Modified Endoscopic Distal Soft Tissue Procedure (mEDSTP) and Arthroscopic Lapidus Arthrodesis for Correction of Severe Hallux Valgus.

Hallux valgus is one of the most common forefoot deformities faced by foot and ankle surgeons. Symptomatic deformity usually needs surgical correction. Endoscopic techniques of hallux valgus correction have been reported that are based on the same principle of the classic distal soft tissue procedure. Recently, the technique has been modified to include reconstruction of the medial metatarsosesamoid ligament and augmentation of the intermetatarsal ligament. In severe deformity or the presence of hypermobility or painful degeneration of the first tarsometatarsal joint, Lapidus arthrodesis of the joint is indicated. Arthroscopic Lapidus arthrodesis has been reported to reduce the complications associated with open procedure, including first metatarsal shortening, metatarsal elevatus, and nonunion. In this technical note, the technical details of a combined modified endoscopic distal soft tissue procedure and arthroscopic Lapidus arthrodesis is described. This is a minimally invasive approach for correction of severe hallux valgus deformity, especially that associated with ligamentous laxity.

Arthroscopic Sesamoidectomy and Plantar Metatarsal Head Bone Shaving in Management of First Metatarsal Head Metatarsalgia After First Metatarsophalangeal Fusion.

First metatarsophalangeal arthrodesis has been used to treat end-stage arthritis of the great toe (e.g., gout, post-traumatic, infection), severe hallux valgus deformity, hallux valgus caused by neuromuscular disorders, rheumatoid forefoot deformity, primary hallux varus, and rigid plantarflexion deformities, as well as a salvage procedure for failed previous operation of the great toe. As with any arthrodesis procedure, proper positioning of the hallux in first metatarsophalangeal arthrodesis is of utmost importance for good clinical outcome. The chief problem tends to be sagittal alignment. In case of the significant dorsiflexion malunion of the fusion site with excessive plantar pressure of the first metatarsophalangeal joint and abutment of the hallux to the shoebox, corrective osteotomy is indicated. If there is isolated excessive plantar pressure of the first metatarsophalangeal joint without hallux problem, arthroscopic sesamoidectomy and bone shaving of the plantar side of the first metatarsal head is another surgical option. The purpose of this technical note is to describe the details of arthroscopic sesamoidectomy and bone shaving of the plantar side of the first metatarsal head.

Endoscopic Decompression of Olecranon Tophus.

The olecranon bursa is very commonly involved in tophaceous gout because of the tendency of monosodium urate crystals to deposit in superficial structures with low temperatures. Surgery is indicated if the olecranon tophus is recalcitrant to medical treatment. Open surgery requires a long incision over the tophus and may lead to wound complications. Endoscopic debridement of the tophus can reduce the risk of wound complications. In this Technical Note, the technical details of endoscopic decompression of an olecranon tophus are described. This endoscopic technique also allows debridement of tophus infiltration of the triceps tendon.

Endoscopic Ganglionectomy of the Tarsal Tunnel: A Medial Approach.

A ganglion inside the tarsal tunnel can compress the tibial nerve, leading to posterior tarsal tunnel syndrome. Classically, the ganglion is resected with an open approach. This requires release of the flexor retinaculum and dissection around the tibial neurovascular bundle, which may induce fibrosis around the tibial nerve. Endoscopic resection of a tarsal tunnel ganglion via a posterior approach has been reported. The purpose of this Technical Note is to describe the medial approach of endoscopic ganglionectomy of the tarsal tunnel. This is indicated for tarsal tunnel ganglia compressing the tibial nerve and extending to the flexor retinaculum. It is contraindicated if there is other pathology of the tarsal tunnel that demands open surgery; the ganglion compresses the tibial nerve from its deep side and does not extend to the flexor retinaculum; or in the presence of intraneural ganglion of the tibial nerve.

Arthroscopic Management of Synovial Osteochondromatosis of the Elbow.

Primary synovial chondromatosis is characterized by newly formed chondral or osteochondral nodules in the synovial membrane, which may detach and form loose bodies. The loose bodies can be calcified or ossified, and the condition is termed synovial osteochondromatosis. Three distinct stages can be identified in primary synovial chondromatosis : phase I is active synovitis without loose bodies, phase II shows nodular synovitis along with loose bodies, and phase III is characterized by the presence of loose bodies with the resolution of synovitis. Surgical treatment has been recommended as the first choice of therapy in phases II and III disease. Complete synovectomy and removal of all loose bodies is advisable for prevention of recurrence of the disease. In this technical note, the technical details of arthroscopic removal of loose bodies and synovectomy for the management of synovial osteochondromatosis of the elbow is described. Compared with open procedures, the arthroscopic approach has many advantages, including a shorter rehabilitation period and higher patient satisfaction.