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Correction of Severe Flatfoot Deformity by 3-Portal Arthroscopic Triple Arthrodesis.

ABSTRACT: Severe flatfoot deformity with lack of coverage of the talonavicular joint is frequently treated by triple arthrodesis. Various arthroscopic triple arthroscopic techniques have been described to reduce the extent of soft-tissue dissection. The purpose of this Technical Note is to describe the details of 3-portal arthroscopic triple arthrodesis for correction of severe flatfoot deformity. This approach allows thorough preparation of all fusion surfaces, and the bone removal by decortications facilitates reduction of the talonavicular joint and correction of the forefoot supination.

SUBMITTER: Li HM

PROVIDER: S-EPMC6993535 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature

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Correction of Severe Flatfoot Deformity by 3-Portal Arthroscopic Triple Arthrodesis.

Li Ho Ming HM Lui Tun Hing TH

Arthroscopy techniques 20191214 1

Severe flatfoot deformity with lack of coverage of the talonavicular joint is frequently treated by triple arthrodesis. Various arthroscopic triple arthroscopic techniques have been described to reduce the extent of soft-tissue dissection. The purpose of this Technical Note is to describe the details of 3-portal arthroscopic triple arthrodesis for correction of severe flatfoot deformity. This approach allows thorough preparation of all fusion surfaces, and the bone removal by decortications faci ...[more]

PMID: 32021782

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Project description:BackgroundSevere adult-acquired flatfoot deformity (AAFD) is often associated with painful medial column collapse at the naviculocuneiform (NC) joint. However, many surgeons surgically correct the deformity without directly addressing this joint. The purpose of this study was to examine the role of first-tarsometatarsal (TMT) fusion combined with subtalar fusion in correcting deformity at the NC joint.MethodsWe retrospectively analyzed 40 patients (41 feet) who underwent first-TMT and subtalar (ST) fusion as part of a flatfoot reconstructive procedure. We assessed 6 radiographic parameters both preoperatively and at a minimum of 6 months postoperatively, including talonavicular (TN) coverage angle, lateral talo-first metatarsal angle, lateral talocalcaneal angle, calcaneal pitch, hindfoot moment arm, and a newly defined navicular-cuneiform incongruency angle (NCIA). Patient-Reported Outcomes Measurement Information System (PROMIS) clinical outcomes were assessed preoperatively and at a minimum 1-year follow-up.ResultsThe NCIA demonstrated excellent interobserver reliability, with no significant change between pre- and postoperative measurements. All other radiographic parameters, except calcaneal pitch, demonstrated statistically significant improvement postoperatively (P < .01). Overall, patients had statistically significant improvement in all PROMIS domains (P < .01), except for depression. Worsening NC deformity was not associated with worse patient-reported outcomes.ConclusionsOur data suggest that when addressing painful collapse of the medial arch in patients with AAFD, fusion of the first-TMT joint in combination with other procedures leads to acceptable radiographic and clinical outcomes. There was no change in deformity at the NC joint in our patient cohort at short-term follow-up, and patients achieved significant improvement in multiple PROMIS domains. Although TMT fusion had no effect on NC deformity, residual or worsening NC deformity did not significantly affect clinical outcomes. In addition, the NCIA was found to be a reliable radiographic parameter to assess NC deformity in the presence of talonavicular and/or first-TMT fusion.Level of evidenceLevel III, retrospective comparative study.

Dataset Information

Correction of Severe Flatfoot Deformity by 3-Portal Arthroscopic Triple Arthrodesis.

Publications

Correction of Severe Flatfoot Deformity by 3-Portal Arthroscopic Triple Arthrodesis.

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