Minimally Invasive Cartilage Resection of the Subtalar Joint: An Anatomical Study.

Foot & Ankle Orthopaedics Pub Date : 2025-03-19 eCollection Date: 2025-01-01 DOI:10.1177/24730114251315666
Sebastian Schilde, Dariusch Arbab, Maria Felsberg, Heike Kielstein, Karl-Stefan Delank, Natalia Gutteck
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Abstract

Background: Subtalar arthrodesis is a commonly performed procedure for the treatment of posttraumatic or primary osteoarthritis and several hindfoot deformities. The primary objective of this study is to evaluate the efficacy and safety of a minimally invasive technique for cartilage removal of the subtalar joint using a modified sinus tarsi approach.

Methods: An anatomical study was performed on 8 pairs of fresh frozen cadaveric feet. A modified 2.5-cm sinus tarsi approach was used to access the subtalar joint. Cartilage removal was performed in 2 groups using either a 13-mm Shannon burr (GB) or a curette (GC) with subsequent systematic dissection. Standardized scaled photographs of the resected articular surfaces were analyzed in ImageJ software to quantify cartilage removal. Nearby vulnerable anatomical structures such as the intermediate and lateral dorsal cutaneous nerves, peroneal, tibialis posterior, flexor digitorum longus, and flexor hallucis longus tendons were assessed for injury.

Results: The area of completely removed cartilage in GC was median 79.7% talar and 76.6% calcaneal. In GB, median 67.8% of the talar cartilage and 76.8% of the calcaneal cartilage was removed. The overall mean of cartilage resection was 73% (±7.7). There was no statistically significant difference between the groups. Anatomical structures at risk were not inadvertently injured.

Conclusion: Subtalar cartilage resection can be performed safely using a minimally invasive modified sinus tarsi approach and either a Shannon burr or curettes. The amount of cartilage resection is less than that reported in the literature for open cartilage resection, but may be beneficial in select patient populations at increased risk for wound healing compromise and infection.

Level of evidence: Level III, comparative cadaver study.

距下关节的微创软骨切除术:解剖学研究。
背景:距下关节融合术是治疗创伤后或原发性骨关节炎和几种后足畸形的常用手术。本研究的主要目的是评估采用改良跗骨窦入路进行距下关节软骨切除术的微创技术的有效性和安全性。方法:对8对新鲜冷冻尸体足进行解剖研究。采用改良的2.5 cm鼻窦入路进入距下关节。两组分别采用13mm Shannon burr (GB)或curette (GC)进行软骨去除,随后进行系统剥离。在ImageJ软件中分析切除关节表面的标准化缩放照片,以量化软骨去除。评估附近脆弱的解剖结构,如中间和外侧背皮神经、腓骨、胫骨后肌、指长屈肌和拇长屈肌肌腱的损伤情况。结果:GC软骨完全切除面积中位数为距骨79.7%,跟骨76.6%。在GB中,67.8%的距骨软骨和76.8%的跟骨软骨被切除。软骨切除的总体平均值为73%(±7.7)。两组间无统计学差异。有危险的解剖结构不是无意中受伤的。结论:距下软骨切除术可采用微创改良跗骨窦入路和Shannon burr或culttes安全进行。软骨切除术的数量比文献中报道的开放性软骨切除术少,但对于伤口愈合受损和感染风险增加的患者群体可能是有益的。证据等级:III级,比较尸体研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Foot & Ankle Orthopaedics
Foot & Ankle Orthopaedics Medicine-Orthopedics and Sports Medicine
CiteScore
1.20
自引率
0.00%
发文量
1152
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