Updated: 3/29/2017

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 EDC 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 q q  
        • most common neurovascular injury
        • specifically, the dorsal intermediate cutaneous branch
    • Anteromedial portal
      • risks saphenous nerve and vein
    • 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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Questions (9)
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(OBQ08.241) Nerve injury is the most common complication of ankle arthroscopy. The superficial peroneal nerve is at greatest risk of injury with which of the following portals shown in Figure A? Review Topic

QID: 627
FIGURES:
1

Portal A

83%

(1890/2273)

2

Portal B

9%

(195/2273)

3

Portal C

2%

(50/2273)

4

Portal D

5%

(119/2273)

5

Portal E

0%

(10/2273)

ML 1

Select Answer to see Preferred Response

PREFERRED RESPONSE 1
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