Percutaneous lateral ankle stabilization: an anatomical investigation

Area of Science:

• Orthopedic Surgery
• Anatomy
• Minimally Invasive Procedures

Background:

• Chronic ankle instability requires effective treatment.
• Percutaneous lateral ankle stabilization is a novel minimally invasive technique.
• Understanding its topographic anatomy relative to neurovascular structures is crucial.

Purpose of the Study:

• To investigate the topographic anatomy of percutaneous lateral ankle stabilization.
• To assess the proximity of the technique to critical neurovascular hindfoot structures.
• To provide anatomical guidance for performing this minimally invasive procedure.

Main Methods:

• Dissection of 11 cadaver specimens.
• Identification of nerves, vessels, ligaments, and tendons.
• Creation of portals and transosseous tunnels using Kirschner wires.
• Measurement of distances between Kirschner wires and neurovascular structures relative to bony landmarks.

Main Results:

• Medial calcaneal branch of tibial nerve: average 7 mm (SD±4) from Kirschner wire; 2 instances of contact.
• Sural nerve: average 13 mm (SD±4) from fibular exit point.
• Superficial peroneal nerve: closest 11.5 mm (SD±3) to ATFL footprint; 28 mm (SD±8) anterior to fibula tip.
• Posterior tibial artery: average 41 mm (SD±6) from Kirschner wire.

Conclusions:

• The novel percutaneous approach for chronic ankle instability demonstrated minimal risk to neurovascular structures in a cadaver model.
• This anatomical study provides essential data for safe execution of the technique.
• Further clinical studies are needed to compare its efficacy against open surgery.