Cadaver study of anatomic landmark identification for placing ankle arthroscopy portals

Scheibling, Benjamin; Koch, Guillaume; Clavert, Philippe

doi:10.1016/j.otsr.2016.09.026

Cited by 11 publications

(9 citation statements)

References 23 publications

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“…In 22% (4/18), the arthroscope was in direct contact with the neurovascular bundle. 9 Scheibling et al 19 performed anterocentral portal placement in cadaveric ankles with and without ultrasonography and reported distances between the arthroscope and the anterior neurovascular bundle of 6.1 and 3.7 mm, respectively. However, Buckingham et al 2 found a mean distance of 0.7 mm for the artery with direct contact of the arthroscope in 90% and a 1.1-mm mean distance for the DPN.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

“… 26 Moreover, ultrasonography for portal placement might decrease the risk for iatrogenic injuries. 19 …”

Section: Discussionmentioning

confidence: 99%

Anterocentral Portal in Ankle Arthroscopy

Stotter

Klestil

Chemelli³

et al. 2020

Foot Ankle Int.

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“…A recent study reported a full-thickness injury to the extensor hallucis longus tendon by the anterior portal when ultrasonography was not used preoperatively [13]. Their study, however, found no cases of iatrogenic injury when preoperative ultrasonography was used.…”

Section: Discussionmentioning

confidence: 99%

The Distribution Pattern of the Neurovascular Structures for Anterior Ankle Arthroscopy to Minimize Structural Injury: Anatomical Study

Jeon

Seo

Lee

et al. 2018

BioMed Research International

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Introduction The aim of this study was to investigate entry points for anterior ankle arthroscopy that would minimize the risk of neurovascular injury. Methods Thirty-eight specimens from 21 Korean cadavers (age range from 43 to 92 years, mean age of 62.3 years) were used for the study. For the measurements, the most prominent points of the lateral malleolus (LM) and the medial malleolus (MM) were identified before dissection. A line connecting the LM and MM, known as the intermalleolar line, was used as a reference line. We measured 14 variables passed on the reference line. Results This study found that the nerves were located at 40.0%, 50.0%, and 82.0% of the reference line from the lateral malleolus. We also found that the arteries were located at 22.0%, 35.0%, and 60% of the reference line from the lateral malleolus. Discussion If all the variables are combined (nerves, arteries, and veins), then there is no safety zone for anterior portal placement. Therefore, we recommend that surgeons concentrate primarily on the arteries and nerves in the clinical setting.

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“…We work with a classic 2-portal endoscopic approach: 1 posterolateral portal for the camera and 1 posteromedial portal for the instruments 9,10 (Fig 3). Performing dissection using the ArthroCare Super Turbovac 90 wand handpiece (Smith & Nephew Endoscopy, Andover, MA), we visualize the posterolateral tubercle of the talus and the subtalar joint.…”

Section: Surgical Techniquementioning

confidence: 99%

Endoscopic Tenolysis of Flexor Hallucis Longus Tendon: Surgical Technique

Olden

Vallotton

2020

Arthroscopy Techniques

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Flexor hallucis longus tendon release for surgical treatment of functional hallux limituseassociated conditions is described. This release is obtained by arthroscopic correction of the tendon's blockage, which is located at the retrotalar pulley. The procedure restores the ability for dorsiflexion of the first toe in ankle dorsiflexion (positive stretch test result). Such movement was not possible before, causing a modified gait pattern and affecting the biomechanics of the foot and leg. This explains why the procedure creates favorable changes concerning foot dynamics by restoration not only of the normal tendon glide but also of the normal mobility of the subtalar joint.

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Cadaver study of anatomic landmark identification for placing ankle arthroscopy portals

Abstract: IV, cadaver study.

Cited by 11 publications

References 23 publications

Anterocentral Portal in Ankle Arthroscopy

Anterocentral Portal in Ankle Arthroscopy

The Distribution Pattern of the Neurovascular Structures for Anterior Ankle Arthroscopy to Minimize Structural Injury: Anatomical Study

Endoscopic Tenolysis of Flexor Hallucis Longus Tendon: Surgical Technique

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