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

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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The Origin of the Anterior Lateral Malleolar Artery From the Anterior Tibial Artery: A Fresh Cadaveric Study

Foot & Ankle Specialist ◽

10.1177/1938640018823066 ◽

2019 ◽

Vol 13 (1) ◽

pp. 69-73

Author(s):

Ichiro Tonogai ◽

Fumio Hayashi ◽

Yoshihiro Tsuruo ◽

Koichi Sairyo

Keyword(s):

Ankle Joint ◽

Sagittal Plane ◽

External Iliac Artery ◽

Cadaveric Study ◽

Anterior Tibial Artery ◽

Tibial Artery ◽

Anterior Tibial ◽

Branching Point ◽

Enhanced Computed Tomography ◽

Distal Direction

The anterior lateral malleolar artery (ALMA), which usually originates from the anterior tibial artery (ATA), courses transversely and laterally, passing under the extensor digitorum longus and peroneus tertius tendons. Variations in the origin of the ALMA from the ATA can occur. Branches of the ATA, such as the ALMA, are prone to pseudoaneurysm. This study reviewed the origin of the ALMA from the ATA and aimed to identify problems in anterior ankle arthroscopy that might cause injury to the ALMA. Enhanced computed tomography scans of 24 feet of 24 fresh cadavers (13 males, 11 females; average age 78.1 years) were assessed. The limb was injected with barium sulfate suspension through the external iliac artery; the origin of the ALMA from the ATA on the sagittal plane was recorded. The origin was at the ankle joint level in 4 specimens and below the ankle joint in 17 specimens. The distance from the ankle joint to the branching point of the ALMA on the sagittal plane was 5.2 mm distal to the joint. The level of origin of the ALMA from the ATA was established. Instruments should not be inserted from the distal direction when placing anterolateral portals. Levels of Evidence: Level IV, cadaveric study

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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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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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