Through the anteromedial portal, we then turn our attention to the fibula. The anchor is tapped gently until the threads engage the subchondral bone ( Fig 5). Introduce the FiberTape suture anchor (Arthrex) and seat it into the talus ( Fig 4). Through the accessory portal, a guide pin is placed at the talar footprint, and it is over drilled with a cannulated 3.5 mm drill to the laser line ( Fig 3). This corresponds to the anatomic foot print of the Talar attachment of the ATFL. Mark an area 1 cm anterior to the tip of the fibula which will serve as the third portal site ( Fig 2). Elevate the attachment of the ATFL off of the distal fibula. Debridement of the area around the anatomic footprint is also recommended to enhance visibility of the area. To facilitate visualization, begin by resecting part of the AITFL to identify the anatomic foot print of the ATFL on the fibula ( Fig 3). Work has now focused on describing scenarios where in-office needle arthroscopy can safely and effectively replace arthroscopy performed in a standard operating room suite as surgeons continuously refine their treatment algorithms to provide high quality patient care. Even more importantly, this system comes with instrumentation including punches, graspers, scissors, a retractable probe, shavers, burrs, and resectors that allow for surgical intervention for any identified pathology. Advancements in IONA have led to the development of a new disposable chip-on-tip camera with 400 × 400 resolution and 120° field of view fed through a 13″ high-definition monitor (Arthrex, Inc., Naples, FL). The technique was never widely accepted in part because of a lack of defined indications, an inability to simultaneously treat identified pathologies, and poor picture resolution. In-office needle arthroscopy (IONA) first became available in the 1990s as a tool for visualization and evaluation of anatomic structures with patients under local anesthesia.
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