Ankle Anatomy for the Arthroscopist. Part I: The Portals

Treatment of osteochondral defects of the talus

“…Third, in the dorsiflexed position, the talus is concealed in the joint, thereby protecting the cartilage from potential iatrogenic damage. 158 Mechanical distraction and use of a small-diameter arthroscope may be beneficial in some situations. These include treatment of ossicles, a soft tissue impediment, a loose body caught in the joint space between the fibula and tibia (the intrinsic syndesmotic area), an OCD located in the posterior tibial plafond, and posterior ankle problems.…”

“…First, distraction of the joint may result in tightening of the anterior capsule, leading to a reduction of the anterior working area (Figure 3). 158 Second, loose bodies and osteophytes are usually located in the anterior compartment of the ankle joint. Dorsiflexion creates an anterior working area, which makes removal easy.…”

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

“…These differences may relate to large variability in the location of this portal, further stressing the importance of creating it as close as possible to the lateral border of the Achilles tendon. Such as for the AL portal, some authors have advocated creating the PL portal using an inside-out technique [19], although this would require an extensive distraction, as discussed by others [3]. The fact that all structures other than the posterior tibial artery were, at least in one specimen, \5 mm away from the respective portal, emphasises the importance of using needles rather than cannulas when creating the portals.…”

“…The AM portal was located immediately medial to the tibialis anterior tendon and at the anterior joint line; the AL portal was located at the anterior joint line and immediately lateral to the fibularis tertius tendon (when present) or to the extensor digitorium longus tendons; the PM and PL portals were just medial or lateral, respectively, to the Achilles tendon, 1.2-2.5 cm proximal to an horizontal line drawn from the tip of lateral malleolus. The placement of these portals has been described in greater detail by others [3,4]. Finally, the anatomical regions around each portal were dissected and, using a calliper, the distance to neighbouring neurovascular structures was measured.…”

Hindfoot Endoscopy for the Treatment of Posterior Ankle Impingement Syndrome: A Comparison of Two Methods (a Standard Method versus a Method Using a Protection Cannula)

“…However, the conventional posteromedial portal of the ankle is not recommended by several previous reports because of the potential risk of injury to the medial neurovascular bundle and tendinous tissue. [1][2][3][4][5] In this study, we used a protection cannula for approaching via the posteromedial portal to ensure safety and compared the results with the standard hindfoot endoscopy method. This cannula is used for retracting and protecting the surrounding soft tissue, including the neurovascular bundle (Fig.…”