Special FocusArthroscopic Tibiotalocalcaneal ArthrodesisVilá-Rico, Jesús MD, PhD*,†,‡; Vacas-Sánchez, Elena MD*,‡; Abarquero-Diezhandino, Ana MD*; Mellado-Romero, María MD*Author Information *Department of Orthopaedics, ‘12 Octubre’ University Hospital †Department of Surgery, Complutense University of Madrid ‡Department of Orthopaedics, Complejo Hospitalario Ruber Juan Bravo, Madrid, Spain The authors declare no conflict of interest. Address correspondence and reprint requests to Elena Vacas-Sánchez, MD, Department of Orthopaedic Surgery, Hospital Universitario 12 de Octubre, Avenida Cordoba, s/n, Madrid 28041, Spain. E-mail: [email protected]. Techniques in Foot & Ankle Surgery: March 2020 - Volume 19 - Issue 1 - p 37-42 doi: 10.1097/BTF.0000000000000258 Buy Metrics Abstract Introduction: Arthrodesis is still the gold standard for severe ankle and hindfoot osteoarthritis. The arthroscopic tibiotalocalcaneal arthrodesis technique has been described and developed in the past decade. Tibiotalocalcaneal arthrodesis (TTCA) is the election procedure for combined severe ankle and subtalar osteoarthritis after failure of conservative treatment. The arthroscopic technique is more respectful to the surrounding soft tissues and the vascular supply; hence, it provides a theoretical benefit in terms of consolidation, and it is suitable for cases in which the open surgery is not desirable. We perform the surgery with the patient in prone decubitus position, and we use conventional arthroscopic instruments. We use the posterior portals described by van Dijk to access both tibiotalar and posterior subtalar joints and perform the cartilage denudation. We aim to have a healthy, well-vascularized subchondral bone and obtain a good coaptation of the articular surfaces. The retrograde tibiotalocalcaneal nail is the implant of choice for the TTCA. We consider that the lower surgical aggression of the arthroscopic procedure compared with the open technique should allow a satisfactory union rate without bone grafting. The global consolidation rate reported is 67% to 100%. The global complication rate reported is 7% to 33%. Most are related to osteosynthesis material and superficial wound infections. Arthroscopic TTCA offers excellent results in selected patients. A protocolized surgical technique using posterior endoscopic portals is mandatory. Level of Evidence: Diagnostic Level V. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.