Ankle arthroscopy: Neurovascular and arthroscopic anatomy of standard and trans-achilles tendon portal placement

Arthroscopic resection of symptomatic “os trigonum”

“…They stated that anterocentral, transachillis, and posteromedial portals should never be used because of the potential neurovascular and tendon injury. Voto et al [35] noted that the posteromedial portal is potentially hazardous even if placed adjacent to the achillis tendon, because of the location of neurovascular bundle. Recent anatomical and clinical studies have showed that the postero-medial portal for ankle arthroscopy is safe as well as the well established postero-lateral portal.…”

“…Although anterior and posterior portals for ankle arthroscopy have been well documented [30,33], the standard posteromedial portal has recognized risks because of the proximity of the posterior neurovascular structures [34,35]. Several investigators have reported technical difficulties in addressing posterior ankle synovectomy [36,37].…”

Übersicht über die Arthroskopie des oberen Sprunggelenks

“…Dieser Zugang ist bisher lediglich von Voto et al (63) erwähnt und hat in der Literatur und für uns bisher keine weitere Verwendung gezeigt. Guhl (24) beschrieb diese Zugänge zur besseren Erreichbarkeit der hinteren Talusanteile in der Behandlung osteochondraler Defekte.…”

Gross and Arthroscopic Anatomy of the Ankle

“…These nerves are most vulnerable to injury during arthroscopy because they are small and have a somewhat variable location; each is located near a commonly established arthroscopic portal. Voto et al 13 showed in cadaver studies that the location of the subcutaneous nerves about the ankle does not change significantly with ankle motion, distraction, or joint distension. However, their anatomic location is somewhat variable from specimen to specimen.…”

“…The trans-Achilles tendon and posteromedial portals are of historic interest only and have been abandoned because of the risk of injury to neurovascular structures and tendons. [1][2][3][7][8][9]13,20 The posteromedial aspect of the ankle can be approached via the posterior tibial tendon sheath portal. The transmalleolar approaches are divided into the transmedial and translateral.…”