Effectiveness of a modified posterior approach for arthroscopic resection on painful talocalcaneal coalition in adults_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WU Guozhong ,  WANG Wenhuai , CHEN Shoubo , LIN Sanfu

Department of Orthopedics, the Second Affiliated Hospital of Fujian Medical University, Quanzhou Fujian, 362000, P.R.China;

Corresponding?author：

WANG Wenhuai, Email: xiaodi50a@163.com

Keywords：

Talocalcaneal coalition; posterior ankle approach; flexor hallucis longus tendon; medial talocalcaneal ligament; ankle arthroscope

DOI：

10.7507/1002-1892.201905087

Video：

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Objective To investigate the effectiveness of arthroscopic talocalcaneal coalition resection in painful adults via a modified posterior approach.Methods Between January 2015 and December 2017, 9 patients with painful talocalcaneal coalition accepted arthroscopic resection via the posterior malleolus high lateral observation approach combined with the lower medial operation approach. Of them, 6 were male and 3 were female, aged from 19 to 30 years (mean, 24 years). Among them, 2 cases had no definite local trauma and 7 cases had a history of sprain of foot and ankle. The disease duration ranged from 6 to 30 months, with a median of 12 months. Rozansky classification of talocalcaneal coalition for the 9 patients: 5 cases (5 feet) were type Ⅰ, 2 cases (2 feet) type Ⅱ, and 2 cases (2 feet) type Ⅲ. The patients had no sequelae of limb dysfunction and no limb joint surgery in the past. All the patients received anteroposterior and lateral X-ray films and CT scans of the ankle joint during follow-up. The visual analogue scale (VAS) score and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hind foot score were used to evaluate the effectiveness.Results The operation time was 60-90 minutes (mean, 76 minutes). All patients were followed up 12-24 months (mean, 18 months). All the incisions healed by first intention, without infection, skin necrosis, lower extremity deep vein thrombosis, vascular nerve and tendon injury, bone bridge recurrence, and other complications. The ankle function recovered well and the pain was relieved obviously after operation, and the patients returned to work at 3-5 months after operation, with an average of 3.9 months. At last follow-up, the VAS score was 0.7±0.5, which was significantly improved (t=20.239, P=0.000) when compared with preoperative score (4.2±0.5); the AOFAS ankle-hind foot score was 94±4, which was significantly improved (t=?27.424, P=0.000) when compared with preoperative score (62±2). According to AOFAS ankle-hindfoot scoring system, the results were excellent in 7 cases and good in 2 cases at last follow-up.Conclusion It is more intuitive, more space, and more flexibility for operation via the modified posterior malleolus high lateral observation approach combined with the lower medial operation approach in talocalcaneal coalition. It is feasible to remove talocalcaneal coalition programmatically according to the specific anatomic signs during the operation.

Citation： WU Guozhong, WANG Wenhuai, CHEN Shoubo, LIN Sanfu. Effectiveness of a modified posterior approach for arthroscopic resection on painful talocalcaneal coalition in adults. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(1): 46-52. doi: 10.7507/1002-1892.201905087 Copy

