Christiaan J. A. van Bergen

Posterior Ankle Arthroscopy and Endoscopy

Posterior ankle pathology can be treated by means of hindfoot endoscopy. The posteromedial and lateral hindfoot portals provide excellent access to the posterior aspect of the ankle and subtalar joint, including extra-articular structures in the hindfoot. An increasing amount of pathological conditions can nowadays be treated with this relatively new technique. Recently a three-portal minimal invasive groove-deepening technique, based on the posteromedial and lateral portal, was introduced to treat recurrent peroneal tendon dislocation. Other indications include subtalar arthrodesis, posterior ankle impingement, and flexor hallucis longus release. The endoscopic hindfoot portals are safe and reliable, both anatomically and clinically. It compares favorably to open surgery with regard to an overall lesser morbidity and quicker recovery.

“Small” Fractures Below the Knee: Do Not Miss—Do Not Mistreat!

Many of the small fractures below the knee are known by eponyms. Although some are well known such as the Maisonneuve and Lisfranc fractures, several are less well known, such as the Cedell and Tillaux fractures. Unfamiliarity with these small fractures may result in failure of detection at initial emergency department surveys or treated suboptimally by lack of experience. This ICL chapter consists of an overview of several common “small” fractures of the foot and ankle, not to be missed, not to be mistreated.

HemiCAP for Secondary Treatment for Osteochondral Talar Defects

The optimal treatment for large osteochondral defects of the talus or secondary defects has to be determined yet. A metal implant with a diameter of 15 mm has been developed for treatment of these lesions of the medial talar dome. We prospectively studied 20 consecutive patients for a mean of 4.5 years (3–5) post-surgery. There was statistically significant reduction of pain in rest, walking, and stair climbing (p ≤ 0.01). The median American Orthopaedic Foot and Ankle Society ankle-hindfoot score improved from 62 (interquartile range (IQR), 46–72) preoperatively to 85 (IQR, 75–99) at final follow-up (p < 0.001). The Foot and Ankle Outcome Score improved on subscale pain, function, sports, and quality of life (p ≤ 0.01). The mean Short-Form 36 physical component scale improved from 36 (23–50) preoperatively to 45 (29–55) at final follow-up (p = 0.001); the mental component scale did not change significantly. On radiographs, progressive joint space narrowing of the ankle was observed in two patients. One patient required additional surgery for the osteochondral defect. The midterm results show that a metal implant is a promising treatment for osteochondral defects of the medial talar dome after failed previous surgery.

Juvenile wakeboarder locks ankle on shore

This report presents an adolescent wakeboarder with persistent pain after conservative treatment of a Salter Harris type II distal fibular fracture. On physical examination the pain was localised over the anterior inferior tibiofibular ligament. Additional imaging revealed that this syndesmotic impingement was caused by a loose body caught in the syndesmotic area. The loose body was successfully removed from the anterior inferior tibiofibular ligament by anterior ankle arthroscopy. With functional aftertreatment, the patient had resumed full sports activities after 8xa0weeks. At 1-year follow-up there were no persistent symptoms.