Safety of neurovascular structures in ankle arthroscopy: 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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Minimally Invasive Calcaneal Osteotomy: Does the Shannon Burr Endanger the Neurovascular Structures? A Cadaveric Study

The Journal of Foot & Ankle Surgery ◽

10.1053/j.jfas.2015.05.007 ◽

2015 ◽

Vol 54 (6) ◽

pp. 1062-1066 ◽

Cited By ~ 12

Author(s):

Abigail Durston ◽

Rana Bahoo ◽

Sujit Kadambande ◽

Kartik Hariharan ◽

Lyndon Mason

Keyword(s):

Minimally Invasive ◽

Cadaveric Study ◽

Calcaneal Osteotomy ◽

Neurovascular Structures

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Proximity of the Coracoid Process to the Neurovascular Structures in Various Patient and Shoulder Positions: A Cadaveric Study

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/j.arthro.2018.09.031 ◽

2019 ◽

Vol 35 (2) ◽

pp. 372-379 ◽

Cited By ~ 3

Author(s):

Chaiwat Chuaychoosakoon ◽

Porames Suwanno ◽

Prapakorn Klabklay ◽

Chitpon Sinchai ◽

Yada Duangnumsawang ◽

...

Keyword(s):

Coracoid Process ◽

Cadaveric Study ◽

Neurovascular Structures

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The safety of the posterior ankle arthroscopy in management of posterior ankle impingement: A cadaveric study

The Foot ◽

10.1016/j.foot.2015.09.004 ◽

2016 ◽

Vol 27 ◽

pp. 4-9 ◽

Cited By ~ 7

Author(s):

T.H. Lui ◽

L.K. Chan

Keyword(s):

Cadaveric Study ◽

Ankle Arthroscopy ◽

Ankle Impingement ◽

Posterior Ankle Impingement ◽

Posterior Ankle Arthroscopy

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Percutaneous cubital tunnel release with a dissection thread: a cadaveric study

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193419856591 ◽

2019 ◽

Vol 44 (9) ◽

pp. 920-924

Author(s):

Danqing Guo ◽

Michel Kliot ◽

Logan McCool ◽

Alexander Senk ◽

Brionn Tonkin ◽

...

Keyword(s):

Ulnar Nerve ◽

Ultrasound Guidance ◽

Cadaveric Study ◽

Cubital Tunnel ◽

Anatomical Dissection ◽

Direct Injury ◽

Prerequisite Knowledge ◽

Fresh Frozen ◽

Extent Of Damage ◽

Neurovascular Structures

This cadaveric study tested the feasibility of decompressing the ulnar nerve across the elbow percutaneously with a commercially available surgical dissection thread, a guiding needle, hydrodissection and ultrasound guidance. We performed the procedure in 19 fresh-frozen cadaveric upper extremities. Subsequently, we did an anatomical dissection of the specimens to visualize the extent of ulnar nerve decompression and the extent of damage to surrounding structures. The cubital tunnel and deep across the medial elbow were completely transected leaving the ulnar nerve fully decompressed in all cases. There was no evidence of direct injury to the ulnar nerve or adjacent neurovascular structures. A prerequisite knowledge of sonographic anatomy and experience with interventional ultrasound is essential. Future clinical studies should evaluate this technique’s safety and efficacy compared with conventional ones.

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Safety of posterior ankle arthroscopy portals in different ankle positions: a cadaveric study

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-014-3475-6 ◽

2014 ◽

Vol 24 (7) ◽

pp. 2119-2123 ◽

Cited By ~ 7

Author(s):

Halil İbrahim Balcı ◽

Gökhan Polat ◽

Göksel Dikmen ◽

Atacan Atalar ◽

Mehmet Kapıcıoğlu ◽

...

Keyword(s):

Cadaveric Study ◽

Ankle Arthroscopy ◽

Posterior Ankle Arthroscopy

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Proximity of the neurovascular structures during all-inside lateral meniscal repair in children: a cadaveric study

Journal of Experimental Orthopaedics ◽

10.1186/s40634-018-0166-0 ◽

2018 ◽

Vol 5 (1) ◽

Cited By ~ 3

Author(s):

Yi-Meng Yen ◽

Peter D. Fabricant ◽

Connor G. Richmond ◽

Aleksei B. Dingel ◽

Matthew D. Milewski ◽

...

