SLR - July 2019 - Michelle A. Hurless
Reference: Knorr J, Soldado F, Menendez ME, Domenech P, Sanchez M, Sales de Gauzy J. Arthroscopic Talocalcaneal Coalition Resection in Children. Arthroscopy: The Journal of Arthroscopic and Related Surgery,2015: pp 1-7Scientific Literature Review
Reviewed By: Michelle A. Hurless, DPM
Residency Program: Hunt Regional Medical Center – Greenville, TX
Podiatric Relevance: Diagnosis and treatment of tarsal coalitions is an interesting topic in podiatric medicine. Although likely not encountered on a daily basis, it is something we need to pay mind to. In the world of emerging minimally invasive surgery, and the trend towards this, we must stay up to date and informed on these surgical options. The goal of this study was to evaluate the surgical technique and outcomes of talocalcaneal coalition resections arthroscopically. The authors hypothesized that an arthroscopic approach would yield safe and effective results.
Methods: This is a level IV therapeutic prospective case series in which they evaluated resection of coalitions in 16 feet (15 patients) with persistent symptomatic talocalcaneal coalitions for > six months after failing conservative care, using a posterior arthroscopic resection. Calcaneo-stop procedure was performed in patients with >20O hindfoot valgus. Patients were excluded which had a coalition affecting >50 percent of the STJ and degenerative changes. Mean age of 11.8 years, and a mean follow-up of 28 months. The outcomes were evaluated using plantar footprint, subtalar motion, pain, the AOFAS scale score and pre and post op CT scans evaluating extent of TCC’s.
Results: The study showed satisfactory results with all patients reporting improvement in pain after surgery, which was statistically significant. The CT scans taken at one year in 15 patients and three years in five patients, revealed total resection with no recurrences of the TCC’s. There was improvement in the footprint classification by at least one point in all patients as well as increase in STJ mobility. Statistically significant increase in AOFAS score was seen in preoperative vs postoperative scores. One patient developed CRPS.
Conclusions: As stated in the article, results of open resection have positive long term outcomes, however still have their complications. This study showed satisfactory outcomes using an arthroscopic resection method, however in a small patient population, and the authors concluded that it was a viable option for TCC resection moving forward. It would be helpful to determine if there was a difference in outcomes between the Rozansky classes and/or evaluate in a larger sample. This may help guide more specific treatment for future patients. Due to the positive results with decreased pain and hospital stays, decrease in wound healing complications, and a faster recovery, arthroscopic resection of TCC coalitions by a posterior approach should be considered in every day practice. Additionally, this approach has the potential to provide superior visualization compared to the alternatives. A possible downfall to this approach is the potential of damage to the medial neurovascular bundle, so it should be performed only after practice and with care.