SLR - August 2022 - Nicholas Chang, DPM
Reference: Corin, Boris, et al. “Resection of Calcaneonavicular Coalition: Arthroscopic or Open Approach?” Journal of Children’s Orthopaedics, vol. 16, no. 2, Apr. 2022, pp. 136–140, 10.1177/18632521221087170. Accessed 9 June 2022.Level of Evidence: III
Reviewed By: Nicholas Chang, DPM
Residency Program: VA Puget Sound Heath Care System, Seattle, Washington
Podiatric Relevance: Calcaneonavicular (CN) and talocalcaneal (TC) coalitions are the two most common types of tarsal coalitions, and studies have shown the incidence of CN being the highest. Although symptoms vary in intensity, they correlate directly with level of activities. Those with CN coalition usually describe pain at sinus tarsi. Physical exams typically show hindfoot valgus, forefoot abduction, and limited subtalar range of motion. Imagings aid with ruling in the diagnosis. Because CN coalition can greatly affect a young and active population, it is important to treat them appropriately for a chance to restore patients’ quality of life. The objective of this study is to compare the clinical outcomes of CN resection by arthroscopic versus open approach.
Methods: The retrospective review looked at patients between ages 8 and 18 who underwent surgery for coalition resection between January 2009 and December 2017 at the affiliated tertiary care university hospital. A total of 127/238 patients had either unilateral or bilateral CN coalition that failed conservative management. Two surgeons performed the arthroscopic procedures in 81 patients, whereas several different surgeons performed the open surgeries in 46 patients. Minimum follow-up was 24 months. Mean follow-up of the entire cohort was 67.1 months. The open technique involved an Ollier’s incision and the interposition of extensor digitorum brevis (EDB) muscle flap. The arthroscopic technique was carried out with the arthroscopic portal dorsal to the Gissane angle at the posterior aspect of the anterior process of the calcaneus, and the instrument portal placed anterior and distal to the anterior process of the calcaneus and lateral to the extensor digitorum longus tendon. The EDB muscle was detached with a shaver, and the CN bar was resected using an arthroscopic burr and curette without flap interposition. The amount of resection for both groups was approximately 10mm.
Results: On average, the study revealed shorter hospital stay for arthroscopic group (2.6 days) compared to open group (3); longer duration of procedure for arthroscopic group (24.5 minutes) versus open group (20.5). Regarding subjective findings, the Foot and Ankle Ability Measure (FAAM) survey was used; there was no statistically significant difference in activity of daily living subscale while the arthroscopic group score better in sports subscale. Nevertheless, revision rate was significantly higher in the arthroscopic subjects (12 patients) versus open (1). Persistent symptoms were the main reason for revision in 10 of the arthroscopic candidates, with the other 2 being surgical site infections. During revision, it was revealed that recurrence of CN coalition was found in 4 of the 12 arthroscopic group patients as well as in the one open group patient.
Conclusion: Although shorter hospital stays and better FAAM sports subscale favor the arthroscopic approach, it was undeniably demonstrated that arthroscopic treatment of CN coalition is associated with a higher revision rate than the open approach due to pain and recurrence. Therefore, it is justified for open surgery to be the procedure of choice in CN coalition resection.