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

Abdul-Jabar, Hani B.; Bhamra, Jagmeet; Quick, Tom; Fox, Michael

doi:10.1093/jscr/rjw097

Cited by 6 publications

(5 citation statements)

References 9 publications

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“…For many years ankle arthroscopy has proved to be a useful diagnostic and therapeutic procedure for ankle and foot disorders. Although it is a minimally invasive surgery neurological complications are most frequently reported referring to the tibial, sural, superficial peroneal and deep peroneal nerves [1,45,47]. According to Freedman et.al [13] all neurovascular impairments are caused by distractor pin or portal placement.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the histological structure of the tibial nerve and its terminal branches in the fresh and fresh-frozen cadavers

et al. 2021

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Background: The aim of this study was to compare the histological structure (cross-sectional area (CSA) and number of nerve fascicles) of the distal part of the tibial nerve (TN) and its terminal branches (medial plantar nerve [MPN], lateral plantar nerve [LPN]) in the fresh and fresh-frozen cadavers using computer assisted image analysis. Materials and methods: The tibial nerve with terminal branches (medial and lateral plantar nerves) were dissected from the fresh and fresh-frozen cadavers. Each nerve was harvested 5 mm proximally and respectively 5 mm distally from the tibial nerve bifurcation, marked, dehydrated, embedded in paraffin, sectioned at 2 µm slices and stained with haematoxylin and eosin. Then the specimens were photographed and analyzed using Olympus cellSens software. Results: The fresh cadavers group comprised 60 feet (mean age 68.1 ± 15.2 years). The mean CSA and the number of nerve fascicles were respectively 15.25 ± 4.6 mm 2 , 30.35 ± 8.45 for the tibial nerve, 8.76 ± 1.93 mm 2 , 20.75 ± 7.04 for the medial plantar nerve and 6.54 ± 2.02 mm 2 , 13.40 ± 5.22 for the lateral plantar nerve. The fresh-frozen cadavers group comprised 21 feet (mean age 75.1 ± 9.0 years). The mean CSA and the number of nerve fascicles were respectively 13.71 ± 5.66 mm 2 , 28.57 ± 8.00 for the tibial nerve, 7.55 ± 3.25 mm 2 , 18.00 ± 6.72 for the medial plantar nerve and 4.29 ± 1.93 mm 2 , 11.33 ± 1.93 for the lateral plantar nerve. Only lateral plantar nerves showed statistical differences in the CSA and the number of nerve fascicles between examined groups (p = 0.000, p = 0.037 respectively). A positive correlation was found between donors age and tibial nerve CSA in the fresh cadavers group (r = 0.44, p = 0.000). A statistical difference was found between the medial and lateral plantar nerves both in the CSA and the number of nerve fascicles (p < 0.001, p < 0.001 respectively). Conclusions: The CSA and the number of nerve fascicles of the tibial and medial plantar nerves were similar in the fresh and fresh-frozen cadavers whilst different in the lateral plantar nerve. The tibial nerve showed increasing CSA with the advanced age in the fresh cadavers. The medial plantar nerve had larger CSA and more nerve fascicles than the lateral plantar nerve.

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Section: Introductionmentioning

confidence: 99%

Comparison of the histological structure of the tibial nerve and its terminal branches in the fresh and fresh-frozen cadavers

et al. 2021

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“…Abdul-Jabar et al reported a complete division of the posterior tibial nerve during an anterior AA combined with an additional posterolateral portal. According to these authors, the complication was due to poorly controlled use of arthroscopic instruments ( 3 ).…”

Section: Complications Of Ankle Arthroscopymentioning

confidence: 99%

“…can diminish the risk of adverse events. Abdul-Jabar et al ( 3 ) 2016 Case report NA 1 Complete division of the posterior tibial nerve during an anterior ankle arthroscopy combined with an additional posterolateral portal. This complication was due to a poorly controlled use of the arthroscopic instruments.…”

Section: Complications Of Ankle Arthroscopymentioning

confidence: 99%

“…AA has provided good to excellent results (up to 90%) in the literature for the treatment of certain intra-articular disorders of the ankle. However, due to the superficial location of the ankle joint and its abundance of neurovascular structures, the complications of AA are greater than those occurring in other joints ( 3 ). Furthermore, as the indications for AA increase, so do its complications ( 4 ).…”

Section: Introductionmentioning

confidence: 99%

“…As early as 1996, Ferkel et al indicated AA for patients with ankle pain, swelling, locking, and instability who did not respond to non-surgical treatment ( 5 ). Subsequently, the indications for AA have been expanded ( 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 ). Table 1 summarises the current indications for AA.…”

Section: Introductionmentioning

confidence: 99%

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Complications of ankle arthroscopy: frequency, prevention, and treatment

Rodríguez-Merchán,

Encinas-Ullán,

Ruiz-Pérez

et al. 2024

EFORT Open Reviews

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The complication rate of ankle arthroscopy (AA) ranges from 3.5% to 14%. To avoid such complications, it is essential to have a thorough understanding of the anatomy of the ankle, to perform the procedure very carefully and with appropriate instrumentation, and to use a non-invasive distraction technique. The most frequent complications are neurological (cutaneous nerve injuries), which are usually caused by direct injury during arthroscopic portals or by a distracting pin when using an invasive distraction technique. They usually resolve spontaneously within a few months. The iatrogenic formation of a pseudoaneurysm is a severe but extremely rare complication (an incidence of 0.008%). There are several treatments for pseudoaneurysms: external compression; direct thrombin injection, surgical intervention (resection of the damaged segment of the artery and reconstruction with a reversed long saphenous vein interposition graft), and endovascular embolisation. Other rare complications include wound infections (localised superficial infection), problems at the portal incisions (prolonged portal drainage, residual pain in the portal, portal scar dehiscence, cyst at the portal site), type I complex regional pain syndrome, instrument breakage, painful scars and nodules, and a number of other rarer complications. In conclusion, when performing AA, it is important to remember the potential complications and try to avoid them. When they do occur, it is essential to diagnose and treat them appropriately.

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Nerve Injury After Knee Arthroscopy, ACL Reconstruction, Multiligament Knee, and Open Knee Surgery

Hill

Apostolakos

et al. 2021

Peripheral Nerve Issues After Orthopedic Surgery

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

Cited by 6 publications

References 9 publications

Comparison of the histological structure of the tibial nerve and its terminal branches in the fresh and fresh-frozen cadavers

Comparison of the histological structure of the tibial nerve and its terminal branches in the fresh and fresh-frozen cadavers

Complications of ankle arthroscopy: frequency, prevention, and treatment

Nerve Injury After Knee Arthroscopy, ACL Reconstruction, Multiligament Knee, and Open Knee Surgery

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