Anterocentral Portal in Ankle Arthroscopy

Stotter, Christoph; Klestil, Thomas; Chemelli, Andreas; Naderi, Vahid; Nehrer, Stefan; Reuter, Philippe

doi:10.1177/1071100720931095

Cited by 6 publications

(2 citation statements)

References 38 publications

(92 reference statements)

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“…These results were comparable with those of our study, in which the mean distance was 2.2 mm and direct contact occurred in 40% of cases. In contrast, Stotter et al 30 recommended using an AC portal because of its broad visualization and low rate of neurovascular injury in the clinical setting. The present study showed that the MM portal had a longer distance from the neurovascular bundle and almost the same visibility as the AC portal.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Visibility and Risk of Neurovascular Tissue Injury Between Portals in Needle Arthroscopy of the Anterior Ankle Joint: A Cadaveric Study

Inoue

Yasui

Sasahara

et al. 2023

Orthopaedic Journal of Sports Medicine

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Background: For needle arthroscopy with 0° viewing, the visible range of intra-articular structures and the difference between portals remain unknown, as do the risks for neurovascular tissue at each portal. Purpose: To clarify the visibility and safety of needle arthroscopy. Study Design: Descriptive laboratory study. Methods: Ten cadaveric ankle specimens were used. A needle arthroscope with a 1.9-mm diameter was inserted from 4 portals (anteromedial [AM], anterolateral [AL], medial midline [MM], and anterocentral [AC]). Visibility was assessed using a 15-point ankle arthroscopy checklist. In addition, the ankles were dissected to measure the distance between each portal and neurovascular tissues. The visibility of the ankle joint was compared between portals. Results: The success rate of visibility in the deltoid ligament and the tip of the medial malleolus was 100% from the AM, MM, and AC portals and 10% from the AL portal, with significant differences between the portals ( P < .01). The visibility success rates in the origin of the anterior talofibular ligament and the tip of the lateral malleolus were 20% for the AM portal, 90% for the MM and AC portals, and 100% for the AL portal, with significant differences between the portals ( P < .01). All other points of the ankle joint were visualized from all the portals with a 100% success rate. The AC portal was in contact with the anterior neurovascular bundle in 4 of the 10 specimens. Conclusion: When needle arthroscopy was performed from the AM or AL portal, the site opposite to the portal in the ankle joint was difficult to visualize. Conversely, most points of the ankle joint could be visualized from the MM and AC portals. Care should be taken when creating an AC portal because of its proximity to the anterior neurovascular bundle. Clinical Relevance: The present study provides information regarding which portal should be selected to perform needle arthroscopy in the ankle joint, which will be beneficial for management of ankle injuries.

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Section: Discussionmentioning

confidence: 99%

Comparison of Visibility and Risk of Neurovascular Tissue Injury Between Portals in Needle Arthroscopy of the Anterior Ankle Joint: A Cadaveric Study

Inoue

Yasui

Sasahara

et al. 2023

Orthopaedic Journal of Sports Medicine

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“…Such procedures are usually performed through two classic portals: the anteromedial (AM) portal and the anterolateral (AL) portal. The superficial peroneal nerve (SPN) is one of the most frequently injured structures during ankle arthroscopy, specifi-cally occurring when the AL portal is performed (5,6) . On the other hand, the deep peroneal nerve (DPN) is rarely injured during ankle arthroscopy.…”

Section: Introductionmentioning

confidence: 99%

Peroneal nerve injuries during anterior ankle arthroscopy

Batista¹,

Arrondo²,

Matías-Joannas³

et al. 2022

J Foot Ankle

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Objective: Ankle arthroscopic surgery is considered a safe procedure with minimal risk of peripheral nerve injury. The primary objective of this study was to determine the incidence of peripheral nerve injuries during anterior ankle arthroscopy. The secondary objective was to evaluate the most frequent types and the clinical relevance of deep peroneal nerve injuries. Methods: Patients who underwent anterior ankle arthroscopy at our institution from 2000 to 2020 were retrospectively analyzed. Those present neurological symptoms after surgery were evaluated with clinical examination and ankle ultrasonography looking for nerve injuries. Results: Three hundred and thirty-four patients were included in the present study. There were 26 iatrogenic neurological complications (7.78%). The superficial peroneal nerve was injured in 16 cases (4.79%) and the deep peroneal nerve, in 10 cases (2.99%). Among the injuries of the deep peroneal nerve, 1.5% of cases had nerve entrapment in postoperative tissue adhesions, 0.9% presented neuromas, and 0.6% had axonotmesis. Complications were classified using the Modified Clavien-Dindo-Sink Complication Classification System: 2.1% of complications were grade I, while 0.9% were grade II. Conclusion: Nerve injury is the most common complication related to anterior ankle arthroscopy. The deep peroneal nerve is rarely damaged during this procedure. We found that most deep peroneal nerve injuries are not clinically relevant and do not have a big impact on patient evolution during the postoperative period. Level of Evidence II; Retrospective Study; Prognostic Studies.

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