1.	陳臨新, 郭秦煒. 疼痛性跟距骨橋的診療進展. 足踝外科電子雜志, 2016, 3(4): 50-57.
2.	Tsang AY, Cheuk YY, Au-Yeung AW. Posterior facet talocalcaneal non-osseous coalition: an uncommon but easily missed cause of hindfoot pain. Hong Kong Med J, 2016, 22(6): 623. e1-e2.
3.	解冰, 閆碩, 張浩, 等. 骨橋切除治療成人非關節炎性跟距骨橋的療效觀察. 中國骨傷, 2017, 30(11): 1048-1051.
4.	郭秦煒, 荊立忠, 焦晨, 等. 跟距骨橋切除術初步療效分析. 中國運動醫學雜志, 2013, 32(8): 686-690.
5.	de Wouters S, Tran Duy K, Docquier PL. Patient-specific instruments for surgical resection of painful tarsal coalition in adolescents. Orthop Traumatol Surg Res, 2014, 100(4): 423-427.
6.	Hamel J. Resection of talocalcaneal coalition in children and adolescents without and with osteotomy of the calcaneus. Oper Orthop Traumatol, 2009, 21(2): 180-192.
7.	俞光榮, 李春光, 李兵, 等. 手術治療跟距骨橋療效觀察. 中國修復重建外科雜志, 2012, 26(5): 522-526.
8.	Hayashi K, Kumai T, Tanaka Y. Endoscopic resection of a talocalcaneal coalition using a posteromedial approach. Arthrosc Tech, 2013, 3(1): e39-e43.
9.	Bonasia DE, Phisitkul P, Saltzman CL, et al. Arthroscopic resection of talocalcaneal coalitions. Arthroscopy, 2011, 27(3): 430-435.
10.	Jagodzinski NA, Hughes A, Davis NP, et al. Arthroscopic resection of talocalcaneal coalitions—a bicentre case series of a new technique. Foot Ankle Surg, 2013, 19(2): 125-130.
11.	Rozansky A, Varley E, Moor M, et al. A radiologic classification of talocalcaneal coalitions based on 3D reconstruction. J Child Orthop, 2010, 4(2): 129-135.
12.	Lee KT, Park YU, Jegal H, et al. Femoral and sciatic nerve block for hindfoot and ankle surgery. J Orthop Sci, 2014, 19(4): 546-551.
13.	王洪軍, 宋兵, 張曉紅, 等. 跟距骨橋的高頻超聲診斷價值. 中國超聲醫學雜志, 2018, 34(10): 935-938.
14.	王志斌, 馬春忠. MRI 診斷后踝關節疼痛的病因. 中國醫學影像技術, 2017, 33(10): 1587-1590.
15.	Tom?ov?ík L. C-sign and talocalcaneal coalition. Acta Chir Orthop Traumatol Cech, 2011, 78(5): 468-471.
16.	Shirley E, Gheorghe R, Neal KM. Results of Nonoperative Treatment for Symptomatic Tarsal Coalitions. Cureus, 2018, 10(7): e2944.
17.	Mahan ST, Spencer SA, Vezeridis PS, et al. Patient-reported outcomes of tarsal coalitions treated with surgical excision. J Pediatr Orthop, 2015, 35(6): 583-588.
18.	Bonasia DE, Phisitkul P, Amendola A. Endoscopic coalition resection. Foot Ankle Clin, 2015, 20(1): 81-91.
19.	李春光, 俞光榮. 跗骨間骨橋臨床診斷與治療研究進展. 中國修復重建外科雜志, 2012, 26(7): 874-879.
20.	Lee SH, Park HJ, Yeo ED, et al. Talocalcaneal coalition: A focus on radiographic findings and sites of bridging. Indian J Orthop, 2016, 50(6): 661-668.
21.	Aldahshan W, Hamed A, Elsherief F, et al. Endoscopic resection of different types of talocalcaneal coalition. Foot Ankle Int, 2018, 39(9): 1082-1088.
22.	Kn?rr J, Soldado F, Menendez ME, et al. Arthroscopic talocalcaneal coalition resection in children. Arthroscopy, 2015, 31(12): 2417-2423.
23.	Mosca VS. Subtalar coalition in pediatrics. Foot Ankle Clin, 2015, 20(2): 265-281.
24.	Tower DE, Wood RW, Vaardahl MD. Talocalcaneal joint middle facet coalition resection with interposition of a juvenile hyaline cartilage graft. J Foot Ankle Surg, 2015, 54(6): 1178-1182.
25.	Zhou B, Tang K, Hardy M. Talocalcaneal coalition combined with flatfoot in children: diagnosis and treatment: a review. J Orthop Surg Res, 2014, 9: 129.
26.	Exner GU, Jacob HAC, Maquieira GJ. Fibulocalcaneal impingement in a growing child with otherwise asymptomatic talocalcaneal coalition. J Foot Ankle Surg, 2017, 56(6): 1323-1327.
27.	Javier Masquijo J, Vazquez I, Allende V, et al. Surgical reconstruction for talocalcaneal coalitions with severe hindfoot valgus deformity. J Pediatr Orthop, 2017, 37(4): 293-297.
28.	Song W, Liu W, Chen B, et al. Posteromedial ankle impingement caused by hypertrophy of talocalcaneal coalition: a report of five cases and introduction of a novel index system. J Foot Ankle Surg, 2016, 55(6): 1312-1317.
29.	Klammer G, Espinosa N, Iselin LD. Coalitions of the tarsal bones. Foot Ankle Clin, 2018, 23(3): 435-449.
30.	Aibinder WR, Young EY, Milbrandt TA. Intraoperative three-dimensional navigation for talocalcaneal coalition resection. J Foot Ankle Surg, 2017, 56(5): 1091-1094.
31.	Murphy JS, Mubarak SJ. Talocalcaneal coalitions. Foot Ankle Clin, 2015, 20(4): 681-691.
32.	Stokman JJ, Mitchell J, Noonan K. Subtalar coalition resection utilizing live navigation: a technique tip. J Child Orthop, 2018, 12(1): 42-46.
33.	Sobrón FB, Benjumea A, Alonso MB, et al. 3D printing surgical guide for talocalcaneal coalition resection: technique tip. Foot Ankle Int, 2019, 40(6): 727-732.
34.	Edmonds WB, Wiley K, Panas K. Technique article: tarsal coalition resection using Kirschner wires across the subtalar joint in a two-incision approach. J Foot Ankle Surg, 2019, 58(2): 337-340.
35.	孫堅. 虛擬手術計劃及術中導航輔助的下頜骨重建——從精確走向微創. 中國修復重建外科雜志, 2018, 32(7): 821-826.
36.	吳超, 鄧佳燕, 譚倫, 等. 3D 打印技術輔助不穩定性骨盆骨折手術療效分析. 中國修復重建外科雜志, 2019, 33(4): 455-461.

