An anatomical study of a new portal for ankle arthroscopy

Buckingham, Rachel; Winson, Ian; Kelly, Andrew

doi:10.1302/0301-620x.79b4.7428

Cited by 40 publications

(30 citation statements)

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“…The medial midline portal described by Buckingham et al appears to be safer from the point of view of both superficial peroneal nerve and tibialis anterior vascular bundle. 3 However, even if the risk of laceration is small and the smallest after the anteromedial one, we could not confirm it as a 100% safe portal placement.…”

Section: Resultsmentioning

confidence: 81%

“…Despite the fact that the anterocentral portal to the ankle joint allows an excellent trochlear view and access to both sides of the joint it is rarely used because of the risks to the tibialis anterior vascular bundle and the deep peroneal nerve. 3,5,12 Vascular injury after using anterocentral approach has been described by Morgan 17 and Ferkel. 8 Given the close correlation between the tibialis anterior vascular bundle and the ankle joint capsule, vascular complications have been described even after the use of the anterolateral and anteromedial portals.…”

Section: Discussionmentioning

confidence: 97%

“…These results suggest that even with the medial midline portal there is a small risk of laceration of the tibialis anterior vascular bundle, as opposed to Buckingham et al findings, who found the medial midline portal located at least 5 mm away from the tibialis anterior artery. 3 Given the variation in the position of the different extensor tendons and the variable distance between these tendons it may be more practical to consider that in average the medial margin of the bundle was located midway between the two malleoli (32.3 mm of 66.5 mm). With only one exception the vascular bundle had its medial margin located between 40 and 60% of the intermalleolar distance.…”

Section: Discussionmentioning

confidence: 99%

“…The medial midline portal is located between the tibialis anterior and the extensor hallucis longus tendons and the anterocentral portal is located between the extensor hallucis longus and the extensor digitorum longus tendons. 3 Of these, the anteromedial and the anterolateral portals are most commonly used. 21 Given the irregular shape of the joint and the abundance of tendons and neurovascular structures around it, each of these portals predisposes to certain complications.…”

Section: Introductionmentioning

confidence: 99%

“…20,26 Vascular complications 8,17 have made the anterocentral ankle portal rather unpopular, but a recent anatomical study showed that a more medially placed anterior portal (medial midline) is safer. 3 To our knowledge there is no anatomical study to analyse, quantify and compare the risks of neurovascular damage for all described anterior arthroscopic portals to the ankle.…”

Section: Introductionmentioning

confidence: 99%

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Anatomical Study of the Ankle With View to the Anterior Arthroscopic Portals

Solomon

Ferris

Henneberg

2006

ANZ Journal of Surgery

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This article evaluates the risk of interference with the neurovascular structures in the four anterior ankle arthroscopic portals, described on each side of the extensor tendons: anteromedial, medial midline, anterocentral and anterolateral. Complications after ankle arthroscopies have been described in up to 17%, most being neurovascular. To quantify the neurovascular risks we dissected 68 cadaveric feet and evaluated the correlations between tendons, vessels and nerves. The mean distance between tibialis anterior and extensor hallucis longus and between extensor hallucis longus and extensor digitorum longus is 4 mm, but in 10-20% these tendons are in apposition or are overlapped. The tibialis anterior vascular bundle was absent in 11.8%, was located between the tibialis anterior and the extensor hallucis longus in 3% and between the extensor hallucis longus and the extensor digitorum longus in 64.7%. A peroneal vascular bundle or branches of the tibialis anterior vascular bundle were located lateral to the extensor digitorum longus/peroneus tertius tendon in 88.2%. Transverse vascular branches were identified in 41.2% over the medial side of the joint line and in 52.9% over the lateral side. The deep peroneal nerve was located between the extensor hallucis longus and the extensor digitorum longus tendons in 58.8%. The superficial peroneal nerve had branches located between the tibialis anterior and the extensor hallucis longus tendons in 2.9%, between the extensor hallucis longus and the extensor digitorum longus tendons in 23.5% and lateral to the extensor digitorum longus/peroneus tertius tendon in 32.4%. These results show that the anteromedial and medial midline portals are the safest. The anterolateral portal should be noted not only for the risks to the superficial peroneal nerve, but also to the peroneal vessels.

