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Published on: January 24, 2018
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Posterior Ankle Structure Injury During Total Ankle Replacement.
Christopher W Reb1, Jeffrey E McAlister2, Christopher F Hyer1
1Orthopedic Foot and Ankle Center, Westerville, OH.
Summary
Total ankle replacement may risk posterior ankle structure injury. Surgeons must be aware of potential damage to nerves and tendons during bone resection, impacting patient outcomes.
Area of Science:
- Orthopedic Surgery
- Anatomy
- Biomedical Engineering
Background:
- Total ankle replacement (TAR) complications are typically clinical or radiographic.
- Unexplained persistent pain after TAR suggests other causes.
- Posterior ankle structure injury risk during TAR is not well-defined.
Purpose of the Study:
- To assess the risk of injury to posterior ankle structures during TAR.
- To evaluate the relationship between surgical instruments and critical anatomical elements.
Main Methods:
- Ten cadaveric below-the-knee specimens were used.
- Specimens were positioned using an approved TAR system and fluoroscopic imaging.
- Digital calipers measured the proximity of tibial cutting guide pins to posterior neurovascular and tendon structures.
Main Results:
- High rates of posterior structural injury were observed.
- Proximal-medial pins frequently contacted posteromedial neurovascular structures (e.g., tibial nerve).
- Distal-medial pins often encountered tendinous structures (e.g., flexor digitorum longus).
- Proximal lateral pins commonly contacted the Achilles tendon and sural nerve.
Conclusions:
- Tibial neurovascular structures face significant risk during bony resection in TAR.
- Posterior ankle soft tissue injuries during implantation are possible but their frequency and significance are unknown.
- Further research into posterior structural injuries is needed for improved TAR complication management.
