Background: Subtalar arthritis presents as severe pain, inability to walk on uneven ground, and instability which hampers the normal gait biomechanics in patients. Arthrodesis is considered the gold standard to alleviate these symptoms. Over time, arthroscopic subtalar arthrodesis has established itself as a viable method of treatment for isolated subtalar arthritis without significant deformity. This systematic review analyzes the functional outcomes and fusion rates following arthroscopic subtalar arthrodesis for subtalar arthritis.
Materials and Methods: The systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) guidelines from peer-reviewed journals published in English between June 2000 and March 2021. Quality appraisal of all selected articles was done and data was subsequently extracted and analyzed.
Results: After a thorough literature search, 13 studies were included for analysis. A total of 361 patients (376 feet) undergoing subtalar arthrodesis using arthroscopic technique have been described in literature. Pooled data showed improvement in AOFAS score from 44.2 to 79.6 (p < 0.001) and a fusion rate of 94.6%. Mean time to fusion was 9.9 weeks (±0.9 week) with no significant increase in complication rates with use of the arthroscopic technique.
Conclusion: Based on available literature, arthroscopic subtalar arthrodesis appears to be a reliable and safe technique. This study showed promising results for isolated arthroscopic subtalar arthrodesis with good fusion rates and improved functional outcomes. The authors recommend further studies for exploring use of this approach for subtalar arthritis.
Level of evidence: Level IV.
Bartoníček J, Rammelt S, Naňka O. Anatomy of the subtalar joint. Foot Ankle Clin 2018;23(3):315–340. DOI:10.1016/j.fcl.2018.04.001
Carro LP, Golanó P, Vega J. Arthroscopic subtalar arthrodesis: the posterior approach in the prone position. Arthroscopy 2007;23(4):445.e1–445.e4. DOI: 10.1016/j.arthro.2006.07.049
Rungprai C, Phisitkul P, Femino JE, et al. Outcomes and complications after open versus posterior arthroscopic subtalar arthrodesis in 121 patients. J Bone Joint Surg Am 2016;98(8):636–646. DOI: 10.2106/JBJS.15.00702
Glanzmann MC, Sanhueza-Hernandez R. Arthroscopic subtalar arthrodesis for symptomatic osteoarthritis of the hindfoot: a prospective study of 41 cases. Foot Ankle Int 2007;28(1):2–7. DOI: 10.3113/FAI.2007.0001
Lee KB, Park CH, Seon JK, et al. Arthroscopic subtalar arthrodesis using a posterior 2-portal approach in the prone position. Arthroscopy 2010;26(2):230–238. DOI: 10.1016/j.arthro.2009.07.008
Angthong C. Treatment of malunited calcaneal fracture with posttraumatic subtalar osteoarthritis using lateral endoscopic calcaneoplasty with posterior arthroscopic subtalar arthrodesis. Arthrosc Tech 2018;7(3):e245–e249. DOI: 10.1016/j.eats.2017.08.077
Amendola A, Lee KB, Saltzman CL, et al. Technique and early experience with posterior arthroscopic subtalar arthrodesis. Foot Ankle Int 2007;28(3):298–302. DOI: 10.3113/FAI.2007.0298
Vilá-Rico J, Ojeda-Thies C, Mellado-Romero MÁ, et al. Arthroscopic posterior subtalar arthrodesis for salvage of posttraumatic arthritis following calcaneal fractures. Injury 2018;49:S65–S70. DOI: 10.1016/j.injury.2018.07.022
Coulomb R, Hsayri E, Nougarede B, et al. Do clinical results of arthroscopic subtalar arthrodesis correlate with CT fusion ratio? Orthop Traumatol Surg Res 2019;105(6):1125–1129. DOI: 10.1016/j.otsr.2019.01.017
El Shazly O, Nassar W, El Badrawy A. Arthroscopic subtalar fusion for post-traumatic subtalar arthritis. Arthroscopy 2009;25(7):783–787. DOI: 10.1016/j.arthro.2008.12.017
Narita N, Takao M, Innami K, et al. Minimally invasive subtalar arthrodesis with iliac crest autograft through posterior arthroscopic portals: a technical note. Foot Ankle Int 2012;33(9):803–805. DOI: 10.3113/FAI.2012.0803
Vilá Rico J, Jiménez Díaz V, Bravo Giménez B, et al. Results of arthroscopic subtalar arthrodesis for adult-acquired flatfoot deformity vs posttraumatic arthritis. Foot Ankle Int 2016;37(2):198–204. DOI: 10.1177/1071100715604237
Thaunat M, Bajard X, Boisrenoult P, et al. Computer tomography assessment of the fusion rate after posterior arthroscopic subtalar arthrodesis. Int Orthop 2012;36(5):1005–1010. DOI: 10.1007/s00264-011-1448-7
Albert A, Deleu PA, Leemrijse T, et al. Posterior arthroscopic subtalar arthrodesis: ten cases at one-year follow-up. Orthop Traumatol Surg Res 2011;97(4):401–405. DOI: 10.1016/j.otsr.2011.02.005
Walter RP, Walker RW, Butler M, et al. Arthroscopic subtalar arthrodesis through the sinus tarsi portal approach: a series of 77 cases. Foot Ankle Surg 2018;24(5):417–422. DOI: 10.1016/j.fas.2017.04.006
Martín Oliva X, Falcão P, Fernandes Cerqueira R, et al. Posterior arthroscopic subtalar arthrodesis: clinical and radiologic review of 19 cases. J Foot Ankle Surg 2017;56(3):543–546. DOI: 10.1053/j.jfas.2017.01.021