Ankle Arthroscopy

 

 

Ankle Arthroscopy TractionAnkle scopeAnkle scope syndesmosis

 

Types

 

Anterior ankle arthroscopy

Posterior ankle and hindfoot arthroscopy

 

Anterior ankle arthroscopy

 

Indication

 

Osteochondral lesions

Loose bodies

Tibial talar anterior impingement

Syndesmotic injuries

Anterolateral impingement

PVNS

Ankle arthrodesis

 

Stage IIITalus MRI

Talus ostechondral lesions

 

Loose bodiesAnkle Scope Loose BodyAnkle Scope Loose Body 2

Ankle loose bodies

 

Ankle CT Anterior OsteophyteAnterior ankle spur

Anterior tibial spur and tibio-talar impingment

 

Syndes 2SyndesSyndes 3

 

Position

 

Supine on table with tourniquet +/- traction

- standard knee arthroscope which allows outflow

- 2.7 mm 30° scope - smaller but no outflow

- often insufflate ankle joint with fluid prior to portals

 

Traction

 

Ankle Arthroscopy TractionHalter traction

Foot halter traction attached to bed

 

Options

 

Halter traction - to bed / to surgeon

Calcaneal pins

 

Portals

 

Ankle Scope Medial and Lateral PortalsAnkle scope

Anteromedial and anterolateral portals

 

Anterolateral (AL) portals

- lateral to peroneus tertius

- often inserted first so can transilluminate and avoid saphenous nerve on AM portal

- structure at risk is branches superficial peroneal nerve

- incision in skin only and blunt dissect down to capsule

- insert blunt trochar behind anterior extensor tendons aiming medially

 

Anteromedial (AM) portal

- medial to tibialis anterior

- structure at risk is great saphenous vein and saphenous nerve

- use transillumination to avoid

- insert and visualise needle

- skin incision only and blunt dissection to capsule

 

Ankle Superficial Peroneal Nerve

Superficial peroneal nerve

 

Technique

 

Vumedi 21 point ankle arthroscopy video

 

Arthroscopy techniques ankle arthroscopy

 

Inspect

- talar dome and tibial plafond for chondral lesions

- medial gutter

- lateral gutter

- syndesmosis

- posterior capsule and FHL

 

Ankle Scope Talar DomeAnkle Arthroscopy Medial Gutter

Talar dome

 

Ankle Scope Medial GutterAnkle Scope Medial Gutter

Medial gutter

 

Ankle scope lateral gutterAnkle Scope Lateral Gutter

Lateral gutter

 

Ankle Arthroscopy Lateral GutterAnkle scope syndesmosisAnkle scope syndesmosis 2

Syndesmosis

 

Syndes 3Disrupted syndesmosis

Disrupted and unstable syndesmosis

 

Ankle Scope Posteromedial CapsuleAnkle scope posterior capsule laterally

Posterior capsule and FHL

 

Complications

 

Arshad et al BJJ 2023

- systematic review of complications following anterior ankle arthroscopy

- overall complication rate 4%

- neurological injury 2%

- superficial peroneal nerve most commonly injured

- some deep peroneal / saphenous

 

Rare

- compartment syndrome - extravasation of fluid into calf

- infection

- DVT

- pseudoaneurysm

 

Pseudoaneurysm AngiographyPseudoaneurysm MRI

Pseudoaneurysm following anterior ankle arthroscopy

 

Posterior ankle and hindfoot arthroscopy

 

scopescope

 

Indications

 

Insertional achilles tendinosis / Haglund's deformity / retrocalcaneal bursitis

Posterior ankle impingement - os trigonum / FHL tendinopathy

Posterior talus osteochondral lesions

Subtalar arthritis / arthrodesis

PVNS

 

Posterior ankle arthroscopyPosterior ankle scope

 

Portals

 

Posterolateral

- just lateral to tendoachilles tendon

- at the level of or just above the tip of fibula

- aim for 1st webspace

- stay medial to sural nerve

 

Posteromedial

- just medial to tendoachilles tendon

- at the level or just above the tip of the medial malleolus

- aim laterally to avoid posteromedial neurvascular structures

- aim for webspace between 2nd and 3rd toe

 

Technique

 

Vumedi posterior ankle arthroscopy portals

 

Vumedi posterior ankle arthroscopy technique

 

JBJS Essential Surgical Techniques PDF

 

Complications

 

Arshad et al BJJ 2023

- systematic review of complications following posterior ankle arthroscopy

- overall complication rate 7%

- neurological injury 4%

 

Nickisch et al JBJS Am 2012

- 189 posterior ankle and hindfoot arthroscopies

- 2% sural nerve injury, 2% plantar numbness

- 1% infection