A Technique for the Reduction of Complications Associated With Anterior Portal Placement During Ankle Arthroscopy Using a Peripheral Vein Illumination Device

Tsuyuguchi, Yusuke; Nakasa, Tomoyuki; Ishikawa, Masakazu; Ikuta, Yasunari; Sawa, Masahiro; Yoshikawa, Masahide; Adachi, Nobuo

doi:10.1016/j.eats.2017.08.060

Cited by 5 publications

(7 citation statements)

References 13 publications

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“…Repeated sprain of ankle joint caused by CAI can cause injury of articular cartilage, so CAI with cartilage injury has a high incidence rate [7]. If effective therapy measures are not given in time, with the development of the disease, sufferers will have persistent pain and will cause certain damage to ankle joint function.…”

Section: Discussionmentioning

confidence: 99%

Application of platelet rich plasma injection in the therapy of youth ankle joint instability with cartilage injury

Zhou

Yang

Wang

et al. 2023

Preprint

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Aim To estimate the clinical efficacy of platelet-rich plasma (PRP) injection in the therapy of Chronic Ankle Instabiliy (CAI) in young adults. Methods 80 sufferers with CAI with cartilage injury (from March 2018 to March 2021) enrolled to our hospital were differentiated into two groups at random (n = 40/group). The arthroscopic group and the PRP with arthroscopic group were handled with ankle arthroscopy and PRP injection combined with ankle arthroscopy respectively. The ankle dorsal extension, metatarsal flexion range of motion and pain, ankle function and balance ability were contrasted among the two groups before and 6 months after therapy. The levels of serum indexes were contrasted among the two groups pre-therapy and post-therapy. Results 6 months after therapy, the ankle dorsal extension, metatarsal flexion activity, visual analog score (VAS), American orthopedic foot, ankle society (AOFAS) and Berg Balance Scale (BBS) scores were boosted in two groups, and versus the arthroscopic group, the ankle dorsal extension, metatarsal flexion motion and AOFAS, BBS scores were enhanced and VAS scores were lessened in the PRP with arthroscopic group. The contents of MMP-3, TIMP-1 and TNF- α were boosted in both groups, and versus the arthroscopic group, the contents of MMP-3, TIMP-1 and TNF-α were memorably lessened in the PRP with arthroscopic group. Conclusion The application of PRP injection combined with ankle arthroscopic surgery in the therapy of young CAI sufferers merged with cartilage injury is helpful to relieve ankle pain and improve ankle function.

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Section: Discussionmentioning

confidence: 99%

Application of platelet rich plasma injection in the therapy of youth ankle joint instability with cartilage injury

Zhou

Yang

Wang

et al. 2023

Preprint

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“…Using a peripheral vein illumination device during portal placement might help reduce complications. 26 Moreover, ultrasonography for portal placement might decrease the risk for iatrogenic injuries. 19 In this study, we used high-resolution ultrasonography at follow-up to image the structures at risk.…”

Section: Discussionmentioning

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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“… Anastomosis for the anterior tibial artery injury was carried out successfully. Tsuyuguchi et al ( 38 ) 2018 Technical note NA NA A vein imaging system was developed that projected images of subcutaneous vasculature directly onto the skin with the use of N-IR light to avert injury to the IDCN and the MDCN, which is a frequent complication during anterior portal placement. This technique created an ankle arthroscopic portal using an NIR imaging system, which displayed the vein image on the skin, to avert injury to the superficial veins and, therefore, diminished IDCN and MDCN injuries.…”

Section: Complications Of Ankle Arthroscopymentioning

confidence: 99%

“…According to Tsuyuguchi et al , injury to the intermediate dorsal cutaneous nerve (IDCN) and medial dorsal cutaneous nerve (MDCN) is a common complication during anterior portal placement ( 38 ). To avoid such injuries, methods such as topographical palpation of the nerves and marking of the nerves by transillumination of the skin with an arthroscope have been proposed.…”

Section: Complications Of Ankle Arthroscopymentioning

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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A Technique for the Reduction of Complications Associated With Anterior Portal Placement During Ankle Arthroscopy Using a Peripheral Vein Illumination Device

Cited by 5 publications

References 13 publications

Application of platelet rich plasma injection in the therapy of youth ankle joint instability with cartilage injury

Application of platelet rich plasma injection in the therapy of youth ankle joint instability with cartilage injury

Anterocentral Portal in Ankle Arthroscopy

Complications of ankle arthroscopy: frequency, prevention, and treatment

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