Arthroscopic Release and Hindfoot Fusion for the Spastic Equinovarus Foot: An All-Inside Technique

Research Type: Level 4 – Case series Introduction/Purpose: To identify functional outcomes using arthroscopic assisted, minimally invasive contracture tenotomies paired with a tibio-talo-calcaneal (TTC) arthrodesis in the reconstruction of SEF. Methods: Surgeons log retrospective study on patients who underwent arthroscopic assisted, minimally invasive contracture tenotomies paired with tibio-talo-calcaneal (TTC) arthrodesis in reconstruction of SEF deformities. All cases were performed completely arthroscopically, utilizing posterior approach with TTC fusion done in a prone position by a single surgeon at our institution. Patient demographics, SEF pattern, perioperative complications, and radiographs were collected. Paired t-test was applied for FADI and VAS scores to determine improvement. Multivariate logistic regression was used to determine influence that variables have on failure rates. Any correlation between type of procedure, radiographic findings scores and VAS or FADI scores were examined using Pearson’s correlation coefficient at 3 months. Test statistics with p-value less than 0.05 considered significantly different. Analysis was performed with Microsoft Excel. Results: 10 patient cases included. Average 37 years old. 6 male (60%), 4 female (40%). Mean BMI 30.4. 2 tobacco users (20%). No illicit drugs. Preop, 2 patients used AFO or walker (20%), 1 crutches (10%), 7 non-ambulatory 2 years or more (70%). Average time from injury 6.1 years. Mechanisms of injury: drug induced ABI (20%), fall (20%), MVA (30%), CVA (10%), crush (10%), ABI (10%). Average tourniquet time 120.2 minutes. 10 patients underwent tenotomies and TTC nail. All had restoration of alignment. 100% fusion rates 3 months post op. None required bracing. 5 minor complications (50%): 4 skin tears,1 superficial infection. No major complications. FAS Scores - change in pre/post op FAS scores statistically significant (p-value 0.001). VAS Scores - change not statistically significant. Conclusion: Patients who undergo arthroscopic assisted minimally invasive surgical treatment for SEF have improved functionality based on FAS scores and post operative activity levels. Pre and post op assessments of functional ambulatory scale (FAS) scores