Anterocentral Portal in Ankle Arthroscopy

Background: The anterocentral portal is not a standard portal in anterior ankle arthroscopy due to its proximity to the anterior neurovascular bundle. However, it provides certain advantages, including a wide field of vision, and portal changes become redundant. The purpose of this study was to evaluate the neurovascular complications after anterior ankle arthroscopy using the anterocentral portal. Methods: We retrospectively identified patients who had undergone anterior ankle arthroscopy with an anterocentral portal at our institution from 2013 to 2018. Medical record data were reviewed and patients were invited for clinical follow-up, where a clinical examination, quantitative sensory testing for the deep peroneal nerve, and ultrasonography of the structures at risk were performed. A total of 101 patients (105 arthroscopies) were identified and evaluated at a mean follow-up of 31.5 ± 17.7 months. Results: Leading indications to surgery were heterogeneous and included anterior impingement (48.6%), osteochondral lesions of the talus (24.8%), chronic ankle instability (14.3%), and fractures (8.6%). The overall complication rate was 7.6%, and no major complications were observed. In 1.9% (2/105) of the cases, the complications were associated with the anterocentral portal and included injury to the medial branch of the superficial nerve (1/105) and to the deep peroneal nerve (1/105). Injury to the deep peroneal nerve was associated with a loss of detection and nociception. There were no injuries to the anterior tibial artery. In 41.9% (44/105) of the cases, only 1 working portal was used in addition to the anterocentral portal, and in 19% (20/105) the anterolateral portal could be avoided. Ultrasonography confirmed the integrity of the deep peroneal nerve, the medial branch of the superficial peroneal nerve, and the anterior tibial artery in all patients. Patients with nerve injuries associated with the anterocentral portal showed no signs of neuroma or pseudoaneurysm. Conclusion: Using a standardized technique, the anterocentral portal in ankle arthroscopy is safe with a low number of neurovascular injuries and can be recommended as a standard portal. The anterolateral portal remains associated with a high number of injuries to the superficial peroneal nerve. Level of Evidence: Level III, retrospective cohort study.

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Anterior Tibial Artery and Deep Peroneal Nerve Entrapment in Spiral Distal Third Tibia Fracture

Orthopedics ◽

10.3928/01477447-20081201-13 ◽

2008 ◽

Vol 31 (12) ◽

pp. 1-3 ◽

Cited By ~ 2

Author(s):

Roberto Augusto Miki ◽

James P. Lawrence ◽

Thomas J. Gillon ◽

Brandon D. Lawrence ◽

Richard A. Zell

Keyword(s):

Peroneal Nerve ◽

Tibia Fracture ◽

Nerve Entrapment ◽

Anterior Tibial Artery ◽

Deep Peroneal Nerve ◽

Tibial Artery ◽

Anterior Tibial

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Examination of the Origin and Branching Direction of the Anterior Medial Malleolar Artery From the Anterior Tibial Artery: A Cadaveric Study

Foot & Ankle Specialist ◽

10.1177/1938640018768046 ◽

2018 ◽

Vol 12 (2) ◽

pp. 167-171 ◽

Cited By ~ 3

Author(s):

Ichiro Tonogai ◽

Fumio Hayashi ◽

Yoshihiro Tsuruo ◽

Koichi Sairyo

Keyword(s):

