Patient Positioning / Exposure / Ankle Arthroscopy

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Designed in conjunction with Prof. Beat Hintermann, Liestal, Switzerland

This surgical technique describes the positioning of a medial osteotomy plate
in the treatment of a valgus ankle osteoarthritis (closing wedge osteotomy).
The same principles and application of the instrumentation set can be applied to the antero
-lateral and antero-medial plates and for opening wedge osteotomies.

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Patient Positioning The patient is placed in the supine position on a radiolucent operating table A tourniquet is applied at the thigh, with a pad under lower leg for elevation The heel should be flush with the operating table   Exposure For tibial osteotomy, a medial skin incision (length 7-8cm) is performed directly over the distal tibial metaphysis (figures 1a, 1b) The saphenous vein and nerve run posteromedially to the incision and usually do not hinder a direct bone approach Soft tissues are retracted en bloc with a retractor Ankle Arthroscopy Ankle arthroscopy is done at the beginning of surgical realignment Assessment of cartilage, ligaments and instability pattern is performed Scarred and inflammatory soft tissues causing soft tissue impingement are removed Osteophytes are debrided to eliminate impingement or restricted range of motion Microfracturing of the cartilage may be indicated if circumscribed confined chondral lesions are present

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