Bresler F, Molé D, Schmidt D
Clinique de Traumatologie et d'Orthopédie, Nancy.
Rev Chir Orthop Reparatrice Appar Mot. 1994;80(8):744-8.
The authors describe an arthroscopic technique of tibio-talar arthrodesis. They discuss the advantages, indications and results of this technique.
Seven arthroscopic tibio-talar arthrodeses (A.T.T.A.) were performed between may 1992 and september 1993 for post traumatic arthritis (five following bimalleolar fractures, two following talar fractures).
Traction by means of a transcalcaneus pin was applied to obtain articular distraction. Arthroscopic debridement was performed using two standard anterolateral and anteromedial portals. The arthrodesis was secured in neutral position by two percutaneous tibio talar cannulated cancellous screws.
Fusion was obtained in all cases over an average period of 12 weeks. No infections or cutaneous complications were noted. In one case, however, screw positioning caused an injury to a branch of the superficial peroneal nerve. At last follow-up, according to the Duquennoy grading system, the results were good or very good.
In this study, we noticed a particularly low rate of complications, a significantly lesser recovery time and a higher fusion rate compared to open ankle arthrodesis techniques. This is probably due to the careful handling of the periarticular soft tissues, possible with the arthroscopic procedure. The best indication for this procedure seems to be "centered" ankle arthritis. However, a significant deviation in one plane, or a tibial or talar bone loss needing an autogenous graft is considered to be a contra-indication for the procedure.
A.T.T.A. seems to be a simple and reliable technique for centered ankle arthritis.
