Abstract
- Lui T.H.
Indications | Contraindications |
---|---|
1. It is indicated if there is symptomatic tarsometatarsal destruction of the lesser rays | 1. It is contraindicated if there is significant bone loss requiring strut graft reconstruction |
2. It is contraindicated if the bone is soft and cannot be stably fixed with screws | |
3. It is contraindicated if open reduction is required for deformity correction |
Technique
Preoperative Planning and Patient Positioning

Portal Placement

Debridement of the Lateral Half of the Tarsometatarsal Joint of the Lesser Rays

Debridement of the Medial Half of the Tarsometatarsal Joint of the Lesser Rays

Preparation of the Fusion Surfaces

Positioning of the Lesser Ray Tarsometatarsal Joints and Screw Fixation of the Fusion Sites

Pearls | Pitfalls |
---|---|
1. The position of the arthroscopic instrument is regularly checked under fluoroscopy because there is no clear arthroscopic landmark in the destructed joint | 1. The patient should be compliant to the prolonged cast immobilization and strict non-weight-bearing |
2. Joint debridement should be completed down to the plantar capsule | 2. If there is difficulty in accessing some part of the joint, an additional Lisfranc portal should be established |
3. The midfoot should be fixed in a slightly supinated position to avoid excessive pressure over the lateral column |
Advantages | Risks |
---|---|
1. Less wound complication | 1. Injury to the superficial peroneal nerve |
2. Less soft tissue trauma | 2. Injury to the deep peroneal nerve |
3. Better cosmesis | 3. Injury to the dorsalis pedis artery |
4. Less bone resection and less shortening of the foot rays | 4. Malunion and metatarsalgia |
5. More thorough debridement of the deep part of the joints under arthroscopic visualization | 5. Nonunion |
6. Implant failure |
Discussion
- (1)The second to fifth tarsometatarsal joints share a common capsular compartment.
- (2)The erosive arthropathy eliminates the stepping at the second tarsometatarsal joint making the lesser ray tarsometatarsal joints at the same level.
- (3)The destructed joint is spacious enough to allow insertion of the arthroscopic instruments into the joint space throughout its span.
Supplementary Data
- Video 1
Arthroscopic arthrodesis of the lesser ray tarsometatarsal joints of the left foot. The patient is in the supine position. The P1-2 portal is the viewing portal. The lateral half of the lesser ray tarsometatarsal joints is debrided. The arthroscope is switched to the lateral portal and the medial half of the lesser ray tarsometatarsal joints is debrided. After clearance of the joint space, microfracture of the fusion surfaces is performed with an arthroscopic awl. The joint is reduced and transfixed with cannulated screws.
- ICMJE author disclosure forms
References
- Intramedullary foot fixation for midfoot Charcot neuroarthropathy.J Foot Ankle Surg. 2012; 51: 531-536
- Tarsometatarsal joint arthrodesis with trephine joint resection and dowel calcaneal bone graft.J Foot Ankle Surg. 2014; 53: 243-247
- Review of the evidence: Surgical management of 4th and 5th tarsometatarsal joint osteoarthritis.Foot Ankle Surg. 2013; 19: 207-211
- Results of arthrodesis of the tarsometatarsal joints after traumatic injury.J Bone Joint Surg Am. 1996; 78: 1665-1676
- Lisfranc arthrodesis for chronic pain: A cannulated screw technique.J Foot Ankle Surg. 1998; 37: 28-36
- Corrective tarsometatarsal arthrodesis for malunion after fracture-dislocation.Orthopade. 2006; 35: 435-442
- The diagnosis and treatment of injury to the tarsometatarsal joint complex.J Bone Joint Surg Br. 1999; 81: 756-763
- Arthroscopic tarsometatarsal (Lisfranc) arthrodesis.Knee Surg Sports Traumatol Arthrosc. 2007; 15: 671-675
- Arthroscopic lysis of arthrofibrosis of the fifth tarsometatarsal joint.Arthrosc Tech. 2015; 4: e707-e710
- Lateral foot pain following open reduction and internal fixation of the fracture of the fifth metatarsal tubercle: Treated by arthroscopic arthrolysis and endoscopic tenolysis.BMJ Case Rep. 2014; ([published online April 17, 2014])https://doi.org/10.1136/bcr-2014-204116
- Arthroscopy and endoscopy of the foot and ankle: Indications for new techniques.Arthroscopy. 2007; 23: 889-902
- Arthroscopic tarsometatarsal arthrodesis.Arthrosc Tech. 2016; 5: e1311-e1316
- Arthrodesis of the fourth and fifth tarsometatarsal joints of the midfoot.Foot Ankle Int. 2003; 24: 584-590
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The author reports that he has no conflicts of interest in the authorship and publication of this article. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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