Foot & Ankle Arthroscopy Flashcards
What is arthroscopy?
Minimally invasive surgical procedure on a joint
What is one of the most common indication for ankle arthroscopy?
Osteochondral lesions
What are two important reasons for ankle arthroscopy?
- Preservation of soft tissue envelope: accelerated return to daily activities and athletic endeavors
- Diagnostic arthroscopy: more sensitive than pre-operative physical examination and imaging re: chronic instability
Define anterior portals
Portals oriented along the anterior joint line
What are the three anterior portals?
- anterolateral
- anteromedial
- anterocentral
Describe the anterolateral portal
Lateral to peroneus tertius
Medial to lateral malleolus
Describe the anteromedial portal
Medial to tibialis anterior
What are the two most common ankle portal?
Anterolateral portal
Anteromedial portal
Describe anterocentral portal
Lateral to the EHL
Which portal is not recommended?
Anterocentral portal
Which portal do you typically start with?
Anteromedial
Which posterior portal is the safest and most common?
Posterolateral portal
Are anterior or posterior portals utilized more?
Anterior portals
What are the safest and most common portals ?
- Anteromedial
- anterolateral
- posterolateral
What should you be aware of with anteromedial portal?
- saphenous nerve/vein
What do you have to be aware of with the anterolateral portal?
Superficial peroneal nerve
What do you have to be aware of with the posteriorlateral portal?
- branches of the sural nerve
- small saphenous vein
How are the associated complications from ankle arthroscopy?
49% of complications are related to nerve injury at portals
What is the purpose of the 21 point exam?
To establish reproducible and thorough intro-articular examination of the ankle
How many points are there on the anterior, central and posterior exam?
8-point anterior exam
6-point central exam
7-point posterior exam
What are the 8 anterior points via the anteromedial portal?
- Deltoid ligament
- Medial gutter
- Medial talus
- Central talus and central overhang
- Lateral talus
- Trifurcation with the talus, tibia and fibula, including AITFL
- Lateral gutter, including ATFL
- Anterior gutter
What are 6 central points via the anteromedial portal?
- Medial talus
- Central talus
- Lateral talus
- PITFL
- Transverse tibiofibular ligament
- Capsular reflection of the FHL
What are thee 7 posterior points via the anteromedial portal?
- Medial gutter
- Medial talus
- Central talus
- Lateral talus
- Tall fibular articulation
- Lateral gutter
- Posterior gutter
What are some indications for arthroscopy?
- symptomatic tenosynovitis
- small tears
Absolute contraindications for arthroscopy?
- tendon injury requiring open resection
- infection
- severe edema
Relative contraindications for arthroscopy?
- extensive scarring
- poor tissue quality
- vascular compromise
What is Tenosynovitis
Inflamed tissue
Typically results from repetitive and/or prolonged activity, trauma or anatomic factors: enlarged peroneal tubercle, low lying breves muscle, peroneus quartus
Reasons for subluxing peroneals?
- Peroneal instability
- superior peroneal retinaculum compromise
- lack of space during DF and eversion
- flat or convex peroneal groove
- space occupying process
- low lying muscle belly
- peroneus quartus
Describe 1st portal placement?
- 2cm distal to fibular tip
- proximal to peroneal tubercle
Describe the 2nd portal placement
- 5-10cm proximal to the tip of the fibula
- trans-illuminate, 18 gauge needle
- primary working portal
