Anatomical relations of anterior and posterior ankle arthroscopy portals: a cadaveric study

Oliva, Xavier Martín; López, José Manuel Méndez; Planella, Mariano Monzo; Bravo, Alejandro; Rodrigues-Pinto, Ricardo

doi:10.1007/s00590-014-1559-0

Cited by 15 publications

(4 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A comparison between the results of the current study and previous reports on the safety of arthroscopy of the ankle shows substantial variability. For example, where this study found an average distance of 6.8‐mm between the anteromedial portal and the great saphenous vein, previous studies reported distances of 5.4‐mm [18], 9.0‐mm [4], and 10.7‐mm [13]. Whilst this and previous studies do provide a general idea of which portals can safely be used for arthroscopy, the variability in anatomic distributions underscores the need for careful introduction of arthroscopic portals.…”

Section: Discussionmentioning

confidence: 77%

Two-millimetre diameter operative arthroscopy of the ankle is safe and effective

Stornebrink

Altink

Appelt

et al. 2020

Knee Surg Sports Traumatol Arthrosc

View full text Add to dashboard Cite

Purpose Technical innovation now offers the possibility of 2-mm diameter operative arthroscopy: an alternative to conventional arthroscopy that no longer uses inner rod-lenses. The purpose of this study was to assess whether all significant structures in the ankle could be visualized and surgically reached during 2-mm diameter operative arthroscopy, without inflicting iatrogenic damage. Methods A novel, 2-mm diameter arthroscopic system was used to perform a protocolled arthroscopic procedure in 10 fresh-frozen, human donor ankles. Standard anteromedial and anterolateral portals were utilized. Visualization and reach with tailored arthroscopic instruments of a protocolled list of articular structures were recorded and documented. A line was etched on the most posterior border of the talar and tibial cartilage that was safely reachable. The specimens were dissected and distances between portal tracts and neurovascular structures were measured. The articular surfaces of talus and tibia were photographed and inspected for iatrogenic damage. The reachable area on the articular surface was calculated and analysed. Results All significant structures were successfully visualized and reached in all specimens. The anteromedial portal was not in contact with neurovascular structures in any specimen. The anterolateral portal collided with a branch of the superficial peroneal nerve in one case but did not cause macroscopically apparent harm. On average, 96% and 85% of the talar and tibial surfaces was reachable respectively, without causing iatrogenic damage. Conclusion 2-mm diameter operative arthroscopy provides safe and effective visualization and surgical reach of the anterior ankle joint. It may hold the potential to make ankle arthroscopy less invasive and more accessible.

show abstract

Section: Discussionmentioning

confidence: 77%

Two-millimetre diameter operative arthroscopy of the ankle is safe and effective

Stornebrink

Altink

Appelt

et al. 2020

Knee Surg Sports Traumatol Arthrosc

View full text Add to dashboard Cite

show abstract

“…The structure at highest risk of injury is the IDCN, and clinical studies have frequently reported injury to the SPN or its branches when using the anterolateral portal. 11 Ferkel et al. 2 also reported an overall complication rate of 9% in 612 ankle arthroscopies, with the most common complication being neurologic injury, which accounted for 49% of the complications.…”

Section: Discussionmentioning

confidence: 98%

“…To avoid these complications, several methods to establish portals, such as use of a mosquito clamp after skin incision, a nerve palpation technique, and a transillumination technique, have been suggested. 1 , 2 , 11 , 13 , 14 However, to reduce the risk of iatrogenic injury to the nerve, it is expected that our method will identify neurovascular structures more easily before making arthroscopic portal incisions. Ferkel et al.…”

Section: Discussionmentioning

confidence: 99%

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

Tsuyuguchi

Nakasa

Ishikawa

et al. 2018

Arthroscopy Techniques

View full text Add to dashboard Cite

Ankle arthroscopy is a minimally invasive technique for ankle joint treatment. However, injury to the intermediate dorsal cutaneous nerve (IDCN) and the medial dorsal cutaneous nerve (MDCN) is a common complication during anterior portal placement. To prevent injuries, methods such as palpating the nerves topographically and marking the nerves by transilluminating the skin with an arthroscope have been proposed. Easier and more definitive methods of identifying the IDCN and MDCN should result in a reduction of complications. Recently, a vein imaging system was developed that projects images of subcutaneous vasculature directly onto the skin with the use of near-infrared (NIR) light. Because anatomic studies have shown that superficial veins accompany the IDCN and MDCN, protecting the subcutaneous veins could lower the risk of nerve injury. We introduce our technique for the creation of an ankle arthroscopic portal using an NIR imaging system, which displays the vein image on the skin, to prevent injury to the superficial veins and, consequently, reduce IDCN and MDCN injuries. This is the first technical report on the prevention of vein and nerve injuries using an NIR imaging system. Our technique for avoiding vein injury using a peripheral vein illumination device during anterior portal placement in ankle arthroscopy could lower the risk of complications.

show abstract

“…Oliva et al reported that the intermediate dorsal cutaneous nerve was the structure most likely to be injured by the anterolateral portal [11]. Another study reported that SPN, namely, the intermediate dorsal cutaneous nerve and the medial dorsal cutaneous nerve, is one of the most common complications, accounting for up to 50% of the cases [6].…”

Section: Discussionmentioning

confidence: 99%

The Distribution Pattern of the Neurovascular Structures for Anterior Ankle Arthroscopy to Minimize Structural Injury: Anatomical Study

Jeon

Seo

Lee

et al. 2018

BioMed Research International

View full text Add to dashboard Cite

Introduction The aim of this study was to investigate entry points for anterior ankle arthroscopy that would minimize the risk of neurovascular injury. Methods Thirty-eight specimens from 21 Korean cadavers (age range from 43 to 92 years, mean age of 62.3 years) were used for the study. For the measurements, the most prominent points of the lateral malleolus (LM) and the medial malleolus (MM) were identified before dissection. A line connecting the LM and MM, known as the intermalleolar line, was used as a reference line. We measured 14 variables passed on the reference line. Results This study found that the nerves were located at 40.0%, 50.0%, and 82.0% of the reference line from the lateral malleolus. We also found that the arteries were located at 22.0%, 35.0%, and 60% of the reference line from the lateral malleolus. Discussion If all the variables are combined (nerves, arteries, and veins), then there is no safety zone for anterior portal placement. Therefore, we recommend that surgeons concentrate primarily on the arteries and nerves in the clinical setting.

show abstract

Anatomical relations of anterior and posterior ankle arthroscopy portals: a cadaveric study

Cited by 15 publications

References 19 publications

Two-millimetre diameter operative arthroscopy of the ankle is safe and effective

Two-millimetre diameter operative arthroscopy of the ankle is safe and effective

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

The Distribution Pattern of the Neurovascular Structures for Anterior Ankle Arthroscopy to Minimize Structural Injury: Anatomical Study

Contact Info

Product

Resources

About