Indications Indications osteochondral lesions of the talus microfracture of OCD debridement of post-traumatic synovitis ATFL anterolateral impingement AITFL anterolateral impingement resection of anterior tibiotalar spurs such as anterior bony impingement os trigonum excision removal of loose bodies cartilage debridement in conjunction with ankle fusions Positioning and Scope insertion Position patient placed supine leg over well padded bolster Tourniquet place tourniquet and exsanguinate limb Joint distention external traction device applied to distract tibiotalar joint can load joint with saline to distend joint Scope insertion nick and spread method commonly utilized to access joint and minimize neurovascular injury Portals Anteromedial function primary viewing portal typically established first access to anteromedial joint location and technique medial to tibialis anterior and lateral to medial malleolus make portal between tibialis anterior and saphenous vein Anterolateral function primary viewing portal access to anterolateral joint location and technique located just lateral to peroneus tertius and superficial peroneal nerve and medial to lateral malleolus can trace out superficial peroneal nerve prior to incision Anterocentral function anterior viewing portal location and technique not commonly utilized due to danger to dorsal pedis artery medial to EDL and lateral to EHL Posterolateral function posterior viewing portal for access to os trigonum location and technique located 2cm proximal to tip of lateral malleolus medial to peroneal tendons and lateral to achilles tendon Posteromedial function posterior viewing portal for access to os trigonum location and technique just medial to achilles tendon Complications Synovial cutaneous fistula avoid by immobilization to allow portal skin healing and closure Neurovascular injury from portal placement neuropraxia most common complication Anterolateral portal risks superficial peroneal nerve most common neurovascular injury specifically, the dorsal intermediate cutaneous branch Anteromedial portal risks saphenous nerve and vein risk of tibialis anterior tendon injury Anterocentral portal risks dorsalis pedis artery Posterolateral portal risks sural nerve and short saphenous vein Posteromedial portal risks posterior tibial artery
Ankle Arthroscopy complications Neurovascular injury from portal placement OBC What nerve is at risk with an anterolateral portal? Anterolateral portal risks superficial peroneal nerve specifically, the dorsal intermediate cutaneous branch Show Bullets