Subtalar Fusion Preparation: What Are We Really Doing? A Cadaver Study

Abyar, Eildar; McKissack, Haley; Pinto, Martim; Littlefield, Zachary; Moraes, Leonardo; Stefani, Kelly; Shah, Ashish

doi:10.1177/1938640019846970

Cited by 8 publications

(3 citation statements)

References 32 publications

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“…It remains unclear how much cartilage of a joint has to be removed to obtain a mechanically stable arthrodesis. A cadaver study of Abyar et al 1 demonstrated that the percentage of total unprepared articular surface area was mean 8.7% when performing subtalar arthrodesis via the most frequently used open lateral sinus tarsi approach. Klassen et al 9 reported a nonunion rate of 8.9% after subtalar joint arthrodesis in a retrospective analysis of 157 cases.…”

Section: Discussionmentioning

confidence: 99%

Open vs Minimally Invasive Resection of the First Metatarsocuneiform Joint: An Anatomical Study

Schilde,

Arbab,

Felsberg

et al. 2023

Foot Ankle Int.

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Background: The modified Lapidus arthrodesis is a standard procedure to correct middle to severe hallux valgus (HV) deformities. Recently, minimally invasive techniques of first metatarsocuneiform joint (MCJ) resection using a Shannon burr were described. The primary goal of this study is to compare the anatomical efficacy and safety of first MCJ resection using a straight 2 × 13-mm Shannon burr and minimally invasive technique (MIS) vs an open technique using an oscillating saw. Methods: Ten pairs of fresh frozen cadaveric feet were randomly assigned to open or MIS first MCJ resection with subsequent systematic dissection. For the MIS procedure, a dorsomedial approach was used and for the open procedure a medioplantar approach was used. Cartilage removal was investigated by analyzing standardized scaled photographs of the resected articular surfaces with ImageJ software. Nearby structures at risk were analyzed for iatrogenic violation: tibialis anterior (TA), extensor hallucis longus (EHL) and peroneus longus (PL) tendons, and the Lisfranc ligament complex (LLC). Results: In the MIS group, the median cartilage resection was 85.9% at the cuneiform and 85.6% at the metatarsal bone compared to 100% cartilage resection in open technique ( P < .01). Iatrogenic damage of the LLC, EHL, and TA tendons was not found in any group. The PL tendon was thinned out (<25% of tendon thickness) in 4 cases (40%) in the open group and in 1 case (10%) in the MIS group. A safe zone of 3.0 mm between the articular surface of the cuneiform bone and the LLC was identified, which can be resected without putting the LLC at risk when performing lateral-based wedge resections. Conclusion: In this cadaver study with the procedures performed by an experienced foot and ankle surgeon, and using 2 different surgical approaches, we found general parity between the Shannon burr MIS technique vs oscillating saw open technique techniques with more risk to the PL with our open technique and approximately 15% less cartilage resection with our MIS technique. Level of Evidence: Level V, cadaver study.

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Section: Discussionmentioning

confidence: 99%

Open vs Minimally Invasive Resection of the First Metatarsocuneiform Joint: An Anatomical Study

Schilde,

Arbab,

Felsberg

et al. 2023

Foot Ankle Int.

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“…Anticipated mean and standard deviation was estimated from prior joint preparation studies. 1,8,9 Alpha was set at 0.05 and power at 80%. The joints of interest for this study included the tibiotalar joint, posterior facet of the talocalcaneal joint, TN joint, CC joint, NC joint, TMT joints of rays 1-3, hallux MTP joint, and hallux IP joint.…”

