SLR- January 2014- Michael J. Kim
Reference: Chul Hyun Park, Sung Yoon Kim, Jung Rae Kim and Woo Chun Lee. Arthroscopic Excision of a Symptomatic Os Trigonum in a Lateral Decubitus Position. FAI 2013; 34(7) 990-994.
Scientific Literature Review
Reviewed By: Michael J. Kim, DPM
Residency Program: St. John Hospital and Medical Center
Podiatric Relevance: Symptomatic os trigonum can be excised either with an open procedure or arthroscopically. Open excision of os trigonum yields satisfactory outcome while arthroscopic excision provides lower complication rates and a shorter recovery period. There are various arthroscopic techniques described in the current literature for creating portals, but each has its own limitation. Park et al introduce a new technique utilizing anterolateral, centrolateral and posterolateral portals with patient in the lateral decubitus position and reports that the technique is safe and effective.
Methods: The authors conducted a retrospective study on 23 ankles of 23 consecutive patients who underwent sub-talar arthroscopic removal of os trigonum in lateral decubitus position by a single surgeon (W.C.L) from May of 2007 to May of 2011. Twenty out of 23 patients were male and professional athletes. Mean duration of post-operative follow up was 18 months. The four perimeters including 1) AOFAS ankle-hindfoot score, 2) VAS for pain, 3) measurement for active plantar flexion of ankle preoperatively and at last follow up, and 4) time to return to work and sports activities were used to assess surgical outcome.Results: AOFAS ankle-hindfoot score improved from 71.3 (59-85) preoperatively to 94.7 (90-100) postoperatively and VAS for pain decreased from 6.7 (range 3-10) to 1.5 (0-3). Average plantarflexion of the ankle increased from 28.8 degrees to 42.5 degrees post-operatively. Average time to return to sports activity was 6.7 weeks.
Conclusions: Arthroscopic excision through anterolateral and posterolateral portals with the patient in supine position has been reported, however, the manipulation of surgical instruments through posterolateral portal was technically challenging due to supine position of the patient. Others have utilized posteromedial and posterolateral portals with the patient in the prone position, but this requires change of position to supine intra-operatively and poses a greater risk of injuring neurovascular structures due to its proximity. Arthroscopic excision of a symptomatic os trigonum excision utilizing anterolateral, centrolateral and posterolateral portal may offer a more efficient and safer technique by better mobilization of the instrument through central portal, and may offer a more comfortable position for the patient and less risk of injuring neurovascular structures.