The Medial Double Arthrodesis: Over-rated?

There is little debate regarding the utility of arthrodesis type procedures in the treatment of end-stage adult acquired flatfoot deformity. Deliberation rages on, however, between proponents of the single-incision medial double versus the traditional dual-incision, triple arthrodesis.

New kid on the block

The single incision medial double has been gaining in popularity over the last decade. Proponents report advantages including fewer wound-healing complications, broad exposure for adequate cartilage resection, a distraction effect on the calcaneocuboid joint, and lower risk for developing ankle valgus, postoperatively.

Hold on now, not so fast

However, Ashlee MacDonald, MD et al. recently conducted an in-vivo study, Single Medial vs 2-Incision Approach for Double Hindfoot Arthrodesis, which compared the cartilage resection between the medial double and triple arthrodesis procedures in eight matched cadaveric specimens. The result: suboptimal debridement for the single incision medial double, particularly with respect to posterior subtalar joint facet and the inferior talar head. The authors also postulated a greater increased risk of postoperative ankle valgus for the single incision approach given that it requires transection of the deltoid ligament for surgical exposure; diametrically different to early reports regarding the utility and benefits of the procedure.

Look for more research comparing the medial and triple arthrodesis procedures in the future; the debate is far from over.