1. 陳臨新, 郭秦煒. 疼痛性跟距骨橋的診療進展. 足踝外科電子雜志, 2016, 3(4): 50-57.
2. Tsang AY, Cheuk YY, Au-Yeung AW. Posterior facet talocalcaneal non-osseous coalition: an uncommon but easily missed cause of hindfoot pain. Hong Kong Med J, 2016, 22(6): 623. e1-e2.
3. 解冰, 閆碩, 張浩, 等. 骨橋切除治療成人非關節炎性跟距骨橋的療效觀察. 中國骨傷, 2017, 30(11): 1048-1051.
4. 郭秦煒, 荊立忠, 焦晨, 等. 跟距骨橋切除術初步療效分析. 中國運動醫學雜志, 2013, 32(8): 686-690.
5. de Wouters S, Tran Duy K, Docquier PL. Patient-specific instruments for surgical resection of painful tarsal coalition in adolescents. Orthop Traumatol Surg Res, 2014, 100(4): 423-427.
6. Hamel J. Resection of talocalcaneal coalition in children and adolescents without and with osteotomy of the calcaneus. Oper Orthop Traumatol, 2009, 21(2): 180-192.
7. 俞光榮, 李春光, 李兵, 等. 手術治療跟距骨橋療效觀察. 中國修復重建外科雜志, 2012, 26(5): 522-526.
8. Hayashi K, Kumai T, Tanaka Y. Endoscopic resection of a talocalcaneal coalition using a posteromedial approach. Arthrosc Tech, 2013, 3(1): e39-e43.
9. Bonasia DE, Phisitkul P, Saltzman CL, et al. Arthroscopic resection of talocalcaneal coalitions. Arthroscopy, 2011, 27(3): 430-435.
10. Jagodzinski NA, Hughes A, Davis NP, et al. Arthroscopic resection of talocalcaneal coalitions—a bicentre case series of a new technique. Foot Ankle Surg, 2013, 19(2): 125-130.
11. Rozansky A, Varley E, Moor M, et al. A radiologic classification of talocalcaneal coalitions based on 3D reconstruction. J Child Orthop, 2010, 4(2): 129-135.
12. Lee KT, Park YU, Jegal H, et al. Femoral and sciatic nerve block for hindfoot and ankle surgery. J Orthop Sci, 2014, 19(4): 546-551.
13. 王洪軍, 宋兵, 張曉紅, 等. 跟距骨橋的高頻超聲診斷價值. 中國超聲醫學雜志, 2018, 34(10): 935-938.
14. 王志斌, 馬春忠. MRI 診斷后踝關節疼痛的病因. 中國醫學影像技術, 2017, 33(10): 1587-1590.
15. Tom?ov?ík L. C-sign and talocalcaneal coalition. Acta Chir Orthop Traumatol Cech, 2011, 78(5): 468-471.
16. Shirley E, Gheorghe R, Neal KM. Results of Nonoperative Treatment for Symptomatic Tarsal Coalitions. Cureus, 2018, 10(7): e2944.
17. Mahan ST, Spencer SA, Vezeridis PS, et al. Patient-reported outcomes of tarsal coalitions treated with surgical excision. J Pediatr Orthop, 2015, 35(6): 583-588.
18. Bonasia DE, Phisitkul P, Amendola A. Endoscopic coalition resection. Foot Ankle Clin, 2015, 20(1): 81-91.
19. 李春光, 俞光榮. 跗骨間骨橋臨床診斷與治療研究進展. 中國修復重建外科雜志, 2012, 26(7): 874-879.
20. Lee SH, Park HJ, Yeo ED, et al. Talocalcaneal coalition: A focus on radiographic findings and sites of bridging. Indian J Orthop, 2016, 50(6): 661-668.
21. Aldahshan W, Hamed A, Elsherief F, et al. Endoscopic resection of different types of talocalcaneal coalition. Foot Ankle Int, 2018, 39(9): 1082-1088.
22. Kn?rr J, Soldado F, Menendez ME, et al. Arthroscopic talocalcaneal coalition resection in children. Arthroscopy, 2015, 31(12): 2417-2423.
23. Mosca VS. Subtalar coalition in pediatrics. Foot Ankle Clin, 2015, 20(2): 265-281.
24. Tower DE, Wood RW, Vaardahl MD. Talocalcaneal joint middle facet coalition resection with interposition of a juvenile hyaline cartilage graft. J Foot Ankle Surg, 2015, 54(6): 1178-1182.
25. Zhou B, Tang K, Hardy M. Talocalcaneal coalition combined with flatfoot in children: diagnosis and treatment: a review. J Orthop Surg Res, 2014, 9: 129.
26. Exner GU, Jacob HAC, Maquieira GJ. Fibulocalcaneal impingement in a growing child with otherwise asymptomatic talocalcaneal coalition. J Foot Ankle Surg, 2017, 56(6): 1323-1327.
27. Javier Masquijo J, Vazquez I, Allende V, et al. Surgical reconstruction for talocalcaneal coalitions with severe hindfoot valgus deformity. J Pediatr Orthop, 2017, 37(4): 293-297.
28. Song W, Liu W, Chen B, et al. Posteromedial ankle impingement caused by hypertrophy of talocalcaneal coalition: a report of five cases and introduction of a novel index system. J Foot Ankle Surg, 2016, 55(6): 1312-1317.
29. Klammer G, Espinosa N, Iselin LD. Coalitions of the tarsal bones. Foot Ankle Clin, 2018, 23(3): 435-449.
30. Aibinder WR, Young EY, Milbrandt TA. Intraoperative three-dimensional navigation for talocalcaneal coalition resection. J Foot Ankle Surg, 2017, 56(5): 1091-1094.
31. Murphy JS, Mubarak SJ. Talocalcaneal coalitions. Foot Ankle Clin, 2015, 20(4): 681-691.
32. Stokman JJ, Mitchell J, Noonan K. Subtalar coalition resection utilizing live navigation: a technique tip. J Child Orthop, 2018, 12(1): 42-46.
33. Sobrón FB, Benjumea A, Alonso MB, et al. 3D printing surgical guide for talocalcaneal coalition resection: technique tip. Foot Ankle Int, 2019, 40(6): 727-732.
34. Edmonds WB, Wiley K, Panas K. Technique article: tarsal coalition resection using Kirschner wires across the subtalar joint in a two-incision approach. J Foot Ankle Surg, 2019, 58(2): 337-340.
35. 孫堅. 虛擬手術計劃及術中導航輔助的下頜骨重建——從精確走向微創. 中國修復重建外科雜志, 2018, 32(7): 821-826.
36. 吳超, 鄧佳燕, 譚倫, 等. 3D 打印技術輔助不穩定性骨盆骨折手術療效分析. 中國修復重建外科雜志, 2019, 33(4): 455-461.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of a modified posterior approach for arthroscopic resection on painful talocalcaneal coalition in adults

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