Risk of sural nerve injury during lateral distal Achilles tendinoscopy: A Cadaver Study

Appy-Fedida, Benjamin; Vernois, J.; Krief, Élie; Gouron, Richard; Mertl, P.; Havet, É.

doi:10.1016/j.otsr.2014.10.019

Cited by 9 publications

(12 citation statements)

References 25 publications

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“…11 The focus was on the sural nerve in relation to the peroneal and Achilles portals. 1,20 A calibrated dial caliper with 0.01-mm precision was used to measure the distance between these structures and the portal tracts. In addition, both orthopedic surgeons visually inspected each tendon for macroscopically apparent iatrogenic damage.…”

Section: Methodsmentioning

confidence: 99%

2-Mm Diameter Operative Tendoscopy of the Tibialis Posterior, Peroneal, and Achilles Tendons: A Cadaveric Study

et al. 2019

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Background: Technical innovation now offers the possibility of 2-mm-diameter operative tendoscopy with disposable arthroscopes and tablet-like control units. The promises of new technology should be critically scrutinized. Therefore, this study assessed whether 2-mm-diameter operative tendoscopy of the tibialis posterior, peroneal, and Achilles tendons was safe and effective in a cadaveric model. Methods: A 2-mm-diameter arthroscopic system was used to perform a tendoscopic procedure in 10 nonpaired, fresh-frozen, human ankles. Standard tendoscopic portals were utilized. Visual examination and operative reach with tailored tendoscopic instruments within the tendon sheaths were recorded and documented. Adhesiolysis and vincula resections were performed. After dissection, distances between portal tracts and neurovascular structures were measured and the tendons were inspected for signs of iatrogenic damage. Results: The entire tendon sheath and tendon of the tibialis posterior, peroneus brevis, and Achilles tendons were visualized and reached with tailored operative instruments. The proximal part of the peroneus longus tendon was visible and reachable from proximally up to the cuboid bone distally. Adhesiolysis and vincula resections were successfully performed in all specimens. The mean distances between portal tracts and local neurovascular structures ranged between 9.4 and 19.2 mm and there were no cases of contact. None of the tendons showed signs of iatrogenic damage. Conclusion: Two-millimeter-diameter operative tendoscopy provided safe and effective visualization and operative reach of the tibialis posterior, peroneal, and Achilles tendons. Clinical Relevance: Compared with current practice, 2-mm-diameter operative tendoscopy has the potential to make tendoscopy around the ankle less invasive and more accessible. Diagnostic, interventional, and second-look procedures might be performed at substantially reduced risk, time, and costs.

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Section: Methodsmentioning

confidence: 99%

2-Mm Diameter Operative Tendoscopy of the Tibialis Posterior, Peroneal, and Achilles Tendons: A Cadaveric Study

et al. 2019

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“…Despite these considerations, few studies on the anatomy of the SN have discussed the risk of injury during ankle arthroscopy. A recent publication described the risk of injury to the SN due to posterolateral portal positioning in arthroscopy; however, this study was performed on cadavers (Appy‐Fedida et al ). Besides preventing injury, localizing the SN is also important when it is to be harvested as graft tissue for other nerve pathologies and traumatic injuries (Seidel et al ).…”

Section: Introductionmentioning

confidence: 99%

The surgical anatomy of the sural nerve: An ultrasound study

et al. 2017

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The aim of this study was (a) to examine the anatomy of the sural nerve (SN) in a sample of 30 patients and (b) to analyze the incidence of different origins of the SN, and the distance of the SN from planned arthroscopic portals. An ultrasound (USG) examination of the SN was performed bilaterally on thirty healthy patients with no history of surgery or trauma of the lower limb. The SNs were classified into six main types of pattern, with an additional category for new and unclassified types. Each of Types 1 and 3 had two subdivisions. The distances from the superior border of the calcaneal tuberosity to the three simulated arthroscopy portal sites (Z1, Z1.5, Z2) to the SN were measured. A total of 30 patients (n = 60 limbs) with an average age of 27 ± 7.5 years were examined and the SN was visualized in all cases. The most common origin was Type 3A, accounting for 30% of limbs. Type 2 was the second most common seen in 18.3%. The distances of the SN from arthroscopic portal placement sites above the lateral malleolus were 2.07 ± 0.39 cm at the Z1 portal, 2.15 ± 0.38 cm at Z1.5, and 2.28 ± 0.33 cm at Z2. The variability in the anatomy of the SN warrants the use of USG to locate it accurately, thus preventing iatrogenic injury when portals are placed for arthroscopy, improving proper administration of anesthesia, and helping to localize the nerve for graft harvesting. Clin. Anat. 31:450-455, 2018. © 2017 Wiley Periodicals, Inc.

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“…Due to its close relationship to the SSV, the SN is at risk during sapheno‐popliteal junction dissection, stripping, thermal ablation, and phlebectomy of the SSV (Ricci et al, ; Schweighofer et al, ; Kerver et al, ). Injury to the SN has also been reported following Achilles tendoscopy and surgical repair (Kammar et al, ), in the treatment of distal tibial fractures (Mizia et al, ), and ankle arthroscopy (Appy‐Fedida et al, ).…”

Section: Discussionmentioning

confidence: 96%

The anatomical relationship between the sural nerve and small saphenous vein: An ultrasound study of healthy participants

et al. 2018

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Procedures involving the small saphenous vein (SSV) can result in sural nerve (SN) damage due to the proximity of the two structures. The relationship between the SN and SSV has previously been described in cadaveric studies with limited scope on surface landmarks. This study investigates the relationship between the SN and SSV in vivo through ultrasound. Transverse/short-axis ultrasound scans of 128 legs (64 healthy participants) were taken by a single observer using a GE Logiq e ultrasound system with a 5-13 Hz linear transducer (GE Logiq 12L-RS). The SN was identified and traced from the lateral malleolus to the popliteal fossa noting its course and proximity to the SSV. The distance between the SN and SSV was measured at points representing the distal 50% and 25% of the total leg length (the distance between the medial tibial condyle and the inferior edge of the medial malleolus). The SN and SSV were visualized in all participants regardless of BMI and atypical anatomical relationship were noted in 20.3%. The SN pierced the fascia in the distal 25.9% AE 5.3% of the total leg length. The distance between the SN and SSV was 4.06 AE 1.8 mm and 3.4 AE 1.4 mm in the distal 50% and 25% points of the total leg length, respectively. There was no significant effect of sex or body side. The SSV is a viable option for multiple vein harvest. Ultrasound visualization can be a beneficial tool for delineating variations of the SN in relation to SSV prior to surgery. Clin. Anat. 32:277-281, 2019.

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Risk of sural nerve injury during lateral distal Achilles tendinoscopy: A Cadaver Study

Abstract: Level IV. Anatomic Study.

Cited by 9 publications

References 25 publications

2-Mm Diameter Operative Tendoscopy of the Tibialis Posterior, Peroneal, and Achilles Tendons: A Cadaveric Study

2-Mm Diameter Operative Tendoscopy of the Tibialis Posterior, Peroneal, and Achilles Tendons: A Cadaveric Study

The surgical anatomy of the sural nerve: An ultrasound study

The anatomical relationship between the sural nerve and small saphenous vein: An ultrasound study of healthy participants

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