Technical Note
A Novel Technique of Arthroscopic Excision of a Symptomatic Os Trigonum

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Abstract

We describe a new arthroscopic excision technique for a symptomatic os trigonum. With the patient lying in a prone position, a posterolateral portal just lateral to the Achilles tendon, at the 5-mm level proximal to the tip of the fibula, is used for the arthroscope and an accessory posterolateral portal just posterior to the peroneal tendon at the same level is used for instruments. The synovial tissues are then debrided with a power shaver through the accessory posterolateral portal for better visualization. An elevator is used to release the fibrous tissue between the os trigonum and the talus. The os trigonum is completely excised with a grasper to visualize the flexor hallucis longus tendon. Radiographic control is helpful to check the position of the arthroscope if it happens to be inserted into the ankle joint as a result of the reduced subtalar joint space. Postoperatively, no immobilization is necessary, and full weight-bearing is allowed as tolerated. Three of us have performed 11 procedures with excellent results and no cases of complications. This arthroscopic excision technique for the symptomatic os trigonum is a safe and effective procedure.

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

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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].

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