Ankle Arthroscopy With Microfracture for Osteochondral Defects of the Talus Suman Medda, M.D., Ian M. Al'Khafaji, M.D., Aaron T. Scott, M.D. Arthroscopy Techniques Volume 6, Issue 1, Pages e167-e174 (February 2017) DOI: 10.1016/j.eats.2016.09.013 Copyright © 2016 Arthroscopy Association of North America Terms and Conditions
Fig 1 (A) With the patient supine, a tourniquet (white arrow) was placed around the left upper thigh, and the left leg was placed in a thigh holder (red arrow). (B) With the patient supine, a noninvasive ankle distractor (white arrow) was applied to the left foot and set to 30 foot-pounds of inline traction. Arthroscopy Techniques 2017 6, e167-e174DOI: (10.1016/j.eats.2016.09.013) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions
Fig 2 (A) With the patient supine, the medial malleolus and tibialis anterior tendon were palpated on the left lower extremity to serve as landmarks for the anteromedial portal (white circle). (B) With the patient supine, the lateral malleolus and extensor digitorum longus were palpated on the left lower extremity to identify landmarks for the anterolateral portal (white circle), which would be later placed under direct visualization. (C) With the patient supine, the blunt trocar (white arrow) was advanced into the anteromedial portal of the left ankle. (EDL, extensor digitorum longus; EHL, extensor hallucis longus; Saph., saphenous vein; SPN, superficial peroneal nerve; TA, tibialis anterior.) Arthroscopy Techniques 2017 6, e167-e174DOI: (10.1016/j.eats.2016.09.013) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions
Fig 3 With the patient supine and the arthroscope in the anteromedial portal, the joint space between the tibia (superior) and talus (inferior) was appreciated with inflamed synovium (white arrow). Arthroscopy Techniques 2017 6, e167-e174DOI: (10.1016/j.eats.2016.09.013) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions
Fig 4 (A) With the patient supine and the arthroscope in the anteromedial portal, a 20-gauge needle (white arrow) was inserted just lateral to the peroneus tertius tendon of the left ankle at the level of the joint line and was directly visualized by the arthroscope. (B) With the patient supine and the arthroscope in the anteromedial portal, a 20-gauge needle was inserted at the location of the anterolateral portal of the left ankle. A skin incision was then made, and a tonsil (white arrow) was used to bluntly dissect down to the joint before a trocar was introduced. Arthroscopy Techniques 2017 6, e167-e174DOI: (10.1016/j.eats.2016.09.013) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions
Fig 5 With the patient supine and the arthroscope in the anteromedial portal of the left ankle, a probe (white arrow) was introduced into the anterolateral portal of the left ankle and used to elevate the unstable cartilage (red arrow) around the base and within the perimeter of the osteochondral defect of the talus (pictured inferiorly). Arthroscopy Techniques 2017 6, e167-e174DOI: (10.1016/j.eats.2016.09.013) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions
Fig 6 With the patient supine and the arthroscope in the anteromedial portal of the left ankle, an arthroscopic shaver (white arrow) was introduced into the anterolateral portal of the left ankle to debride some of the loose flaps of cartilage (red arrow). Arthroscopy Techniques 2017 6, e167-e174DOI: (10.1016/j.eats.2016.09.013) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions
Fig 7 With the patient supine and the arthroscope in the anteromedial portal of the left ankle, a small sharp curette (white arrow) was introduced into the anterolateral portal of the left ankle and used to remove the remaining unstable cartilage (red arrow). Arthroscopy Techniques 2017 6, e167-e174DOI: (10.1016/j.eats.2016.09.013) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions
Fig 8 With the patient supine and the arthroscope in the anteromedial portal of the left ankle, a grasper (white arrow) was introduced into the anterolateral portal of the left ankle to remove large loose bodies (red arrow) from the left ankle joint. Arthroscopy Techniques 2017 6, e167-e174DOI: (10.1016/j.eats.2016.09.013) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions
Fig 9 With the patient supine and the arthroscope in the anteromedial portal of the left ankle, an anterior lesion curette (white arrow) was introduced into the anterolateral portal of the left ankle and was used to further debride the anterior defect (red arrow). Arthroscopy Techniques 2017 6, e167-e174DOI: (10.1016/j.eats.2016.09.013) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions
Fig 10 With the patient supine and the arthroscope in the anteromedial portal of the left ankle, an arthroscopic cannula (white arrow) was introduced into the anterolateral portal of the left ankle and connected to suction and used to capture the remaining loose fragments (red arrow) from the left ankle joint. Arthroscopy Techniques 2017 6, e167-e174DOI: (10.1016/j.eats.2016.09.013) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions
Fig 11 With the patient supine and the arthroscope in the anterolateral portal of the left ankle, the talofibular articulation was assessed with the talus on the left (white arrow) and the fibula on the right (red arrow). Arthroscopy Techniques 2017 6, e167-e174DOI: (10.1016/j.eats.2016.09.013) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions
Fig 12 With the patient supine and the arthroscope in the anteromedial portal of the left ankle, a microfracture pick (white arrow) was introduced through the anterolateral portal of the left ankle and used to create several small fractures in the subchondral bone (red arrow). Arthroscopy Techniques 2017 6, e167-e174DOI: (10.1016/j.eats.2016.09.013) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions
Fig 13 With the patient supine and the arthroscope in the anteromedial portal of the left ankle, the water pressure within the left ankle joint was released and good bleeding was observed from the microfracture sites (white arrow). Arthroscopy Techniques 2017 6, e167-e174DOI: (10.1016/j.eats.2016.09.013) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions