Modified posterior portals for hindfoot arthroscopy

Area of Science:

• Orthopedic Surgery
• Anatomy
• Surgical Techniques

Background:

• Hindfoot arthroscopy is a valuable procedure for diagnosing and treating various ankle pathologies.
• Establishing safe and effective surgical portals is crucial for minimizing iatrogenic injury.
• Modified coaxial portals offer a potential advancement in hindfoot arthroscopy access.

Purpose of the Study:

• To determine the anatomical course and safe distances of modified coaxial portals used in hindfoot arthroscopy.
• To evaluate the clinical outcomes and safety of this modified portal technique.

Main Methods:

• Anatomic measurements were performed on 30 embalmed and 10 fresh-frozen cadaveric ankle specimens.
• Modified posteromedial and posterolateral coaxial portals were created using an inside-out technique.
• Clinical evaluation included 18 hindfoot arthroscopies in 15 patients with a mean 38-month follow-up.

Main Results:

• Neurovascular structures, including the posterior tibial nerve and arteries, were at safe mean distances (8.7-12.9 mm) from the portals.
• The sural nerve and lesser saphenous vein were further protected at mean distances of 27.6 mm and 28.3 mm.
• Clinical outcomes were favorable, with a mean West Point score of 91.5 and no complications related to the portals.

Conclusions:

• Modified coaxial portals for hindfoot arthroscopy demonstrate significant safety margins from vital neurovascular structures.
• The technique is clinically safe, effective, and reproducible for posterior ankle arthroscopy.