Double Posteromedial Portals for Excision of a Symptomatic Os Trigonum With Ankle Arthroscopy in Supine Position

Background: The existence of abnormal os trigonum often causes posterior ankle impingement syndrome, the commonly used method for excision of symptomatic os trigonum is standard arthroscopic approach when posterior and anterior abnormalities appear in one patient. However, the arthroscopy of posterior and anterior compartement of the ankle joint must be undertaken in one surgical position. In most cases, when adopting the standard arthroscopic approach, the patient has to be firstly positioned supine to perform the anterior procedure, and then re-positioned prone to operate on the posterior compartment. Material: and Methods: To simplify this process and shorten operation time, we describe a double posteromedial ankle portals procedure, which provides access to reach both the posterior and anterior compartment without changing position, to exam both symptomatic compartement. Standard operation are conducted by changing position to reach both compartement. Standard operation and double posteromedial ankle portals procedure were conducted to 46 patients (standard approach 23, 2 posteromedial portals 23). Operation time, AOFAS score, KAF score and VAS score were analyzed. Results: : It shows operation time reduced from 69.78±5.24 min to 36.61±3.63 min (P<0.05) and postoperative recovery index of novel method including AOFAS score, KAF score and VAS score were better than that in standard way one month after operation, but there was no significance difference after one month. Conclusion: The figures strongly suggest that the double posteromedial portals approach is better than the standard procedures in operation time, short-term postoperative recovery.