Ankle arthroscopy

Question 1

What are the indications for ankle arthroscopy?

Answer 1

• 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

Question 2

Describe the patient position and set up for ankle arthroscopy?

Answer 2

• 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

Question 3

Describe the main portals required for ankle arthroscopy?

Answer 3

• 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

Question 4

Describe the complications of ankle arthroscopy?

Answer 4

• 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