Neurovascular injury may occur during ankle arthroscopy. The majority of complications
are neurological injuries; however, vascular injuries do exist. Neurovascular structures
are especially vulnerable during portal placement and debridement of anterior structures.
Routine anteromedial and anterolateral portals are generally accepted to be safe;
this is different from the anterocentral portal, which is associated with a higher
risk of injury. However, injuries may occur in these relatively safe portals. The
purpose of this cadaver study was to examine other relatively minor neurovascular
structures such as medial and lateral malleolar arteries and to determine how these
portals can be more safely placed. The distance between standard anteromedial, anterolateral
portals and the medial and lateral malleolar arteries was measured in 18 ankles from
9 cadavers. These distances varied with the position of the ankle during portals placement,
and measurements were obtained in both flexion and extension. The average distance
in flexion and extension was 6.41 to 2.47 mm on the lateral side and 4.73 to 1.58
mm on the medial side. The distances significantly increased with ankle flexion and
decreased with extension (P < .005). The current study demonstrated that there were other minor vascular structures
at risk other than tibialis anterior artery and proper positioning of the ankle during
portal placement, and that injury risk may be associated with ankle position. Ankle
flexion may decrease the risk of damage to malleolar arteries and decrease minor vascular
complications such as postoperative bleeding and hematoma.
Key words
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Article info
Footnotes
Each author certifies that he or she has no commercial associations (for example, consultancies, stock ownership, equity interest, patent and licensing arrangements, and so forth) that might pose a conflict of interest in connection with the submitted article. Each author certifies that his or her institution has waived approval for this protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.
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Copyright
© 2007 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.
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- Has plantarflexion any positive impact on the clinical risk of vascular injury during ankle arthroscopy ?The Journal of Foot and Ankle SurgeryVol. 46Issue 6
- PreviewI have read with great interest the article by Basarir et al, “Medial and Lateral Malleolar Arteries in Ankle Arthroscopy: A Cadaver Study,” which appeared in the May-June 2007 issue of the Journal (1). I agree that routine plantarflexion of the ankle during portal placement and application of trocars is preferable because it increases the distance between the medial malleolar arteries, lateral malleolar arteries, and standard portals. In the last sentence of the article, the authors state that further studies are required to determine whether plantarflexion could have any positive impact on the clinical risk of vascular injury.
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