Name: Using the NanoScope™ System in the Foot and Ankle
Uploaded: 2019-09-12T00:00:00Z
Channel: Arthrex
Description: James McWilliam, MD (New York, NY), demonstrates the NanoScope™ arthroscopy system and its broad applications in foot and ankle surgery.

<p>James McWilliam, MD (New York, NY), demonstrates the NanoScope™ arthroscopy system and its broad applications in foot and ankle surgery.</p>

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VID1-000307-en-US | B | Using the NanoScope™ System in the Foot and Ankle

James McWilliam

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Using the NanoScope™ System in the Foot and Ankle

Today, we're going to demonstrate the versatility of the NanoScope in the foot and ankle. I've got the sharp obturator in the cannula. I'm going to go into the ankle joint. Just pop right in. I'm going to switch it out for the blunt obturator and we'll take the NanoScope. We'll first go and dry and see what the environment is like. Alternatively, this can be done through a wet scope technique. Now remember this is a zero degree scope with a 120 degree field of view. So you can see with virtually no distraction I'm able to get the scope into the back of the ankle joint. So there's the tibia above the talus below the posterior capsule behind. Now I'm going to go in to the medial gutter, because that's going to be the easiest place to get in from the anteromedial portal. And we can see the posterior aspect of the medial gutter. We can see the deltoid ligament. So the NanoScope not only allows you to view all aspects of the ankle, but you can capture your images either through the buttons that are available on the handle or through the touch screen monitor. Here we can see the syndesmosis. We can see the anterolateral corner of the ankle. Because of the straight nature of the scope, we'll best visualize the lateral gutter through the anterolateral portal. So here's where I'm entering in. Right there we. I put my thumb on the anterolateral corner of the ankle and see where I'm going to enter in with my NanoScope cannula. And in one step, we can facilitate entrance into the ankle joint. Okay. So we're going to leave our portal, take out the camera and just transfer it into the anterolateral portal. And we'll see a new view of the ankle joint. Once again you can see the tibiotalar joint. Okay. So now we can really see the entirety of the posterior aspect of the ankle. Here's the lateral edge of the talus. We're going to get to the lateral gutter and up in the upper left hand corner of the screen you can see the syndesmosis, just as I would do with a standard arthroscopy. I'm going to dorsiflex the foot a little bit in order to drop the scope into the lateral gutter. So now we've gone back into the ankle joint. We're just demonstrating that loose body and demonstrate how the nano instruments will facilitate removal of the loose body through percutaneous incision. So if you're using inflow to increase your visualization it's generally more efficient to provide the inflow through the arthroscopy cannula as opposed to the working cannula. So here we get a great view of the posterior aspect of the ankle. So after arthroscopy and complete visualization of the ankle joint these are the incisions that you're left with for perineal endoscopy. We're going to make a small incision over where I'd expect the musculotendinous junction of the peroneus brevis to be, which is a couple fingerbreadths proximal to the tip of the fibula. So you feel a slight give as you get into the tendon sheath. So here you see the perineal tendons. Once again this is a straight scope. So the floor of the perineal groove is going to be at the top of the screen. The peroneus brevis is going to be closest to the floor of the groove. So this is going to be the peroneus brevis. The peroneus longus is going to be behind the peroneus brevis. So we can go fairly far down the groove and visualize almost the entirety of the tendons. Through that superior portal, we can look for tendinitis. We can look for tendon tears, split longitudinal tears. We could potentially demonstrate dislocation from the from the posterior aspect of the fibula just by manual pressure. So I'm putting manual pressure there. I'm not able to dislocate the tendons from their sheath. So you can see the full scope of tendons. So here you see the normal tendons proximally. Approximately. And as we draw our scope distally, you can see she does have significant degeneration of her distal tendons. We've done a subtalar arthroscopy and a complete perineal endoscopy. So here you can see there is a definitely a potential space. And you can definitely see the tendon. I can pull back and visualize nearly the entirety of the tendinous insertion. This looks very normal. There's no synovitis. There's very little fraying. And as we advance the arthroscope proximally, we can see the entirety of the tendon even as it courses around the medial malleolus. Using the NanoScope, we're able to get in front of the posterior tibial tendon and visualize what would be the floor of the posterior tibial tendon sheath, which is largely comprised of components of the spring ligament. So here I'm getting underneath the tendon and we're looking at the At the floor of the tendon sheath, which includes the spring ligament. Because of the small size of the NanoScope, we are able to easily enter the lesser metatarsophalangeal joints so we could look for an occult cartilage lesion or a planar plate tear. If I'm pointing my handpiece controls proximally, then the top of the screen is going to represent the metatarsal head, and we can view the entirety of the metatarsal head really with this scope, and see the base of the proximal phalanx. And if we distract a little bit, we can get into the joint and go inferiorly and come across and view the insertion of the plantar plate, which is going to be see the metatarsal head on the top, see the proximal phalanx underneath. And if I'm able to advance a little bit more we can see the plantar plate insertion.

Using the NanoScope™ System in the Foot and Ankle

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