Risks Associated With Posterior Ankle Hindfoot Arthroscopy Complications

Abstract

Background: The use of posterior ankle and hindfoot arthroscopy (PAHA) has been expanding over time. Many new indications have been reported in the literature. The primary objective of this study was to report the rate of PAHA complication in a large cohort of patients and describe their potential associations with demographical and surgical variables. Methods: In this IRB-approved retrospective comparative study, patients who underwent posterior ankle and/or hindfoot arthroscopy in a single institution from December 2009 to July 2016 were studied. Three fellowship-trained orthopaedic foot and ankle surgeon performed all surgeries. Demographic data, diagnosis, tourniquet use, associated procedures, and complications were recorded. To investigate a priori factors predictive of neurologic complication after PAHA, univariate and multivariable logistic regression was utilized. Where appropriate, sparse events sensitivity analysis was tested by fitting models with Firth log-likelihood approach. Results: A total of 232 subjects with 251 surgeries were selected. Indications were posterior ankle impingement (37%), flexor hallux longus disorders (14%), subtalar arthritis (8%), and osteochondral lesions (6%). Complications were observed in 6.8% (17/251) of procedures. Neural sensory lesions were noted in 10 patients (3.98%), and wound complications in 4 ankles (1.59%). Seven neurologic lesions resolved spontaneously and 3 required further intervention. In a multivariable regression model controlled for confounders, the use of accessory posterolateral portal was the significant driver for neurologic complications (odds ratio [OR] 32.19, 95% CI 3.53-293.50). Conclusion: The complication rate in this cohort that was treated with posterior ankle and/or hindfoot arthroscopy was 6.8%. Most complications were due to neural sensorial injuries (sural 5, medial plantar nerve 4, medial calcaneal nerve 1 ) and 3 required additional operative treatment. The use of an accessory posterolateral portal was significantly associated with neurologic complications. The provided information may assist surgeons in establishing diagnoses, making therapeutic decisions, and instituting surgical strategies for patients that might benefit from a posterior arthroscopic approach. Level of Evidence: Level III, retrospective comparative study.

Posterior Ankle Impingement: It’s Not Only About the Os Trigonum

“… 15 , 30 However, recent literature have been pointing to various other anatomic structures that could be etiologies of PAIS. 5 Ligamentous, peri-articular bony impingement, synovitis, and capsular structures could also cause impingement in isolation or in combination with trigonal disorders. 5 Failure to address these potential disorders could result in residual or recurrent symptoms.…”

“… 5 Ligamentous, peri-articular bony impingement, synovitis, and capsular structures could also cause impingement in isolation or in combination with trigonal disorders. 5 Failure to address these potential disorders could result in residual or recurrent symptoms. 37 A recent systematic review on surgically treated PAIS found mild to poor satisfaction in endoscopic procedures around 9% and 14% in open surgeries.…”

“… 2 , 3 Posterior ankle and hindfoot arthroscopy (PAHA) is an established approach to treat PAIS. 5 , 15 , 37 The increased magnification, field of view, and real-time dynamics that an arthroscope provides allows assessment of other anatomic structures as potential causes of impingement, in addition to Stieda impingement. 5 , 26 , 30 The real-time visualization of impingement lesions with joint motion, probe examination, and palpation/pressure over different locations of the posterior ankle is the most direct evidence of impingement.…”

“… 5 , 15 , 37 The increased magnification, field of view, and real-time dynamics that an arthroscope provides allows assessment of other anatomic structures as potential causes of impingement, in addition to Stieda impingement. 5 , 26 , 30 The real-time visualization of impingement lesions with joint motion, probe examination, and palpation/pressure over different locations of the posterior ankle is the most direct evidence of impingement. 5 , 28 Although the general impingement condition can be clearly diagnosed preoperatively, the specific structure causing symptoms is not always evident.…”

“… 5 , 26 , 30 The real-time visualization of impingement lesions with joint motion, probe examination, and palpation/pressure over different locations of the posterior ankle is the most direct evidence of impingement. 5 , 28 Although the general impingement condition can be clearly diagnosed preoperatively, the specific structure causing symptoms is not always evident. Therefore, the primary objective of this study was to report the prevalence of associated conditions in a large cohort of os trigonum and Stieda impingement treated with PAHA.…”