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Updated: Jul 27 2023

Ankle Arthroscopy

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  • Indications
    • Indications
      • osteochondral lesions of the talus
      • microfracture of OCD
      • debridement of post-traumatic synovitis
      • ATFL anterolateral impingement
      • AITFL anterolateral impingement
      • resection of anterior tibiotalar spurs
        • such as anterior bony impingement
      • os trigonum excision
      • removal of loose bodies
      • cartilage debridement in conjunction with ankle fusions
  • Positioning and Scope insertion
    • Position
      • patient placed supine
      • leg over well padded bolster
    • Tourniquet
      • place tourniquet and exsanguinate limb
    • Joint distention
      • external traction device applied to distract tibiotalar joint
      • can load joint with saline to distend joint
    • Scope insertion
      • nick and spread method commonly utilized to access joint and minimize neurovascular injury
  • Portals
    • Anteromedial
      • function
        • primary viewing portal
        • typically established first
        • access to anteromedial joint
      • location and technique
        • medial to tibialis anterior and lateral to medial malleolus
        • make portal between tibialis anterior and saphenous vein
    • Anterolateral
      • function
        • primary viewing portal
        • access to anterolateral joint
      • location and technique
        • located just lateral to peroneus tertius and superficial peroneal nerve and medial to lateral malleolus
        • can trace out superficial peroneal nerve prior to incision
    • Anterocentral
      • function
        • anterior viewing portal
      • location and technique
        • not commonly utilized due to danger to dorsal pedis artery
        • medial to EDL and lateral to EHL
    • Posterolateral
      • function
        • posterior viewing portal for access to os trigonum
      • location and technique
        • located 2cm proximal to tip of lateral malleolus
        • medial to peroneal tendons and lateral to achilles tendon
    • Posteromedial
      • function
        • posterior viewing portal for access to os trigonum
      • location and technique
        • just medial to achilles tendon
  • Complications
    • Synovial cutaneous fistula
      • avoid by immobilization to allow portal skin healing and closure
    • Neurovascular injury from portal placement
      • neuropraxia most common complication
      • Anterolateral portal
        • risks superficial peroneal nerve
          • most common neurovascular injury
          • specifically, the dorsal intermediate cutaneous branch
      • Anteromedial portal
        • risks saphenous nerve and vein
        • risk of tibialis anterior tendon injury
      • Anterocentral portal
        • risks dorsalis pedis artery
      • Posterolateral portal
        • risks sural nerve and short saphenous vein
      • Posteromedial portal
        • risks posterior tibial artery
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