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

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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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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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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