Anatomical bases of endoscopic tarsal tunnel release: anatomical and ultra-sonographic study with a preliminary clinical report.

Abstract

PURPOSE:

The purpose of our study is to present the anatomical bases of a new technique for endoscopic tarsal release and to report the preliminary clinical outcome for this technique.

METHOD:

Anatomical study The technique was performed on 12 intact adult lower limb specimens. The location of portals was evaluated as well as the integrity of the neurovascular bundle. Ultra-sonographic study A prospective case control study was done on 10 patients (11 feet) and 14 normal volunteers (28 feet). Three parameters were measured; the thickness of flexor retinaculum, the nerve cross-section area and the depth of tarsal tunnel. Clinical study Seven patients with idiopathic proximal Tarsal Tunnel Syndrome (TTS) were treated by endoscopic TTR using a modified trocar cannula and dilator system. Preoperative and postoperative evaluation was done by electrophysiological studies and ultra-sonography. Evaluation was done using Takakura's rating scale.

RESULTS:

Anatomical study The proximal and distal portals were located at 13 mm (±1.59 STD) and 17.91 mm (±1.44 STD) from the proximal and distal borders of FR, respectively. There was intact neurovascular bundle in all specimens. Ultra-sonographic study There was statistically significant difference in the mean nerve cross-sectional area and the thickness of the FR between the control group and the patients group (P < 0.05). Clinical study The mean TRS improved from 2.28 ± 1.11 STD preoperatively to 8.43 ± 0.97 at 2 years follow-up. The overall good to excellent results was 85.7%.

CONCLUSION:

Based on this preliminary clinical study, endoscopic tarsal tunnel release by the technique described could obtain excellent to good results in 85.7% of patients with idiopathic proximal tarsal tunnel. The anatomical study proved the safety of the technique on the neurovascular structures. Ultra-sonography was an effective tool for preoperative diagnosis and postoperative follow-up.

LEVEL OF EVIDENCE:

Case series study, Level IV.

• Authors: Ossama El Shazly, Ayman El Shazly, Ahmed Desouky, Abeer Kadry El Zohiery, Hossam Moussa Sakr
• Journal: Surgical and radiologic anatomy : SRA (Surg Radiol Anat) Vol. 33 Issue 10 Pg. 929-36 (Dec 2011) ISSN: 1279-8517 [Electronic] Germany
• PMID: 22037778 (Publication Type: Clinical Trial, Journal Article)

Topics

• Adult
• Aged
• Ankle (anatomy & histology, diagnostic imaging, surgery)
• Case-Control Studies
• Endoscopy (methods)
• Female
• Humans
• Male
• Middle Aged
• Prospective Studies
• Tarsal Tunnel Syndrome (diagnostic imaging, surgery)
• Treatment Outcome
• Ultrasonography