Keyword(s):

Meniscal Repair ◽

Cadaveric Study ◽

Neurovascular Structures

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Effectiveness and Safety in Closed Mini-Transverse Incision with Hydro-Dissection Technique in Carpal Tunnel Release: A Cadaveric Study

The Journal of Hand Surgery (Asian-Pacific Volume) ◽

10.1142/s2424835519500309 ◽

2019 ◽

Vol 24 (02) ◽

pp. 224-228

Author(s):

Jirapong Leeyaphan ◽

Rosarin Ratanalekha

Keyword(s):

Median Nerve ◽

Carpal Tunnel ◽

Carpal Tunnel Release ◽

Ulnar Artery ◽

Cadaveric Study ◽

Transverse Carpal Ligament ◽

Transverse Incision ◽

Special Instrument ◽

Dissection Technique ◽

Neurovascular Structures

Background: Closed mini-wrist transverse incision for carpal tunnel release has been reported in decreasing surgical scar problems, but there were few cadaveric studies that proved the effectiveness and safety in this technique without protective instrument to the median nerve. Hydro-dissection was previously showed to separate median nerve and deep structures during percutaneous ultrasound guided transverse carpal ligament release. This cadaveric study aims to demonstrated effectiveness and safety of closed transverse carpal ligament (TCL) release though the mini-transverse incision at distal wrist crease combined with hydrodissection technique. Neither special instrument nor retractor was used to protect neurovascular structures. Methods: Twelve fresh frozen cadaveric wrists were included in this study. Completeness of TCL release and injury to the adjacent neurovascular structures were assessed by direct visualization. Thickness of TCL, TCL length and distance from incision to adjacent neurovascular structures were also recorded. Results: Complete release of TCL was demonstrated in all 12 (100%) wrists underwent the mini-transverse incision TCL release at distal wrist crease and hydro-dissection technique. No injury to the adjacent neurovascular structures was found in all 12 wrists. Mean of thickness of TCL and TCL length were 3 mm and 28.7 mm, respectively. The ulnar artery was the nearest structure to the incision (mean = 3.7 mm). Conclusions: The closed mini-transverse incision TCL release at distal wrist crease with hydro-dissection technique demonstrated completeness of TCL division and safety to the neurovascular structures without protecting retractor or special instrument.

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The Distribution Pattern of the Neurovascular Structures for Anterior Ankle Arthroscopy to Minimize Structural Injury: Anatomical Study

BioMed Research International ◽

10.1155/2018/3421985 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5

Author(s):

Anna Jeon ◽

Chang Min Seo ◽

Je-Hun Lee ◽

Seung-Ho Han

Keyword(s):

Anatomical Study ◽

Ankle Arthroscopy ◽

Lateral Malleolus ◽

Reference Line ◽

Medial Malleolus ◽

Entry Points ◽

Structural Injury ◽

Age Range ◽

Arteries And Veins ◽

Neurovascular Structures

Introduction. The aim of this study was to investigate entry points for anterior ankle arthroscopy that would minimize the risk of neurovascular injury. Methods. Thirty-eight specimens from 21 Korean cadavers (age range from 43 to 92 years, mean age of 62.3 years) were used for the study. For the measurements, the most prominent points of the lateral malleolus (LM) and the medial malleolus (MM) were identified before dissection. A line connecting the LM and MM, known as the intermalleolar line, was used as a reference line. We measured 14 variables passed on the reference line. Results. This study found that the nerves were located at 40.0%, 50.0%, and 82.0% of the reference line from the lateral malleolus. We also found that the arteries were located at 22.0%, 35.0%, and 60% of the reference line from the lateral malleolus. Discussion. If all the variables are combined (nerves, arteries, and veins), then there is no safety zone for anterior portal placement. Therefore, we recommend that surgeons concentrate primarily on the arteries and nerves in the clinical setting.

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