Arthroscopic Arthrodesis (extended)

Video Transcription

0:00 What follows is a DVD of an arthoscopic anthrodesis. This is the best treatment for an osteoarthedic ankle that requires fusion as the arthoscopic fusion allow faster fusion rates, higher fusion rates, with lower morbidity and complications.
0:20 Fluid is introduced posterolaterally. One views with a 3.5mm arthoscope and the soft tissue is removed tibiotalus surfaces. Initially as you can see, with a 3.5mm gator resector. The ankle is distracted using a standard, non-invasive ankle distracter system from Smith and Nephew. Initially, an anterior compartment clearance is preformed, anterior tibial and talus burrs are resected.
0:55 Following this, the residual fiber cartilage is removed from the talar dome, tibial plafond, and medialateral gutters. A typical intra-articular pressure of fluid is in the order of 50mm of mercury, rising sometimes to 80mm of mercury. Overall operating time for this procedure is in the order of 40-45 minutes. Once all the articular surfaces are removed, including the subchondral bone, a fusion is achieved using two cannulated large fragment ayo or ace cannulated screws.
1:44 As the video progresses you can see that the cartilage and fibrocartilage has been carefully removed from the tibial plafond presently and the talar dome beneath us. It is important to remove the fibrocartilage and then remove a thin layer of subchondral bone, taking the bone down to bleeding, healthy subchondral bone, to encourage subsequent fusion. Fusion carefully maintains the convexity of the talar dome and concavity of the tibial plafond. White is the articular-cartilage and fibrocartilage, and the light yellow, the subchondral bone.
2:58 As the cartilage and fibrocartilage is removed, more and more space is made available for the operating surgeon, and the procedure becomes more and more technically “easy.” Fusion rates for athroscopically assisted arthodesis are in the order of 95% plus at 6-8 weeks. Portals include a posteromedial for irrigation, and anteromedial and antereolateral for instrumentation and viewing. There are also one or two small stab incisions, proximal to the medial malleolus for the insertion of the cannulated screws. Overall, therefore, this operation is preformed by 3 small scars. Most of the cartilage and fibrocartilage has now been removed. A burr is then introduced, which will remove the subchrondral bone, and cannulated.

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