ABSTRACT
Arthrodesis can be performed arthroscopically or open. Arthroscopic ankle arthrodesis has been shown to have equivalent union rates with shorter hospital stay; however, it is more difficult to correct deformity. A longitudinal incision is made directly over the lateral aspect of the fibula, of sufficient length to avoid tension on the soft tissue flap. Distally the incision is angled toward the base of the fourth metatarsal to allow greater access to the ankle joint. Subperiosteal dissection of the fibula is carried out, protecting the peroneal tendons posteriorly and distally at all times. The joint line is identified, using an image intensifier, and is marked on the skin. The free distal end of the fibula is then reflected inferiorly and freed of soft tissues and ligamentous attachments, and it is excised. Care is taken not to divide the peroneal tendons at the tip of the distal fibula during excision. Capsulotomy then allows access to the tibiotalar surface.
