. Findings Internal rotation was significantly less in specimens fixed with three screws. No difference was detectable between 2-screw and 3-screw fixation in external rotation or torsional stiffness in either rotation direction. Both 2-screw and 3-screw fixation exhibited torsion resistance surpassing that reported previously for Subtalar joints fixed with two diverging conventional lag screws. Interpretation Performance of the tapered, fully threaded, variable pitch screws exceeded that of conventional lag screws regardless of whether two or three screws were used. Additional resistance to internal rotation afforded by a third screw placed anteriorly may offer some advantage in patients at risk for nonunion.
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Subtalar Arthrodesis in Patients With Avascular Necrosis of the Talus
SAGE Publishing, 2016Co-Authors: Manuel J. Pellegrini, Mark E. Easley, Adam P. Schiff, Travis J. Dekker, James K. Deorio, James A. Nunley, Samuel B. AdamsAbstract:Category: Hindfoot Introduction/Purpose: Avascular necrosis (AVN) of the talus can lead to Subtalar arthritis, pain, and decreased function. Isolated Subtalar Arthrodesis has been attempted in these patients, potentially allowing re-vascularization of the talus from calcaneal bone ingrowth while preserving the tibiotalar joint. The purpose of this study is to determine the union rate and complications of Subtalar Arthrodesis in patients with AVN of the talus. Methods: After obtaining IRB approval, a retrospective review of Subtalar arthrodeses performed at a single academic institution, from 2000 to 2014, was conducted. Patients were included if they had a preoperative diagnosis of avascular necrosis of the talus, underwent Subtalar Arthrodesis and had a minimum follow up of 12 months. Exclusion criteria include: age younger of 18 years, incomplete clinical and radiological data or those whom underwent a concomitant tibiotalar Arthrodesis. Results: Twelve patients with a mean age of 46.6 ± 13.9 years were included in the study. The fusion rate was 58% with a mean time to fuse of 35 weeks (range, 14-146). Seventeen percent of the patients had diabetes or vascular disease and an additional 17% had a positive history for tobacco use. The overall complication rate was 67% (8 patients). Five patients progressed to non-union (42%) and three of them underwent revision to tibiotalocalcaneal Arthrodesis. Two patients (17%) had progression of AVN, one of which necessitated a tibiotalocalcaneal Arthrodesis. Two patients (17%) developed a wound dehiscence that healed uneventfully with local wound care and oral antibiotics administration. One patient (8%) underwent hardware removal. Conclusion: With a fusion rate as low as 58% and a 67% complication rate, caution should be exhibited when considering an isolated Subtalar Arthrodesis in the setting of AVN of the talus. In selected cases, consideration should be given to extending the Arthrodesis site to include the tibiotalar or talonavicular joint or revascularization procedures such as concomitant vascularized bone grafts
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Subtalar fusion rate in patients with previous ipsilateral ankle Arthrodesis
Foot & Ankle International, 2015Co-Authors: Diego H Zanolli, James A. Nunley, Mark E. EasleyAbstract:Background:Isolated Subtalar Arthrodesis is generally successful, with reported fusion rates of 84% to 100%. However, alteration of Subtalar joint mechanics and talar body vasculature after ankle fusion may negatively influence subsequent ipsilateral Subtalar joint fusion. Because there is very limited information on the Subtalar fusion rate in patients with previous ipsilateral ankle fusion, the purpose of this study was to describe fusion rates in Subtalar joint Arthrodesis with and without preexisting ankle fusion in a large consecutive series of primary Subtalar Arthrodesis cases.Methods:All primary Subtalar fusions performed between January 2000 and December 2010 were reviewed. Thirteen of 151 consecutive cases were in patients with existing ipsilateral ankle fusions. All patients were evaluated for clinical and radiographic evidence of nonunion at follow-up, and fusion rates in the groups with and without previous ipsilateral ankle fusion were compared.Results:Five nonunions occurred in the 13 cases...
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screw placement in Subtalar Arthrodesis a biomechanical study
Foot & Ankle International, 2009Co-Authors: Bavornrit Chuckpaiwong, Mark E. Easley, Richard R GlissonAbstract:Background: Clinical outcomes of Subtalar Arthrodesis using screw fixation have been reported but biomechanical support for selection of screw trajectories and patterns has been lacking. This inves...
P Oger - One of the best experts on this subject based on the ideXlab platform.
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computer tomography assessment of the fusion rate after posterior arthroscopic Subtalar Arthrodesis
International Orthopaedics, 2012Co-Authors: Mathieu Thaunat, Xavier Bajard, P Boisrenoult, Philippe Beaufils, P OgerAbstract:Purpose The purpose of this study was to assess the fusion rate on CT examinations and to correlate clinically the functional result with the degree of bone fusion in the Subtalar joint after posterior arthroscopic Subtalar Arthrodesis (PASTA).
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risks relating to posterior 2 portal arthroscopic Subtalar Arthrodesis and articular surfaces abrasion quality achievable with these approaches a cadaver study
Orthopaedics & Traumatology-surgery & Research, 2011Co-Authors: F Mouilhade, P Boisrenoult, P Oger, X Roussignol, J Sfez, Fabrice DuparcAbstract:Summary Introduction Many techniques for arthroscopic Subtalar Arthrodesis have been described since 1985. The procedure can be challenging because posterior and anterior portals are used conjointly with distraction. A posterior 2-portal approach was described in 2000. Hypothesis The goal of this study was to evaluate the quality of the freshening that can be achieved in the posterior Subtalar joint using this approach. Does a posterior 2-portal approach allow for a complete freshening of the posterior Subtalar joint? Material and methods Freshening was performed through an arthroscopic posterior 2-portal approach on 10 cadavers. The quality of bone freshening and proximity of the neurovascular structures to the posterior portals were subsequently evaluated by dissection. Results There was one partial laceration of the sural nerve. The posteromedial portal was 6.8 mm (95% CI: 4.4 to 9.2) away from the posterior tibial vascular pedicle. The entire talar and calcaneal articular surfaces of the posterior Subtalar joint were freshened. In eight of 10 cases (95% CI: 48 to 95%), the posteromedial process of the talus prevented contact between fragments. Discussion This study showed that the entire posterior Subtalar joint can be freshened through an arthroscopic posterior 2-portal approach with little morbidity. Level of evidence Level IV.
