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Posterior Ankle Endoscopy
Posterior hindfoot endoscopy is a minimally invasive approach that allows for less soft-tissue trauma, decreased patient discomfort and morbidity, and faster rehabilitation compared with open surgical treatment of the hindfoot. Posterior hindfoot endoscopy offers excellent access to the posterior aspects of the tibiotalar and subtalar joints in addition to most of the posterior periarticular structures. Posterior hindfoot endoscopy allows both intra-articular and extra-articular pathology to be efficiently managed. Common indications for intra-articular pathology include treatment of posterior osteochondral lesions of the ankle joint, débridement of ankle or subtalar arthritis in articulations without substantial malalignment, loose body excision, synovectomy, and treatment of an intraosseous talar ganglion. Indications for extra-articular pathology include posterior ankle impingement with or without symptomatic os trigonum, posttraumatic arthrofibrosis of the ankle or subtalar joint, chronic insertional and noninsertional Achilles tendinopathy, painful Haglund deformity, and stenosing tenosynovitis of the flexor hallucis longus. The indications for surgical management of these lesions via a posterior arthroscopic approach are the same as for an open approach. In addition, posterior arthroscopy allows access to lesions that would be difficult to reach via an open approach, and it also allows for surgical treatment in patients with soft-tissue compromise that would otherwise be a contraindication to surgery. This chapter discusses the indications, contraindications, techniques, and potential complications associated with posterior hindfoot endoscopic surgery.