Arthroscopically Assisted Modified Jones Procedure Tun Hing Lui, M.B.B.S.(HK), F.R.C.S.(Edin), F.H.K.A.M., F.H.K.C.O.S.  Arthroscopy Techniques  Volume 5, Issue 6, Pages e1401-e1406 (December 2016) DOI: 10.1016/j.eats.2016.08.012 Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 1 Arthroscopically assisted modified Jones procedure in right foot. The hallux interphalangeal arthroscopy is performed through the dorsomedial portal (DMP) and dorsolateral portal (DLP), which are located at the dorsolateral and dorsomedial corners of the hallux interphalangeal joint, respectively. (DP, distal phalanx; EHL, extensor hallucis longus tendon; PP, proximal phalanx.) Arthroscopy Techniques 2016 5, e1401-e1406DOI: (10.1016/j.eats.2016.08.012) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 2 Arthroscopically assisted modified Jones procedure in right foot. (A) The dorsomedial portal (DMP) is the viewing portal. The lateral collateral ligament of the interphalangeal joint is released by SuperCut scissors through the dorsolateral portal (DLP). (B) An arthroscopic view shows release of the lateral collateral ligament (LCL) by the scissors (S). (DP, distal phalanx; PP, proximal phalanx.) Arthroscopy Techniques 2016 5, e1401-e1406DOI: (10.1016/j.eats.2016.08.012) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 3 Arthroscopically assisted modified Jones procedure in right foot. (A) The dorsomedial portal (DMP) is the viewing portal. The articular cartilage is resected by an arthroscopic shaver through the dorsolateral portal (DLP). (B) An arthroscopic view shows debridement of the cartilage by the shaver through the dorsolateral portal. (DP, distal phalanx; PP, proximal phalanx.) Arthroscopy Techniques 2016 5, e1401-e1406DOI: (10.1016/j.eats.2016.08.012) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 4 Arthroscopically assisted modified Jones procedure in right foot. (A) A 4.0-mm cannulated screw is inserted through a small incision at the tip of the hallux to transfix the interphalangeal joint. (B) A fluoroscopic view shows transfixation of the interphalangeal joint by the cannulated screw. Arthroscopy Techniques 2016 5, e1401-e1406DOI: (10.1016/j.eats.2016.08.012) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 5 Arthroscopically assisted modified Jones procedure in right foot. (A) Extensor hallucis longus tendoscopy is performed through the dorsomedial portal (DMP) and proximal-medial portal (PMP). (DLP, dorsolateral portal.) (B) The dorsomedial portal is the viewing portal. The extensor hallucis longus (EHL) tendon is released from the extensor expansion by an arthroscopic shaver (S). (C) Release of the EHL tendon is completed by an open-ended tendon stripper. (D) The tendon is retrieved to the proximal-medial portal, and a stay stitch is applied with No. 0 Vicryl. Arthroscopy Techniques 2016 5, e1401-e1406DOI: (10.1016/j.eats.2016.08.012) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 6 Arthroscopically assisted modified Jones procedure in right foot. If extensor hallucis longus (EHL) transfer to another part of the foot is planned, a 1-cm proximal incision (PI) is made over the EHL tendon just distal to the ankle joint. The EHL tendon is then retrieved to this incision and can be rerouted to the other part of the foot. (DLP, dorsolateral portal; DMP, dorsomedial portal; PMP, proximal-medial portal.) Arthroscopy Techniques 2016 5, e1401-e1406DOI: (10.1016/j.eats.2016.08.012) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 7 Arthroscopically assisted modified Jones procedure in right foot. (A) The proximal-medial portal (PMP) incision is retracted in a plantar manner. A 2.5- to 3.5-mm bone tunnel is made at the first metatarsal neck. The tunnel is from plantar-medial to dorsal-lateral. (B) A 16-gauge angiocath is inserted through the proximal-medial portal and through the bone tunnel and pierces through the dorsal skin. The core needle is removed, and the plastic tube is left for passage of suture. A No. 1 PDS suture loop is passed through the plastic tube. (C) The plastic tube is removed, and the suture limbs are retrieved over the dorsum of the first metatarsal back to the proximal-medial portal by a hemostat. (D) The PDS suture loop serves as a suture retriever to pass the extensor hallucis longus (EHL) tendon and its stay stitches through the bone tunnel, along the dorsum of the first metatarsal neck, back to the proximal-medial portal. Arthroscopy Techniques 2016 5, e1401-e1406DOI: (10.1016/j.eats.2016.08.012) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 8 Arthroscopically assisted modified Jones procedure in right foot. The extensor hallucis longus (EHL) passes through the bone tunnel, along the dorsum of the first metatarsal, back to the proximal-medial portal. Arthroscopy Techniques 2016 5, e1401-e1406DOI: (10.1016/j.eats.2016.08.012) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 9 Arthroscopically assisted modified Jones procedure in right foot. (A) The extensor hallucis longus (EHL) tendon is tensioned and sutured to itself at the proximal-medial portal. (B) Remnant of EHL stump after suturing to itself. (C) The stay stitches are retrieved proximally to a proximal incision (PI) over the EHL tendon. (D) The stay stitches can be sutured to the EHL tendon at the proximal site by an eyed needle. (PMP, proximal-medial portal.) Arthroscopy Techniques 2016 5, e1401-e1406DOI: (10.1016/j.eats.2016.08.012) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions