Table Of Content

Baofu Wei Alan Y. Yan Annunziato Amendola Arthroscopic Techniques and Anatomy of the Foot and Ankle A Surgical Atlas 123 Arthroscopic Techniques and Anatomy of the Foot and Ankle Baofu Wei • Alan Y. Yan • Annunziato Amendola Arthroscopic Techniques and Anatomy of the Foot and Ankle A Surgical Atlas Baofu Wei Alan Y. Yan Hand and Foot Surgery Orthopedic Surgery Linyi People’s Hospital University of Pittsburgh Linyi, Shandong, China Pittsburgh, PA, USA Annunziato Amendola Orthopedic Surgery Duke Medical Center Durham, NC, USA ISBN 978-3-031-05189-0 ISBN 978-3-031-05190-6 (eBook) https://doi.org/10.1007/978-3-031-05190-6 © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022 This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland To my wife, Yanyan Sun, and our beloved daughter Jairong with love and your support for me in those years at Durham, North Carolina. Baofu Wei To my parents, Xingdi Li and Hongcai Yan, for their unconditional love. To my wife Vivienne for sticking with me in my rollercoasting lifestyle throughout the years from our basement in New York City to all the cities we have lived throughout my training and works, and for my children: Brayden and River with love and joy in my life. Alan Y. Yan To all my fellows and residents who have contributed to this textbook, to my continuing education and advancing the specialty of orthopedic surgery. Annunziato Amendola Preface Since the late Pau Golano’s landmark works in foot and ankle surgical anatomy, many further works of detailed surgical anatomies with minimally invasive techniques have continuously emerged from major study groups mostly in Europe and North America. Dr. Baofu Wei, one of our editors and main author of this collection, started his detailed work on surgical anatomy and approaches years ago in China. He subsequently continued his work in the USA while at Duke. At that time, he was working with some of the leaders in the field, especially Dr. Amendola, one of the pioneers in foot and ankle sports surgery in the USA. The collection of the work in the book is to provide a surgical “Google” map in foot and ankle arthroscopic surgery. Minimally invasive surgery (MIS) has been met with increasing interest in recent years due to its presumed faster recovery, decreased trauma, and improved cosmesis. For this reason, an in-depth understanding is required to perform this type of surgery in an efficient and safe way. The continuous development of new surgical techniques and instruments has significantly enlarged our scope of practice and allowed us to improve the outcomes of our patients. With a complex and relatively small structure consisting of 26 bones, 33 joints, and over 100 muscles, ligaments, and tendons in each foot, the human feet have been the result of an evolutionary wonder that makes us uniquely human. A lifetime of walking makes each of us capable of circulating the globe three times over and brings many pathologies to this unique set of marvelous machinery. This includes a variety of injuries, infection, deformities, and debili- tating degenerative conditions. Throughout the last century, safe and efficient open approaches of the forefoot, midfoot, hindfoot, and ankle have been well explored, developed, and constantly refined. The revolu- tionary introduction of arthroscopy over the early to mid-twentieth century in orthopedics has dramatically changed our landscape in orthopedic surgery. Arthroscopy began from early trials by Nordentoft in Denmark and then the cystoscope trial for the knee in Japan by Takagi. Takagi’s student, Watanabe, carried on the endeavor using the technological advances in that golden period in fiberoptics, the modern generation of the camera, and progressing to modern arthroscopic surgery in orthopedics in the 1950s and ankle arthroscopy in the early 1970s. Due to the smaller size of the bones and joints of the foot and ankle, as well as the tighter space, the widespread use of foot and ankle arthroscopy has been relatively delayed compared to arthroscopy of other larger joints. However, there has been increasing interest and more and more publications in the recent decades. With the continuous efforts led by some of the pioneers and proponents in the field, especially Niek Van Dijk and his group in Amsterdam, as well as Richard Ferkel in the USA, foot and ankle arthroscopic surgery has become the norm in managing many foot and ankle surgical pathologies. Furthermore, we are now in the era of chip-on-tip nanotechnology and needle arthroscopy which further minimize any iatrogenic injury and represent another paradigm shift moment in foot and ankle surgery. Several textbooks edited by some of the most experienced pioneering surgeons on foot and ankle arthroscopy and endoscopy have been published since the early 2000s. These include Richard Ferkel from the USA, Tung Hing Lui from Hong Kong, China, the Niek van Dijk vii viii Preface group from Amsterdam Foot Ankle School with Pau Golano, James Guhl, Serge Prisien, and Melbourne Boynton from the USA, James Stone, John Kennedy, and Mark Glazebrook from North America AANA. However, a detailed surgical Atlas for references has not been presented. As one of the pioneers in foot and ankle arthroscopic surgery, Dr. Amendola has been influ- ential in the development of surgical techniques and clinical applications of foot and ankle arthroscopic and endoscopic surgery. Most of the modern-day surgical techniques in minimally invasive surgery have been expo- nentially and continuously developed in the recent decade. Many of those surgical skills are not taught during most of the resident training programs or even during fellowships. As surgeons either experienced in traditional open approaches or younger generations entering the practice, the demand of incorporating these newer and safer techniques in surgery will be extremely beneficial. A comprehensive illustrated surgical atlas aids in the process of acquiring the skills for these procedures and may assist with getting over the learning curves and benefit the patients in need. In this illustrated atlas, we have included the details of local anatomies, preoperative evalu- ations, and patient position in the operating room including equipment set up. We have also included the most common approaches with stepwise visual findings of current foot and ankle arthroscopy and endoscopy to forefoot, midfoot, hindfoot joints, and soft tissues to provide an educational and practical illustrated guide for medical students, residents, fellows, and attend- ings with different experience levels in arthroscopic and endoscopic surgery in the foot and ankle. Many thanks to some of the most experienced surgeons in this field to edit and review the topics. Our residents, fellows, and assistants offered much help along the way by collecting clinical materials and coordinating with our patients during the entire process. It has been a privilege and great pleasure to advance our understanding in the field of arthroscopic and endoscopic surgery in this specialty. I believe we will continue making advances and progress in the future for the best interest of our patients in need. Pittsburgh, PA, USA Alan Y. Yan Acknowledgments Without the persistent effort, support, and hard work of this team of fellows and surgeons, who have an abundance of experience and leadership in arthroscopic foot and ankle surgery, this project would not be possible. Dr. Wei has been a well-published surgeon and scholar with his extraordinary works in surgical anatomy in foot and ankle surgery throughout his career in China. He was first intro- duced to me by former AOFAS president Dr. Thomas Lee, who met Dr. Wei and was impressed by his works while teaching in China. Dr. Wei then continued his works and studies at Duke University Medical Center, where he carried on his further detailed anatomical studies. During those few years, Dr. Wei worked with some of the leaders in the field of foot and ankle surgeons including Dr. James Nunley, Dr. James DeOrio, Dr. Mark Easley, and Dr. Samuel Adams. He finally dedicated over 2 years of his time with Dr. Annunziato Amendola to the anatomy of arthroscopic foot and ankle surgery, thus the creation of this book. Many fellows of foot and ankle surgery at Duke at that time, followed by teamwork with some of the leading and most experienced surgeons with deep understanding in minimally invasive surgery (MIS) and arthroscopic surgery, joined our continuous effort in this important atlas of surgical techniques in foot and ankle surgery. A very special thanks to Kristopher Spring who recognized the unique role of this collection of works and for his continuous support throughout the process. I am indebted to Mr. Lee Klein, our editor, in his prompt and tireless efforts to make this project a reality. Many thanks to my staff, my fellows, and my residents, and especially my assistant Kristi Price for keeping my daily schedule up-to-date and helping with editing every step of the way. Alan Y. Yan ix Contents 1 Gross Anatomy of the Ankle Joint for Arthroscopy. . . . . . . . . . . . . . . . . . . . . . . . . 1 1.1 Skin and Landmarks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1.2 Ankle Joint . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 1.2.1 Ankle Mortise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 1.2.2 The Inferior Syndesmosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 1.3 Anatomy of the Talus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 1.4 Anatomy of the Subtalar Joint . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 1.5 The Capsule of the Ankle Joint . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 1.6 The Ligaments Around the Ankle Joint . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 1.6.1 Medial Ligament . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 1.6.2 Lateral Ligament . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 1.6.3 Posterior Intermalleolar Ligament . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 1.7 Deep Fascia Layer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 1.7.1 Anterior Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 1.7.2 Posterior Superficial Compartment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 1.7.3 Posterior Deep Compartment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 1.7.4 Lateral Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 1.7.5 Medial Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 1.8 Superficial Nerves and Veins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 1.8.1 Superficial Peroneal Nerve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 1.8.2 Sural Nerve and Lesser Saphenous Vein . . . . . . . . . . . . . . . . . . . . . . . . . 19 1.8.3 Saphenous Nerve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Further Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 2 Arthroscopy Instruments and Applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 2.1 Arthroscopic Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 2.1.1 Arthroscope . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 2.1.2 Trocar, Obturator, and Cannula . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 2.2 Camera, Video Monitor, and Printer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 2.2.1 Camera Control Unit and Camera Head . . . . . . . . . . . . . . . . . . . . . . . . . 28 2.2.2 Video Monitor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 2.2.3 Printer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 2.3 Light Source and Cable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 2.4 Motorized Instrument . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 2.4.1 Energy System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 2.4.2 The Soft Tissue Shaver . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 2.4.3 The Arthroscopic Burr . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 2.4.4 Footswitch Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 2.5 Irrigation Equipment and Suction System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 2.6 Special Instrument . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 2.6.1 Arthroscopic Probe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 2.6.2 Arthroscopic Osteotome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 xi xii Contents 2.6.3 Arthroscopic Elevator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 2.6.4 The Closed-Cup Curette . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 2.6.5 The Open Curette . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 2.6.6 The Chondro-Picks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 2.6.7 The Grasper . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 2.6.8 The Straight Punch Forceps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 2.6.9 MicroVector Drill Guide System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 2.6.10 Basic Surgical Instruments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 2.7 Noninvasive and Invasive Distraction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 2.8 Other Accessory Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 2.8.1 The Thigh Tourniquet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 2.8.2 Prevention of Deep Vein Thrombosis . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Further Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 3 Anterior Arthroscopy of the Ankle Joint: General Principles and Arthroscopic Examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 3.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 3.2 Regional Anatomy of the Anterior Ankle Joint . . . . . . . . . . . . . . . . . . . . . . . . . . 41 3.3 Indications and Contraindications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 3.3.1 Indications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 3.3.2 Contraindications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 3.4 Procedural Setup and Anesthesia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 3.5 Anterior Portals/Incision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 3.5.1 Anteromedial Portal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 3.5.2 Anterolateral Portal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 3.5.3 Anterocentral Portal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 3.5.4 Accessory Anteromedial Portal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 3.5.5 Accessory Anterolateral Portal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 3.6 Establishing the Portals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 3.7 Diagnostic Arthroscopic Examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Further Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 4 Posterior Arthroscopy of the Ankle and Subtalar Joint: General Principles and Arthroscopic Examination . . . . . . . . . . . . . . . . . . . . . . . . . 51 4.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 4.2 Regional Anatomy of the Posterior Ankle Joint . . . . . . . . . . . . . . . . . . . . . . . . . 51 4.3 Indications and Contraindications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 4.3.1 Indications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 4.3.2 Contraindications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 4.4 Anesthesia, Tourniquet, Position, and Distraction . . . . . . . . . . . . . . . . . . . . . . . . 51 4.5 Posterior Portals/Incision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 4.5.1 Posterolateral Portal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 4.5.2 Posteromedial Portal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 4.5.3 Accessory Posterolateral Portal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 4.5.4 Accessory Posteromedial Portal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 4.6 Creating the Pathway . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 4.7 Diagnostic Arthroscopic Examination: Posterior Ankle Examination . . . . . . . . . 57 Further Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 5 Osteochondral Lesions of Talus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 5.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 5.2 Anatomy of the Articular Cartilage of the Talus . . . . . . . . . . . . . . . . . . . . . . . . . 61 5.3 Symptoms, Physical Examination, and Radiographic Evaluation . . . . . . . . . . . . 66 5.3.1 Symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 5.3.2 Physical Examination. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66