Arthroscopy: The Journal of Arthroscopic & Related Surgery
Technical NoteA Novel Technique of Arthroscopic Excision of a Symptomatic Os Trigonum
Section snippets
Surgical Technique
The patient lies in a prone position under general or spinal anesthesia. A small pillow is placed under the dorsal ankle joint. Both a tourniquet and a distraction strap are usually unnecessary. A 23-gauge spinal needle is inserted into the subtalar joint at the 0.5-cm level proximal to the tip of the fibula, just lateral to the border of the Achilles tendon. After infusion of approximately 10 mL of saline solution into the subtalar joint, a 5-mm vertical skin incision is made with a No. 11
Clinical Results
Three of us have performed 11 procedures, and the os trigonum was successfully removed under arthroscopic control in all cases. There were no complications such as neurovascular injuries. All patients returned to their previous sports activity within 3 months, and the mean American Orthopaedic Foot & Ankle Society score improved from 71 to 99.
Discussion
Abramowitz et al.1 reported the outcome of 41 cases involving resection of a symptomatic os trigonum through the open posterolateral approach. They concluded that the clinical results with this method are satisfactory, but sural nerve palsy occurred in 8 cases. With an open technique, the time to full recovery averaged 5 months.1 In contrast, arthroscopic surgery is less invasive, providing precise diagnosis and treatment with an early return to the previous activity level while minimizing
References (8)
- et al.
A 2-portal endoscopic approach for diagnosis and treatment of posterior ankle pathology
Arthroscopy
(2000) - et al.
Modified arthroscopic excision of the symptomatic os trigonum and release of the flexor hallucis longus tendon: Operative technique and case study
J Foot Ankle Surg
(1999) - et al.
Posterior arthroscopic approach to the ankle: An anatomic study
Arthroscopy
(2003) - et al.
Arthroscopic visualization of the posterior subtalar joint in the prone position: A cadaver study
Arthroscopy
(2006)
Cited by (52)
Posterior Ankle Impingement
2023, Clinics in Podiatric Medicine and SurgeryPosterior Ankle Impingement Syndrome
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2016, Clinics in Podiatric Medicine and SurgeryPosterior Endoscopic Excision of Os Trigonum in Professional National Ballet Dancers
2016, Journal of Foot and Ankle SurgeryDisorders of the Flexor Hallucis Longus and Os Trigonum
2015, Clinics in Sports MedicineCitation Excerpt :Previous reports in the literature showed good to excellent outcomes70 and significant improvement of American Orthopaedic Foot and Ankle Society (AOFAS) score (average AOFAS score of 85.9–99.0 points at final follow-up)23,60–63,65,66,70–72 and visual analog scale (VAS) (average improvement of VAS of 4.9/10 at final follow-up)62 postoperatively. Average time to return to sports or activities was 5.9 weeks to 5.8 months.23,60–63,65,66,70–72 Open excision of the os trigonum through PM or PL approaches were effective and safe in the patients with os trigonum syndrome.29,73
The management of posterior ankle impingement syndrome in sport: A review
2015, Foot and Ankle SurgeryCitation Excerpt :However, this is likely to be an underestimate as some papers acknowledged that wound complications and infections occurred, but did not give a numerical breakdown. A number of different portal combinations have been described for PAIS surgery and 25 papers detailing 521 procedures were analysed for outcomes and complications [2,7–10,15–17,19,20,23–27,32–34,37,50–55]. Endoscopy requires a minimum of two portals – one for the camera and the other for instrumentation.
The authors report no conflict of interest.
Cite this article as: Horibe S, Kita K, Natsu-ume T, Hamada M, Mae T, Shino K. A novel technique of arthroscopic excision of a symptomatic os trigonum. Arthroscopy 2008;24:121.e1-121.e4 [doi:10.1016/j.arthro.2007.04.019].