Patient-specific instruments for surgical resection of painful tarsal coalition in adolescents

IntroductionCongenital tarsal coalition resection in adolescents may be hindered by the complex three-dimensional anatomy of the talocalcaneal joint. Peroperative fluoroscopy is not greatly contributive, especially for talocalcaneal coalition.Hypothesis3D planning and patient-specific instruments facilitate the procedure.Materials and methodsA made-to-measure surgical guide (patient-specific instrument) was used in 9 consecutive patients for tarsal coalition resection (7 talocalcaneal and 2 calcaneonavicular coalitions). The guide was created by 3D modeling from the CT scan of the foot. Placed on the bone surface, it oriented the saw blade to resect the bone bridge at the appropriate depth. A fascia lata allograft was interposed. Complete resection and absence of recurrence were checked on postoperative CT in talocalcaneal and on radiography in calcaneonavicular coalitions.ResultsResection was complete in all cases, with no recurrence at last follow-up.DiscussionThis technique makes tarsal coalition resection easier and more reliable and may be recommended to improve precision.Level of evidenceLevel IV, prospective study of a new surgical technique.