Arthroscopic triple arthrodesis is an alternative to the open procedure, avoiding the risks of wound complications and periarticular dissection. Reports to date are case reports for arthroscopic triple arthrodesis. The principles used for arthroscopic ankle fusion can be followed. The main challenges are getting appropriate portal placement. Arthroscopy and percutaneous techniques are used to remove the cartilage from all three joints. Subsequent screw fixation is used to immobilize the three joints in a neutral position to achieve fusion in the corrected position. Potential benefits of arthroscopic triple arthrodesis are the reduction of wound complications, maintenance of bone blood supply, better cartilage débridement, reduction of bleeding, and assessment of other pathology arthroscopically. Challenges include the steep learning curve, the potential for nerve injury, and correct placement of fixation. To assist in successful surgery, the surgeon should be capable and well trained in the open surgery, as well as arthroscopic and percutaneous techniques. These skills can be obtained through cadaver labs as well as attempting arthroscopy in open cases with consent of the patient. Much of the guidance is through palpation. To assist in the initial débridement and creation of a joint space, a percutaneous Shannon burr can be used to remove osteophytes and get initial cartilage removal within the joint under C-arm control and palpation. This creates a much bigger space for the insertion of the arthroscope. The procedure can also be hybrid arthroscopic and open, with, for example, the subtalar fusion done arthroscopic and the talonavicular fusion done open. For example, this may be determined by prior incisions.

The procedure is done supine with the hip internally rotated (Figure 19.2). A beanbag can allow correct positioning with the foot being 10° to 20° internally rotated on the operating room table.

The procedure can be done under nerve block with a sterile calf tourniquet or with a spinal or general with a thigh tourniquet. The arthroscopy tower is placed on the opposite side of the bed toward the patient’s head. The C-arm is placed at the base of the bed. It is best to release all three joints using a blunt elevator first, then débride all three joints working from back to front, and then transfix all joints with screw fixation in the order of subtalar joint, talonavicular joint, and calcaneocuboid joint.