Ankle Joint ◽

Sagittal Plane ◽

External Iliac Artery ◽

Longitudinal Axis ◽

Cadaveric Study ◽

Ankle Arthroscopy ◽

Anterior Tibial Artery ◽

Tibial Artery ◽

Anterior Tibial ◽

Branching Point

Background. This study characterized the anterior medial malleolar artery (AMMA) branching from the anterior tibial artery (ATA) to identify problems in anterior ankle arthroscopy possibly contributing to injury to the AMMA. Methods. Barium was injected into 12 adult cadaveric feet via the external iliac artery and the origin and branching direction of the AMMA were identified on computed tomography. Results. The AMMA originated from the level of the ankle joint and below and above the ankle joint line (AJL) in 4 (33.3%), 6 (50.0%), and 1 (8.3%) specimen, respectively. Mean distance from the AJL to the branching point of the AMMA on the sagittal plane was 2.5 mm distal to the AJL. Mean angle between the distal longitudinal axis of the ATA and AMMA was 83.2°. Conclusions. This study established the origin and branching of the AMMA from the ATA. The AMMA should be examined carefully during ankle arthroscopy. Levels of Evidence: Level IV: Cadaveric study

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Distance Between the Anterior Distal Tibial Edge and the Anterior Tibial Artery in Distraction and Nondistraction During Anterior Ankle Arthroscopy: A Cadaveric Study

Foot & Ankle International ◽

10.1177/1071100717732550 ◽

2017 ◽

Vol 39 (1) ◽

pp. 113-118 ◽

Cited By ~ 4

Author(s):

Ichiro Tonogai ◽

Fumio Hayashi ◽

Yoshihiro Tsuruo ◽

Koichi Sairyo

Keyword(s):

Arthroscopic Surgery ◽

Joint Space ◽

Ankle Arthroscopy ◽

Anterior Tibial Artery ◽

Saline Injection ◽

Ct Scanner ◽

Tibial Artery ◽

Anterior Tibial ◽

Fresh Frozen ◽

Space Expansion

Background: Anterior ankle arthroscopy is widely applied for various osteoarthropathies. However, distraction of the ankle may put the anterior tibial artery (ATA) at risk of injury during the procedure. The purpose of this study was to assess the difference in the distance between the anterior distal tibial edge and the ATA in distraction and nondistraction of the ankle with joint space expansion by saline injection into the joint. Methods: Eight whole fresh-frozen cadaveric feet (mean age 78.9 years) were used. Barium sulfate suspension was injected into the popliteal artery of each specimen, and the distance from 3 aspects of the anterior distal tibial edge to the ATA was measured to evaluate the possibility of damage to the ATA based on computed tomography (CT) scans, in ankle distraction and nondistraction, using a traction device developed for reproducible ankle positioning inside the CT scanner. Results: The distance between the ATA and the most proximal, middle, and distal parts of the anterior distal tibial edge was 0.5 mm, 3.9 mm, and 7.4 mm, respectively, without saline injection, and 3.7 mm, 7.2 mm, and 11.6 mm, respectively, with saline injection, in nondistraction. The distance was 2.2 mm, 5.9 mm, and 9.8 mm, respectively, with 5-kg distraction, and 1.7 mm, 5.1 mm, and 8.8 mm, respectively, with 10-kg distraction, both with saline injection, respectively. Conclusion: The distance between the anterior distal tibial edge and the ATA with joint space expansion by saline injection into the joint increased, and that distance in distraction of the ankle decreased during anterior arthroscopic surgery. Clinical Relevance: The anatomic relationship of the ATA to its surrounding structures may be at more risk without saline injection or with distraction during anterior ankle arthroscopy.

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Anterior Tibial Artery Pseudoaneurysm following Ankle Arthroscopy in a Hemophiliac Patient

Annals of Vascular Surgery ◽

10.1016/j.avsg.2015.12.017 ◽

2016 ◽

Vol 34 ◽

pp. 269.e17-269.e19 ◽

Cited By ~ 5

Author(s):

Khalil H. Chamseddin ◽

Melissa L. Kirkwood

Keyword(s):

Ankle Arthroscopy ◽

Anterior Tibial Artery ◽

Artery Pseudoaneurysm ◽

Tibial Artery ◽

Anterior Tibial ◽

Hemophiliac Patient

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Anterior tibial artery pseudoaneurysm after ankle arthroscopy

Cardiovascular Surgery ◽

10.1016/s0967-2109(98)00087-8 ◽

1998 ◽

Vol 6 (6) ◽

pp. 604-606 ◽

Cited By ~ 28

Author(s):

