Nerve injury is the most common complication of ankle arthroscopy. The Superficial Peroneal Nerve is the most commonly injured nerve and is at risk with use of the anterolateral portal, shown as Portal A in the Figure.
Ferkel et al (1996). in a retrospective review looking at complications associated with ankle arthroscopy, found an overall complication rate of 9.0%, of these 4.4% were neurological complications. Of the 27 cases of nerve injury, the superficial peroneal nerve was injured in 15 cases, the sural nerve in 6, the saphenous nerve in 5, and the deep peroneal nerve in 1. All nerve injuries occurred through direct injury by portal or distractor pin placement.
Ferkel et al (2001) reviewed the complications associated with ankle arthroscopy and discusses strategies to prevent them. They again state that the overall complication rate is 9%. They report most complications associated with foot and ankle arthroscopy are transient and tend to resolve within 6 months.
Stephens et al describe a technique to identify the superficial peroneal subcutaneously that entails flexion of the fourth toe which accentuates the subcutaneous course of the cutaneous branches of the superficial peroneal nerve. They recommend this technique as a way of identifying the nerve to prevent injury during portal placement.
Illustration A shows the anterior portals used for ankle arthroscopy. Illustration B shows the posterior portals used in ankle arthroscopy.
Ferkel RD, Heath DD, Guhl JF: Neurologic complications of ankle arthroscopy. Arthroscopy 1996;12:200-208
PMID:8776998 (Link to Abstract)
Ferkel RD, Small HN, Gittins JE: Complications in foot and ankle arthroscopy. Clin Orthop Relat Res 2001;391:89-104
PMID:11603693 (Link to Abstract)
Stephens MM, Kelly PM. Fourth toe flexion sign: a new clinical sign for identification of the superficial peroneal nerve. Foot Ankle Int. 2000 Oct;21(10):860-3. Erratum in: Foot Ankle Int 2000 Dec;21(12):995. PubMed PMID: 11128019.
PMID:11128019 (Link to Abstract)