Table 3.

Step-by-step Guide to Performing the Proposed Technique

Step 1: Position the patient comfortably in the prone position with the operative foot free. Mark out relevant surface anatomy and anticipated portals.

Step 2: Inject local anesthesia superficially to anticipated portals and deep in anticipated instrument tracts. Finish with injection into the tibiotalar and subtalar joints.

Step 3: Establish portals with a superficial stab incision followed by blunt dissection. Start with posterolateral portal and finish with posteromedial portal under direct visualization.

Step 4: Carry out careful initial debridement of fatty tissue with triangulation and direct visualization until intermalleolar ligament is seen.

Step 5: Perform diagnostic endoscopy starting with superolateral quadrant and moving counter-clockwise for right ankles and a clockwise for left ankles

Step 6: Assess the posteroinferior tibiofibular ligament and intermalleolar ligament in the superolateral quadrant and check for posterior impingement with plantarflexion.

Step 7: Identify the flexor hallucis longus tendon in the superomedial quadrant with passive motion and assess for tenosynovitis, stenosis, and subluxation.

Step 8: Assess the posterolateral talar process in the inferomedial quadrant and look for the presence of a Stieda lesion or os trigonum.

Step 9: Assess the posterior talofibular ligament and calcaneofibular ligament in the inferolateral quadrant.

Step 10: Debride posterior capsule and assess cartilaginous surfaces of posterior tibiotalar joint and subtalar joints.

Step 11: Ask patient to actively range their ankle to assess for any remaining impingement.

Step 12: Apply wound closure and soft dressing or splint as indicated.