Subtalar arthroscopic debridment for the treatment of sinus tarsi syndrome: case series

Abstract

SUMMARY OBJECTIVE: The objective of this study is to report the results of arthroscopic debridement of the subtalar joint in eight patients with Sinus Tarsi Syndrome (STS) refractory to conservative treatment. METHODS: This is a retrospective study of eight patients with STS who underwent subtalar arthroscopy for debridement of the sinus tarsi between January 2015 and January 2017 after six months of conservative treatment. All patients answered an epidemiological questionnaire and underwent functional evaluation with the Visual Analogue Pain Scale (VAS) and the American Orthopedic Foot and Ankle Society Score (AOFAS) in the preoperative and in the last evaluation (average of 12 months - 6-24 months). RESULTS: All patients showed severe synovitis in the region. Seven patients had remnants of the talocalcaneal ligaments and six of the cervical ligament. AOFAS increased by 30 points on average (51.75 in the preoperative period to 82.62 in the last follow-up) and the VAS decreased on average by 5 points (7.37 preoperatively to 2.12 in the last follow-up). These results were statistically significant with p = 0.043 and p = 0.032 respectively. Six patients described the result as excellent and two as good. No complications were reported. All patients returned to sports after six months of follow-up. CONCLUSION: The arthroscopic debridement of the subtalar joint is an effective and safe alternative in the treatment of STS refractory to conservative treatment. More studies, with a prospective methodology, are necessary to prove the results of this technique.

Six out of ten patients with sinus tarsi syndrome returned to pre-injury type of sport after subtalar arthroscopy

“…It was assessed that the patients reached a post-operative NRS during walking and running of 2.0 and 3.0, respectively, which shows the clinical efficacy of the procedure. This is in line with current literature on arthroscopic treatment [ 3 , 12 , 17 ]. Another clinical score that was measured in the present study was the Foot and Ankle Outcome Score (FAOS).…”

“…Lee et al [12] published a study of 33 patients regarding arthroscopic findings and clinical outcomes. A similar study with 8 patients has been performed by Mansur et al [17]. No long‐term follow‐up study has been performed up to date for the case of subtalar arthroscopies for sinus tarsi syndrome.…”

“…Both the pain outcomes (NRS) and other clinical PROMs of our study should however be interpreted in the light of length of follow‐up of the different studies in the literature. Our study was performed at a median follow‐up time of 60 months, while the different studies had a considerably shorter follow‐up time (ranging from 12 to 24 months) than our data being presented making the present study—to the best of our knowledge—the study with the longest follow‐up in the highest number of patients in the literature [12, 17, 18].…”

“…Concerning the evidence on the efficacy of operative interventions for STS, it is clear that a low number studies with limited number of included patients and low methodological quality have been published [ 12 , 17 , 18 ]. Oloff et al [ 18 ] reviewed 29 cases of patients treated with subtalar arthroscopies as diagnostic or therapeutic treatment for sinus tarsi syndrome.…”

A high rate of talocalcaneal interosseous ligament tears was found in chronic lateral ankle instability with sinus tarsi pain

“…Since STS was first reported by O’Connor and Brown [7, 28], the goal of surgical treatment has been decompressed and evacuated abnormal hypertrophic soft tissue in the subtalar joint. Furthermore, several reports state that arthroscopic debridement of STS yields good results [2, 11, 22, 23, 25, 29]. However, simple arthroscopic debridement without the ligament surgery is not expected to improve STI and ITCL tears.…”