Anterior Ankle Arthroscopy

Epstein, David; Black, Brandee S.; Sherman, Seth L.

doi:10.1016/j.fcl.2014.10.001

Cited by 33 publications

(15 citation statements)

References 63 publications

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“…Comprehensive registry analysis are missing, although the overall rate is reported to be between 0.13 and 1.8% [1, 9, 28, 29, 80]. It is even higher in patients who received an intraoperative intra‐articular corticosteroid injection with an incidence rate of 3.9% [80].…”

Section: Epidemiology and Pathophysiologymentioning

confidence: 99%

Post-operative septic arthritis after arthroscopy: modern diagnostic and therapeutic concepts

Voß

Pfeifer

Kerschbaum

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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Purpose Septic arthritis is a significant complication following arthroscopic surgery, with an estimated overall incidence of less than 1%. Despite the low incidence, an appropriate diagnostic and therapeutic pathway is required to avoid serious long-term consequences, eradicate the infection, and ensure good treatment outcomes. The aim of this current review article is to summarize evidence-based literature regarding diagnostic and therapeutic options of post-operative septic arthritis after arthroscopy. Methods Through a literature review, up-to-date treatment algorithms and therapies have been identified. Additionally, a supportive new algorithm is proposed for diagnosis and treatment of suspected septic arthritis following arthroscopic intervention. Results A major challenge in diagnostics is the differentiation of the post-operative status between a non-infected hyperinflammatory joint versus septic arthritis, due to clinical symptoms, (e.g., rubor, calor, or tumor) can appear identical. Therefore, joint puncture for microbiological evaluation, especially for fast leukocyte cell-count diagnostics, is advocated. A cell count of more than 20.000 leukocyte/µl with more than 70% of polymorphonuclear cells is the generally accepted threshold for septic arthritis. Conclusion The therapy is based on arthroscopic or open surgical debridement for synovectomy and irrigation of the joint, in combination with an adequate antibiotic therapy for 6–12 weeks. Removal of indwelling hardware, such as interference screws for ACL repair or anchors for rotator cuff repair, is recommended in chronic cases. Level of evidence IV.

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Section: Epidemiology and Pathophysiologymentioning

confidence: 99%

Post-operative septic arthritis after arthroscopy: modern diagnostic and therapeutic concepts

Voß

Pfeifer

Kerschbaum

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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“…Currently, anterior ankle arthroscopy is mostly performed by means of a 2-portal dorsiflexion method with intermittent soft tissue distraction, while posterior ankle arthroscopy is mostly performed by means of a two-portal hind foot approach. 1,2,16,17,21 A thigh tourniquet is typically used with ankle arthroscopy. 2,[19][20][21] With this technique an overall complication rate of 3.5 % in 1305 procedures was noted.…”

Section: Introductionmentioning

confidence: 99%

“…1,2,16,17,21 A thigh tourniquet is typically used with ankle arthroscopy. 2,[19][20][21] With this technique an overall complication rate of 3.5 % in 1305 procedures was noted. 21 Zengerink and van Dijk emphasized a limited tourniquet time as a possible factor to lower the complication rate even more.…”

Section: Introductionmentioning

confidence: 99%

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Value of Tourniquet Use in Anterior Ankle Arthroscopy: A Randomized Controlled Trial

2017

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“…The average overall complication rate in ankle arthroscopy is reported to be between 3.4% and 10.3%, 3 , 7 , 8 , 34 - 36 with a substantial drop due to advances in operative equipment and technique. Through use of the dorsiflexion method, Zengerink and van Dijk 36 reported a significant decrease of the overall complication rate to 3.5%.…”

Section: Introductionmentioning

confidence: 99%

Anterocentral Portal in Ankle Arthroscopy

Stotter

Klestil

Chemelli³

et al. 2020

Foot Ankle Int.

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Background: The anterocentral portal is not a standard portal in anterior ankle arthroscopy due to its proximity to the anterior neurovascular bundle. However, it provides certain advantages, including a wide field of vision, and portal changes become redundant. The purpose of this study was to evaluate the neurovascular complications after anterior ankle arthroscopy using the anterocentral portal. Methods: We retrospectively identified patients who had undergone anterior ankle arthroscopy with an anterocentral portal at our institution from 2013 to 2018. Medical record data were reviewed and patients were invited for clinical follow-up, where a clinical examination, quantitative sensory testing for the deep peroneal nerve, and ultrasonography of the structures at risk were performed. A total of 101 patients (105 arthroscopies) were identified and evaluated at a mean follow-up of 31.5 ± 17.7 months. Results: Leading indications to surgery were heterogeneous and included anterior impingement (48.6%), osteochondral lesions of the talus (24.8%), chronic ankle instability (14.3%), and fractures (8.6%). The overall complication rate was 7.6%, and no major complications were observed. In 1.9% (2/105) of the cases, the complications were associated with the anterocentral portal and included injury to the medial branch of the superficial nerve (1/105) and to the deep peroneal nerve (1/105). Injury to the deep peroneal nerve was associated with a loss of detection and nociception. There were no injuries to the anterior tibial artery. In 41.9% (44/105) of the cases, only 1 working portal was used in addition to the anterocentral portal, and in 19% (20/105) the anterolateral portal could be avoided. Ultrasonography confirmed the integrity of the deep peroneal nerve, the medial branch of the superficial peroneal nerve, and the anterior tibial artery in all patients. Patients with nerve injuries associated with the anterocentral portal showed no signs of neuroma or pseudoaneurysm. Conclusion: Using a standardized technique, the anterocentral portal in ankle arthroscopy is safe with a low number of neurovascular injuries and can be recommended as a standard portal. The anterolateral portal remains associated with a high number of injuries to the superficial peroneal nerve. Level of Evidence: Level III, retrospective cohort study.

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Anterior Ankle Arthroscopy

Cited by 33 publications

References 63 publications

Post-operative septic arthritis after arthroscopy: modern diagnostic and therapeutic concepts

Post-operative septic arthritis after arthroscopy: modern diagnostic and therapeutic concepts

Value of Tourniquet Use in Anterior Ankle Arthroscopy: A Randomized Controlled Trial

Anterocentral Portal in Ankle Arthroscopy

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