Section: Methodsmentioning

confidence: 99%

Quality of MIS vs Open Joint Preparations of the Foot and Ankle

et al. 2022

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Background: Minimally invasive surgery (MIS) is growing in the field of foot and ankle, and the MIS burr is an emerging tool. Although commonly used to perform osteotomies, the burr can also be used for arthrodesis joint preparation that traditionally would be performed through open incisions. To date, there is no study comparing the quality of joint preparation between using a fluoroscopy-guided MIS technique compared to traditional open techniques. The goal of this cadaveric study is to compare the percentage of joint surfaces prepared between MIS and open techniques for the most common joints that are fused in foot and ankle surgery. Methods: Open joint preparation was performed under direct visualization with open incisions. MIS joint preparation was performed percutaneously using fluoroscopic guidance alone, without arthroscopy. After joint preparation, cadaveric samples were disarticulated, and joint surfaces were analyzed for percentage of cartilaginous surface removed. The percentage of joint surface prepared was compared between the open and MIS techniques. Results: Ten cadaveric samples were used for the MIS technique and 5 samples for the open technique. Percentage of joint surface prepared was similar for all joint surfaces. Conclusion: The MIS technique in the hands of experienced surgeons was found to provide overall similar percentages of surface area prepared compared to traditional open techniques. Clinical Relevance: MIS joint preparation may be useful for specific patient populations. This study suggests that MIS joint preparation is a reasonable, and possibly advantageous, alternative to open preparation in arthrodesis surgery when performed by experienced MIS surgeons.

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“…High-resolution pictorial images of both joint surfaces were obtained. Estimated fusion contact area was assessed and outlined, and the total fusion contact surface area and the amount of unprepared cartilage on the proximal phalanx and distal metatarsal head were measured using ImageJ software (Figure 2 ) [ 12 - 14 ]. These measurements were used to calculate the percentages of prepared and unprepared cartilage of each articular surface for each specimen.…”

Section: Methodsmentioning

confidence: 99%

Joint Preparation and Ray Shortening in Arthroscopic Versus Open First Metatarsophalangeal Fusion: A Cadaver Study

McKissack

Alexander

Viner

et al. 2020

Cureus

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This study compares the amount of joint preparation and first ray shortening following first metatarsophalangeal (MTP) joint fusion utilizing open conical reaming versus arthroscopic technique. Methods Ten below-knee cadaver specimens were randomly assigned to undergo either open or arthroscopic first MTP fusion. Following fixation, first ray length measurements were obtained from pre-operative and post-operative radiographs and were used to determine first ray shortening. Additionally, the ratio of first ray length to second ray length was calculated both pre-operatively and post-operatively and compared between the two approaches. All ankles were then completely dissected, and prepared surface areas were demarcated. ImageJ photo analysis software (National Institutes of Health, Bethesda, MD, USA) was used to calculate the percentage of prepared and unprepared cartilage of each articular surface of each specimen. Results Overall, the open approach resulted in 99.3% ± 1.6% joint surface preparation, whereas the arthroscopic approach yielded 92.9% ± 7.2% (p = 0.089). On average, the head of the first metatarsal was significantly more prepared with the use of the open approach (99.5% ± 1.1%) than with the arthroscopic approach (96.6% ± 1.5%) (p = 0.008). However, with respect to the base of the phalanx, the average difference in preparation between the arthroscopic approach and the open approach was not statistically significant (90.0% ± 12.8% vs. 99.0% ± 2.2%; p = 0.160). The average amount of first ray shortening in the arthroscopic approach was 2.2 ± 1.8 mm compared to 2.1 ± 3.2 mm in the open approach (p = 0.934). The average change in the first to second ray length ratio was 0.02 for both approaches (p = 0.891).

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Subtalar Fusion Preparation: What Are We Really Doing? A Cadaver Study

Cited by 8 publications

References 32 publications

Open vs Minimally Invasive Resection of the First Metatarsocuneiform Joint: An Anatomical Study

Open vs Minimally Invasive Resection of the First Metatarsocuneiform Joint: An Anatomical Study

Quality of MIS vs Open Joint Preparations of the Foot and Ankle

Joint Preparation and Ray Shortening in Arthroscopic Versus Open First Metatarsophalangeal Fusion: A Cadaver Study

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