C Salgado

Keyword(s):

Ankle Arthroscopy ◽

Anterior Tibial Artery ◽

Artery Pseudoaneurysm ◽

Tibial Artery ◽

Anterior Tibial

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The Deep Peroneal Nerve in the Foot and Ankle: An Anatomic Study

Foot & Ankle International ◽

10.1177/107110079501601110 ◽

1995 ◽

Vol 16 (11) ◽

pp. 724-728 ◽

Cited By ~ 47

Author(s):

Steven J. Lawrence ◽

Michael J. Botte

Keyword(s):

Peroneal Nerve ◽

Average Distance ◽

Extensor Digitorum ◽

Anterior Tibial Artery ◽

Terminal Branch ◽

Foot And Ankle ◽

Deep Peroneal Nerve ◽

Extensor Hallucis Longus ◽

Anterior Tibial ◽

Extensor Digitorum Brevis

Injury to the deep peroneal nerve in the foot and ankle may result from trauma, repetitive mechanical irritation, or iatrogenic harm. The nerve is most susceptible to injury along its more distal anatomic course. Dissection of 17 cadaver specimens was undertaken to describe the course of the deep peroneal nerve and quantify its branch patterns. In the distal one third of the leg, the nerve was located superficial to the anterior tibial artery between the tibialis anterior and extensor hallucis longus muscles. Typically, the nerve crossed deep to the extensor hallucis longus tendon to enter the interval between the extensor hallucis longus and extensor digitorum longus at an average distance of 12.5 mm proximal to the ankle. A proximal bifurcation was usually present at an average distance of 12.4 mm distal to the mortise. The lateral terminal branch penetrated the deep surface of the extensor digitorum brevis to provide motor innervation. The medial terminal branch passed over the talonavicular joint capsule, and coursed an average of 2.9 mm lateral to the first tarsometatarsal joint. Within the forefoot, it passed deep to the extensor hallucis brevis tendon, bifurcated in the midmetatarsal region, and then arborized, supplying sensibility to the first toe interspace and the adjacent sides of the first and second toes.

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Pseudoaneurysm of the Perforating Peroneal Artery following Ankle Arthroscopy

Case Reports in Orthopedics ◽

10.1155/2018/9821738 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6

Author(s):

Ichiro Tonogai ◽

Eiki Fujimoto ◽

Koichi Sairyo

Keyword(s):

Ankle Joint ◽

Vascular Complications ◽

Posterior Tibial Artery ◽

Ankle Arthroscopy ◽

Peroneal Artery ◽

Anterior Tibial Artery ◽

Foot And Ankle ◽

Posterior Tibial ◽

Tibial Artery ◽

Anterior Tibial

The use of standard anterolateral and anteromedial portals in ankle arthroscopy results in reduced risk of vascular complications. Anatomical variations of the arterial network of the foot and ankle might render the vessels more susceptible to injury during procedures involving the anterior ankle joint. The literature, to our knowledge, reports only one case of a pseudoaneurysm involving the peroneal artery after ankle arthroscopy. Here, we report the unusual case of a 48-year-old man in general good health with the absence of the anterior tibial artery and posterior tibial artery. The patient presented with a pseudoaneurysm of the perforating peroneal artery following ankle arthroscopy for traumatic osteoarthritis associated with nonunion of the medial malleolus. The perforating peroneal artery injury was repaired by performing end-to-end anastomosis. The perforating peroneal artery is at higher risk for iatrogenic injury during ankle arthroscopy in the presence of abnormal arterial variations of the foot and ankle, particularly the absence of the anterior tibial artery and posterior tibial artery. Before ankle arthroscopy, surgeons should therefore carefully observe the course of the perforating peroneal artery on enhanced 3-dimensional computed tomography, especially in patients with a history of trauma to the ankle joint.

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