Combined Posterior and Anterior Ankle Arthroscopy

Abstract

Treatment of combined anterior and posterior ankle pathology usually consists of either combined anterior and posterior arthrotomies or anterior ankle arthroscopy with an additional posterolateral portal. The first technique bears the risk of complications associated with the extensive exposure, the latter technique provides limited access to the posterior ankle joint. A case is described of combined anterior and posterior arthroscopy, with the patient lying prone and then turned supine, addressing both anterior and posterior ankle pathologies in one tempo. This minimally invasive combined approach allows quick recovery and early return to work and sports activities.

Anterior and Posterior Arthroscopic Treatment of Primary Synovial Chondromatosis of the Ankle

“…We did not observe a higher rate of infections in our patients, which is in accordance with the data reported by other authors using this approach. 1,3,41 A study of a technique in which anterior ankle arthroscopy was performed first, followed by position switching from supine to prone, reported that the median time needed for position switching was 15 minutes. 28 However, patients were under general anesthesia, the leg was initially positioned in a holder with the hip flexed for 45 degrees, and with the use of noninvasive bandage distraction.…”

“…Other authors used a different approach, performing a posterior ankle arthroscopy in a prone position initially, followed by a position switching to supine, and anterior ankle arthroscopy. 1,3,41 The described technique was used in our study as well. Patients had spinal anesthesia, positioned without the use of a holder, and under no distraction.…”

“…Furthermore, if the patient is placed in a prone position during the whole operation, with the knee flexed at 90 degrees, the dorsiflexion of the foot will be limited, resulting in inadequate visualization and also possibly higher complication rates. 41 Another technique describes positioning of the patient in a supine position during the whole operation and using 2 posterolateral portals to perform the posterior ankle arthroscopy. 45 Visualization of all parts of the posterior compartment is essential in this type of operation, which is difficult with the described technique and we believe it is better achieved with the approach described by van Dijk.…”

Combined Anterior and Dual Posterolateral Approaches for Ankle Arthroscopy for Posterior and Anterior Ankle Impingement Syndrome

“…Reposition of the patient was necessary during the operation. 14 They performed the arthroscopic debridement of the posterior ankle with the patient in prone position and then carried out repeated prep and drape to perform the arthroscopic debridement of the anterior ankle with the patient in the supine position. Wound healing complications were significantly reduced, whereas the posteromedial approach resulted in a higher risk of neurovascular injury.…”

Iatrogenic posterior tibial nerve division during a combined anterior ankle arthroscopy with an additional posterolateral portal

“…Treatment of combined anterior and posterior ankle pathology usually requires either a combined anterior and posterior arthrotomies or anterior ankle arthroscopy with an additional posterolateral portal. The first technique bears the risk of complications associated with extensive exposure while the latter provides limited access to the posterior ankle joint [ 8 ].…”