Ankle arthroscopy Flashcards
1
Q
What are the indications for ankle arthroscopy?
A
- Osteochondral lesions of the talus
- microfracture of OCD
- Debridement of post-traumatic synovitis
- ATFL anterolateral impingement
- AITFL anterolateral impingement
- resection of anterior tibiotalar spurs
- Such as Anterior bony impingement
- OS trigonium excision
- Removal of loose bodies
- cartilage debridment in conjunction with ankle fusions
2
Q
Describe the patient position and set up for ankle arthroscopy?
A
- Position
- Pt placed supine
- leg over padded bolster
- Tourniquet and exsanguinate limb
- Joint distention
- External traction device applied to distract tibiotalar joint- see pic
- can load joint with saline to distend joint
- Scope insertion
- Nick and spread method commonly utilised to access joint and minimize neurovascular injury
3
Q
Describe the main portals required for ankle arthroscopy?
A
-
Anteromedial
- Medial to Tibialis anterior & lateral to medial malleolus
- Make portal between tibialis anterior and saphenous vein
- primary viewing portal, establish FIRST
- access anteromedial joint
-
Anterolateral
- Lateral to peroneus tertius and Superficial peroneal nerve , medial to lateral malleolus
- can trace out superifical peroneal n prior to incision
- acess to anterolateral joint, viewing port
-
Anterocentral
- rarely used as risk to dorsal pedis artery
- medial to Extensor digitorum comminus & lateral to EHL
-
Posterolateral
- Post view to access os trigonium
- Located 2cm proximal to tip of lateral malleolus
- medial to peroneal tendons & lateral to achilles tendon
-
Postmedial
- Post viewing point
- just medial to achilles tendon
4
Q
Describe the complications of ankle arthroscopy?
A
- Synovial cutaneous fistula
- avoid by immobilisation to allow portal skin healing and closure
- Neurovascular injury from portal placement
-
Anterolateral portal
- risk dorsal intermedial branch of Superificial peroneal nerve
- most commonly injured
-
Anteromedial
- saphenous vein and nerve
-
Anterocentral
- dorsadis pedis artery
- Posterolateral
- Sural nerve & small saphenous n
- Posteriomedial
- Posterior tibial artery
-
Anterolateral portal