Arthroscopic Triple Arthrodesis in Management of Chronic Flatfoot Deformity Tun Hing Lui, M.B.B.S.(H.K.), F.R.C.S.(Edin.), F.H.K.A.M., F.H.K.C.O.S. Arthroscopy.

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Arthroscopic Triple Arthrodesis in Management of Chronic Flatfoot Deformity Tun Hing Lui, M.B.B.S.(H.K.), F.R.C.S.(Edin.), F.H.K.A.M., F.H.K.C.O.S. Arthroscopy Techniques Volume 6, Issue 3, Pages e871-e877 (June 2017) DOI: 10.1016/j.eats.2017.02.020 Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 1 Arthroscopic triple arthrodesis in the management of chronic flatfoot deformity of the left foot. The patient is in supine position with the legs spread. (A) Posterior subtalar arthroscopy is performed via the anterolateral and middle portals. (B) The anterolateral subtalar portal is the viewing portal and the middle subtalar portal is the working portal. The articular cartilage of both the talar and calcaneal facets is denuded. (ALP, anterolateral subtalar portal; MP, middle subtalar portal; PFCa, posterior facet of the calcaneus; PFT, posterior facet of the talus.) Arthroscopy Techniques 2017 6, e871-e877DOI: (10.1016/j.eats.2017.02.020) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 2 Arthroscopic triple arthrodesis in the management of chronic flatfoot deformity of the left foot. The patient is in supine position with the legs spread. (A) Anterior subtalar arthroscopy is performed via the anterolateral subtalar and dorsolateral midtarsal portals. (B) The anterolateral subtalar portal is the viewing portal and the dorsolateral midtarsal portal is the working portal. The articular cartilage of both the talar head and anterior calcaneal facet is denuded with an arthroscopic shaver. (AFCa, anterior facet of the calcaneus; ALP, anterolateral subtalar portal; AS, arthroscopic shaver; DLP, dorsolateral midtarsal portal; TH, talar head.) Arthroscopy Techniques 2017 6, e871-e877DOI: (10.1016/j.eats.2017.02.020) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 3 Arthroscopic triple arthrodesis in the management of chronic flatfoot deformity of the left foot. The patient is in supine position with the legs spread. (A) Calcaneocuboid arthroscopy is performed via the lateral and dorsolateral midtarsal portals. (B) The lateral midtarsal portal is the viewing portal and the dorsolateral portal is the working portal. The articular cartilage is denuded with an arthroscopic osteotome. (AO, arthroscopic osteotome; Ca, calcaneus; Cu, cuboid bone; DLP, dorsolateral midtarsal portal; LP, lateral midtarsal portal.) Arthroscopy Techniques 2017 6, e871-e877DOI: (10.1016/j.eats.2017.02.020) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 4 Arthroscopic triple arthrodesis in the management of chronic flatfoot deformity of the left foot. The patient is in supine position with the legs spread. (A) medial talonavicular arthroscopy is performed via the medial and dorsomedial midtarsal portals. (B) Lateral talonavicular arthroscopy is performed via the dorsolateral and dorsomedial midtarsal portals. (C) The articular cartilage is denuded with an arthroscopic shaver. (AS, arthroscopic shaver; DLP, dorsolateral midtarsal portal; DMP, dorsomedial midtarsal portal; MP, medial midtarsal portal; Nv, navicular bone; TH, talar head.) Arthroscopy Techniques 2017 6, e871-e877DOI: (10.1016/j.eats.2017.02.020) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 5 Arthroscopic triple arthrodesis in the management of chronic flatfoot deformity of the left foot. The patient is in supine position with the legs spread. (A) The talar head is resected with an Isham burr via the dorsolateral midtarsal portal. (B) After partial ostectomy of the talar head. (C) Resection of the anterior calcaneal process with an Isham burr via the dorsolateral midtarsal portal. (D) The anterior calcaneal process is resected to level with the cut surface of the talar head. (Ca, calcaneus; Cu, cuboid bone; IB, Isham burr; KW, K-wire; Nv, navicular bone; TH, talar head.) Arthroscopy Techniques 2017 6, e871-e877DOI: (10.1016/j.eats.2017.02.020) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 6 Arthroscopic triple arthrodesis in the management of chronic flatfoot deformity of the left foot. The patient is in supine position with the legs spread. (A) The cuboid bone is pushed dorsally (arrow) before insertion of the calcaneocuboid guide wire. (B) Dorsoplantar radiograph of the foot after arthroscopic triple arthrodesis. (C) Lateral radiograph of the foot after arthroscopic triple arthrodesis. (Ca, calcaneus; Cu, cuboid bone; GW, guide wire; Nv, navicular bone; T, talus.) Arthroscopy Techniques 2017 6, e871-e877DOI: (10.1016/j.eats.2017.02.020) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions