Endoscopic Distal Tibiofibular Syndesmosis Arthrodesis Tun Hing Lui, M.B.B.S., F.R.C.S. (Edin), F.H.K.A.M., F.H.K.C.O.S.  Arthroscopy Techniques  Volume 5, Issue 2, Pages e419-e424 (April 2016) DOI: 10.1016/j.eats.2016.01.021 Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 1 Left ankle. (A) The proximal anterolateral portal (PALP) is located 1.5 cm above the upper border of the overlap and lateral to the tibialis anterior tendon. (B) The proximal posterolateral portal (PPLP) is at the lateral border of the Achilles tendon 2 cm above the PALP. Arthroscopy Techniques 2016 5, e419-e424DOI: (10.1016/j.eats.2016.01.021) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 2 Left ankle. Switching rod technique. (A) The trocar-cannula is introduced from the proximal anterolateral portal to the proximal posterolateral portal. The trocar is removed and the switching rod is inserted into the cannula. (B) The cannula is then removed and reinserted along the rod through the proximal posterolateral portal. The rod is removed and the arthroscopic shaver is inserted half-way into the cannula through the proximal anterolateral portal. (C) The cannula is withdrawn half-way and the arthroscope is inserted. (D) This can guarantee the correct placement of the arthroscope and the shaver. Arthroscopy Techniques 2016 5, e419-e424DOI: (10.1016/j.eats.2016.01.021) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 3 Left ankle. (A) The debridement of the anterior rim of the syndesmosis through the proximal anterolateral portal is difficult because the manipulation of the shaver is blocked by the shin of the patient. (B) The shaver can be inserted to the top of the anterior rim of the syndesmosis through the anterolateral ankle portal. The debridement of the anterior rim of the syndesmosis can be started from the top downward. The handpiece of the shaver is moving upward and would not be hindered by the foot or the shin of the patient. Arthroscopy Techniques 2016 5, e419-e424DOI: (10.1016/j.eats.2016.01.021) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 4 Left ankle. Syndesmosis endoscopic views. The proximal posterolateral portal is the viewing portal. (A) Curettage of the scar tissue of the syndesmosis. (B) Resection of the bone block by an arthroscopic acromionizer. (C) Exposure of the anterolateral part of the talar dome (td) after release of the syndesmosis. (D) Preparation of the fusion surfaces by microfracture with an arthroscopic awl. (f, fibula; ib, impinging bone of the distal tibia; t, tibia.) Arthroscopy Techniques 2016 5, e419-e424DOI: (10.1016/j.eats.2016.01.021) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 5 (A) Preoperative anteroposterior radiograph of the left ankle of the illustrated case showing lateral displacement of the talus inside the ankle mortise. (B) Postoperative radiograph showing that the syndesmosis is stabilized with 2 screws and the talus is reduced. Arthroscopy Techniques 2016 5, e419-e424DOI: (10.1016/j.eats.2016.01.021) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions