CME OnDemand: Small Incisions, Big Results: MIS to the MAX-Symposium 5: MIS Fusion and Beyond

Video Transcription

Video Summary

The video presents a comprehensive discussion on minimally invasive surgery (MIS) fusions for foot and ankle procedures, featuring expert surgeons sharing techniques, outcomes, and challenges.<br /><br />Jesse Doty begins with MIS first metatarsophalangeal (MTP) joint fusion. He emphasizes transitioning from open to MIS techniques and highlights literature showing comparable fusion rates between MIS and open methods. Jesse details his step-by-step technique, stressing careful joint prep with a burr, limited fluoroscopy, and strategic screw and plate fixation. Key takeaways include the importance of removing dorsal bone to avoid toe dorsiflexion and vigilance to avoid extensor hallucis longus (EHL) tendon entrapment.<br /><br />Tyler Gonzales discusses MIS double and triple arthrodeses, reiterating similar indications as open surgery but with benefits such as smaller incisions and less postoperative pain. He underscores the importance of joint preparation, copious irrigation, bone grafting, and robust fixation, advising that MIS can be combined with open techniques if needed. He shares surgical positioning, portal placement, and fixation strategies, noting favorable healing and reduced narcotic requirements postoperatively.<br /><br />Etra Brocano focuses on ankle fusions, advocating MIS to minimize wound complications common in open approaches. He describes portal placement, burr usage, irrigation techniques, fixation methods dependent on bone quality, and outcomes including a 97% fusion rate in his series. Etra prefers MIS over arthroscopic fusions due to simpler setup and fewer logistical challenges.<br /><br />Jonathan Kaplan addresses MIS osteotomies for hindfoot and midfoot deformities, presenting cases where percutaneous burr osteotomies combined with limited incisions improve alignment while minimizing soft tissue disruption. He explores the use of 3D-printed cutting guides to enhance accuracy but notes current limitations like reference point reliability and ergonomic challenges.<br /><br />A panel discussion follows, highlighting the role of arthroscopy in learning MIS fusions, consensus favoring its use during early adoption for quality assurance. The speakers debate joint cartilage removal extent and biological effects of retained cartilage slurry. They discuss learning curves, operative efficiency, cost considerations, fixation hardware choices, and patient outcomes favoring MIS techniques for reduced pain and complications. The potential role of biologics, such as bone graft substitutes and augment products, is briefly discussed, with mixed views on their necessity given preserved soft tissue biology in MIS fusions.<br /><br />Overall, the session underscores that MIS foot and ankle fusions offer equivalent fusion rates to open surgery with benefits including smaller incisions, faster recovery, less pain, and fewer wound complications. Adoption requires mastery of specialized techniques, appropriate fixation, and judicious use of fluoroscopy and arthroscopy, but it represents a forward direction in surgical management of foot and ankle pathologies.

Asset Subtitle

Moderator: Bradley Sabatini, MD

MTP
Jesse F. Doty, MD

Doubles & Triples
Tyler A. Gonzalez, MD, MBA

Ankle
Ettore Vulcano, MD

Biplanar Midfoot Osteotomy & Fusions MIS… Pins to Jig?
Jonathan R.M. Kaplan, MD

Questions/Case Discussion

Keywords

minimally invasive surgery

foot and ankle fusion

MTP joint fusion

double and triple arthrodeses

ankle fusion

osteotomies

arthroscopy

surgical techniques

postoperative outcomes

biologics