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Section: Resultsmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Anatomical Study of the Ankle With View to the Anterior Arthroscopic Portals

Solomon

Ferris

Henneberg

2006

ANZ Journal of Surgery

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Branching patterns of the common and superficial fibular nerves in fetus

2005

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In this study, we focused on finding out whether branching patterns of the common fibular (CFN) and superficial fibular (SFN) nerves change throughout the early period of life. The popliteal fossa and legs on both sides of 20 fetuses (13 females and 7 males) were dissected. The ages of the fetuses varied between 20 and 36 weeks. The levels where the CFN diverged from the sciatic nerve, the CFN diverged to its terminal branches, and the cutaneous branches of the SFN became superficial and diverged were evaluated, together with the similarity of the patterns of these nerves on both sides. We observed that, comparing with the results of previous studies on adults, both the sciatic and the CFNs in the fetuses were diverging into their terminal branches more distally. Additionally, the SFN appeared to become superficial more proximally in the fetus than in the adult. SFN was piercing the crural fascia before diverging into its terminal branches in 29 legs. Only in 8 of them, it was becoming superficial within the middle one-third of the leg, which was observed more frequently in males (42.9% of 14 legs) than in females (13.3% of 15 legs). But there was no statistically significant gender difference (P = 0.07). The medial dorsal cutaneous (MDCN) and intermediate dorsal cutaneous (IDCN) nerves which were piercing the crural fascia separately were observed in 27.5% of the subjects, all females. In these, MDCN was piercing the fascia superior to the level where the SPN becomes superficial, whereas the IDCN was piercing it to a level lower to this and always in the inferior one-third of the leg. We suggest that the detailed information about the branching patterns of the CPN and SPN in early ages will be beneficial, particularly in tumor and deformity surgery. The reason for different patterns and piercing levels of the nerves may be the effect of the elongating extremity during aging that enforces the fascia and modifies its position with a more stable structure, the nerve.

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Relationship between the deep peroneal nerve and dorsalis pedis artery in the foot: A cadaveric study

et al. 2008

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The aim of our work was to study the relationship between deep peroneal nerve (DPN) and dorsalis pedis artery (DPA) so that the frequency of these variations can be kept in mind by the angiographers and surgeons to ensure safe surgical approach during flap surgery. Ninety-two legs in 46 cadavers were dissected to study the relationship between DPN and DPA on the dorsum of the foot. The relationship of neurovascular bundle of the dorsum of the foot was classified into four types. Type I: division of the DPN distal to the midpoint between the two malleoli (observed in 26 limbs). In Type II, the division of the DPN was midway between the two malleoli (seen in 20 limbs). Both Type I and II are further divided into two subtypes (a and b) depending upon the crossing pattern of terminal branches of the DPN over DPA. In Type III, multiple branches of DPN were noted in two limbs. In Type IV, the looping pattern of DPN around the DPA was considered and was seen in eight limbs. Awareness of possible variations in the relationship of the DPA to DPN on the dorsum of the foot is important for vascular and reconstructive surgeons. Because it might help in decreasing confusion when considering treatment options like microvascular anastomosis in reconstruction of the leg.

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An anatomical study of a new portal for ankle arthroscopy

Cited by 40 publications

References 0 publications

Anatomical Study of the Ankle With View to the Anterior Arthroscopic Portals

Anatomical Study of the Ankle With View to the Anterior Arthroscopic Portals

Branching patterns of the common and superficial fibular nerves in fetus

Relationship between the deep peroneal nerve and dorsalis pedis artery in the foot: A cadaveric study

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