Endoscopic Accessory Navicular Synchondrosis Fusion

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Endoscopic Accessory Navicular Synchondrosis Fusion 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 e1267-e1272 (December 2016) DOI: 10.1016/j.eats.2016.07.018 Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 1 Endoscopic accessory navicular synchondrosis fusion of left foot. The surface landmarks of the medial malleolus (MM), tibialis posterior tendon (TPT), navicular bone (N), accessory navicular (AN), and synchondrosis (S) are outlined. Accessory navicular synchondrosis endoscopy is performed through the dorsal portal (DP) and plantar portal (PP). Arthroscopy Techniques 2016 5, e1267-e1272DOI: (10.1016/j.eats.2016.07.018) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 2 Endoscopic accessory navicular synchondrosis fusion of left foot. (A) The synchondrosis can be marked by a needle (arrowhead) that is inserted under fluoroscopy. (B) The needle can serve as an arthroscopic landmark for the synchondrosis during endoscopy. (AN, accessory navicular; MM, medial malleolus; N, navicular bone; S, synchondrosis; TPT, tibialis posterior tendon.) Arthroscopy Techniques 2016 5, e1267-e1272DOI: (10.1016/j.eats.2016.07.018) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 3 Endoscopic accessory navicular synchondrosis fusion of left foot. The plantar portal is the viewing portal. The synchondrosis (S) is debrided with an arthroscopic shaver through the dorsal portal. (AN, accessory navicular; N, navicular bone.) Arthroscopy Techniques 2016 5, e1267-e1272DOI: (10.1016/j.eats.2016.07.018) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 4 Endoscopic accessory navicular synchondrosis fusion of left foot. The plantar portal is the viewing portal. The bone surface of the accessory navicular (AN) is cleared by a small periosteal elevator through the dorsal portal. (N, navicular bone.) Arthroscopy Techniques 2016 5, e1267-e1272DOI: (10.1016/j.eats.2016.07.018) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 5 Endoscopic accessory navicular synchondrosis fusion of left foot. The plantar portal is the viewing portal. (A) Percutaneous drilling of the synchondrosis (S) by a K-wire through the proximal end of the accessory navicular (AN). (B) The bone surface of the navicular (N) is drilled through by the K-wire. (MM, medial malleolus; N, navicular bone; TPT, tibialis posterior tendon.) Arthroscopy Techniques 2016 5, e1267-e1272DOI: (10.1016/j.eats.2016.07.018) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 6 Endoscopic accessory navicular synchondrosis fusion of left foot. The plantar portal is the viewing portal. Microfracture of the bone surface of the accessory navicular (AN) is performed by an arthroscopic awl through the dorsal portal. (N, navicular bone.) Arthroscopy Techniques 2016 5, e1267-e1272DOI: (10.1016/j.eats.2016.07.018) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 7 Endoscopic accessory navicular synchondrosis fusion of left foot. The plantar portal is the viewing portal. Bleeding from the microfracture sites can be seen after the tourniquet is deflated. (AN, accessory navicular; N, navicular bone.) Arthroscopy Techniques 2016 5, e1267-e1272DOI: (10.1016/j.eats.2016.07.018) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 8 Endoscopic accessory navicular synchondrosis fusion of left foot. (A) A preoperative radiograph of the illustrated case shows diastasis (arrowhead) of the type II accessory navicular (AN) from the navicular bone (N). (B) Intraoperative fluoroscopy shows the diastasis is reduced and transfixed by a screw (arrowhead). Arthroscopy Techniques 2016 5, e1267-e1272DOI: (10.1016/j.eats.2016.07.018) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 9 Endoscopic accessory navicular synchondrosis fusion of left foot. Posterior tibial tendoscopy (A) and talonavicular arthroscopy (B) can be performed through the dorsal portal (DP). (AN, accessory navicular; MM, medial malleolus; N, navicular bone; PP, plantar portal; TH, talar head; TPT, tibialis posterior tendon.) Arthroscopy Techniques 2016 5, e1267-e1272DOI: (10.1016/j.eats.2016.07.018) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions