By Ned Amendola
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Extra info for AANA Advanced Arthroscopy. The Foot and Ankle
These methods of distraction require little equipment and are very cost effective. However, it is difficult to maintain consistent traction, and some operators may find the multitasking of operating and controlling distraction somewhat onerous. Another disadvantage is that placing the Kerlix roll underfoot or behind the back may compromise the sterility of the procedure. Through controlled methods, specific amounts of distraction can be applied and maintained with ease. The most common means of controlled distraction is to use one of the many commercially available, sterile foot straps and attach the sling Chapter 3 Instrumentation and Operative Setup for Ankle and Subtalar Arthroscopy 21 FIGURE 3-6 The most common means of controlled distraction uses one of the many commercially available sterile foot straps and attaches the sling to a tensioning device.
4-16). The posterolateral portal is placed approximately 2 cm posterior and 1 cm proximal to the tip of the fibula, which is lateral to the border of the Achilles tendon. If the subtalar arthroscopy is performed after ankle joint arthroscopy, the posterolateral portal used for the ankle can be redirected into the subtalar joint. The central portal is located just distal and inferior to the lateral malleolus tip. This portal is immediately anterior to the peroneal tendon sheath. I find that arthroscopy of the subtalar joint is more reproducible if the portal locations are first confirmed using 18-gauge needles.
All structures visualized from the anteromedial portal are evaluated from the anterolateral perspective for complete assessment. The final assessment of the joint is from the posterolateral approach, with the inflow and arthroscopic probe placed in one of the anterior portals. This view optimizes visualization of the posteromedial talar dome and may be especially useful for treatment of osteochondral lesions of the posteromedial talar dome, which may be difficult to appreciate fully from anterior approaches.
AANA Advanced Arthroscopy. The Foot and Ankle by Ned Amendola