Open removal of anterior osteophytes has been performed in the past with good results. In the past several years, arthroscopy has been increasingly used to treat these lesions with equal effectiveness, but with the benefit of a much easier recovery. The surgery is performed with the patient in the supine position with the leg supported on the operating table, and standard antero-medial and anterolateral portals are established. Nearly all anterior osteophytes will be within the joint capsule and are best visualized without distraction with the ankle in maximal dorsi-flexion9,16 (Fig. 67-7). Small joint osteotomes and a 4.0-mm bur are used to take down the osteophytes off the anterior tibia and from the notch on the anterior talar neck. Any hypertrophic syn-ovium or scar tissue in this area is carefully removed with a shaver.
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