Arthroscopic Joint

Arthroscopic approaches to the ankle joint: A review

Introduction

Over the decades, the use of ankle arthroscopy for both as a diagnostic and treatment tool has increased substantially. Many pathological conditions of ankle that have been treated with open surgery are now treated with arthroscopy. Arthroscopic surgery of ankle allows direct visualization of intra-articular structures. The increase use in arthroscopy is attributed to its speedy recovery, decreased morbidity and quicker rehabilitation. Gasparetto F.

Arthroscopic approaches to the ankle joint

The arthroscopic surgery begins by making two or three small openings called portals. Through these portals, arthroscope and surgical instruments are placed inside the ankle. A cannula

Anteromedial portal

Function

Anteromedial portal is primary viewing portal and typically established first to access anteromedial joint

Location and technique

Anteromedial portal is located in a region that is devoid of major neurovascular structures. Anteromedial portal is made medial to the tibiallis anterior tendon and just proximal to the joint line by using 15 or 11 scalpel. After portal is made 2.7 mm arthroscope is introduced into the joint by using blunt trocar. The greater saphenous vein and nerve are at risk with this portal, lying 7–9 mm medial to the portal.

Anterolateral portal

Function

Anterolateral portal is primary viewing portal. It is used for the inflow cannula placement and used to access to anterolateral joint.

Location and technique

Anterolateral portal is made lateral to peroneus tendon or proximal to the joint line using 25-guage 1.5 inch needle. However, the placement of portal depends on the type and ankle pathology. The arthoscope is used to transilluminate the anterolateral skin, which allows localization of underlying neurovascular structures and tendons. The branches of the superficial peroneal nerves are at risk while inserting this portal. It should be noted that distance between intermediate superficial peroneal nerves is 6.2mm from this

Location and technique

Posterolateral portal is made adjacent to lateral edge of Achilles tendon and 1–1.5 cm proximal to the tip pf fibula. The portal is 9.5 mm posterior to the small saphenous vein and 6 mm posterior to the sural nerve.

Posteromedial portal

Posteromedial is made medial to Achilles tendon at the joint line. The branches of calcaneal nerve, flexor hallucis and flexor digitorium are at risk while creation posteromedial portal.

Combined posterior and anterior arthroscopy

In general, patient having combined anterior and posterior ankle pathology, treatment includes either combined anterior and posterior open surgery or anterior ankle arthroscopy combined with postlateral portal. Patients undergoing combined anterior and posterior open surgery are at high risk of developing complications, increased morbidity and have prolonged rehabilitation period. Additionally In latter case, anterior arthroscopic approach with an additional portal may limit access to posterior