Posterior ankle and subtalar arthroscopy: Safety, efficacy, and expanding indications.

Over the last decade, arthroscopy in the prone position for hindfoot pathology has gained popularity in addition to open and supine anterior arthroscopic approaches. Open approaches to the hindfoot limits visualization and may increase surgical morbidity, leading to slower rehabilitation and return to sport activity. The posterior aspect of the ankle joint is difficult to access effectively with the traditional anterior arthroscopic approach, and does not allow exploration of the subtalar joint, requiring to switch the patient from the supine to the prone position to better access the hindfoot by posterior arthroscopy. The principal advantages of posterior hindfoot arthroscopy include less postoperative pain, improved visualization of the pathology, decreased risk for complications, and optimal recovery in the early postoperative phase. A combination of posterolateral and posteromedial portals allows the surgeon to visualize and access effectively periarticular structures around the tibiotalar and subtalar joints, the posterior half of the ankle, and the posterior subtalar facet. Preoperative evaluation of the patient with clear surgical indications is essential for optimal surgical outcomes. In addition to a detailed physical examination, radiographic assessment should include a complete series with standing anteroposterior and lateral view of the foot and ankle, and a Saltzman hindfoot alignment view. Despite the relatively recent experience with prone arthroscopy and using posteromedial portals, improvement in arthroscopic techniques and development of suitable instrumentation have had an important role in making prone arthroscopy a safe and reliable procedure.