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Posterior ankle and hindfoot endoscopy: A cadaveric study.
1Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong SAR, China.
Summary
Posterior ankle endoscopy poses a risk to the posterior tibial neurovascular bundle when using the posteromedial portal. However, the posterolateral portal approach appears safe for posterior ankle procedures.
Area of Science:
- Orthopedic surgery
- Minimally invasive procedures
- Anatomy
Background:
- Posterior ankle endoscopy indications are expanding.
- Procedures like frozen ankle release and osteochondral lesion treatment require access medial to the flexor hallucis longus tendon.
- Assessing neurovascular bundle injury risk is crucial.
Purpose of the Study:
- To evaluate the risk of posterior tibial neurovascular bundle injury during posterior ankle endoscopy.
- To compare risks associated with different surgical portals.
Main Methods:
- Utilized fourteen fresh frozen foot and ankle specimens.
- Inserted a metal rod through posteromedial, posterolateral, and modified posteromedial portals.
- Examined the neurovascular bundle and flexor hallucis longus tendon for kinking.
Main Results:
- Posterior tibial neurovascular bundle kinking occurred in 100% of specimens via the posteromedial portal.
- Kinking occurred in 79% of specimens with the modified posteromedial portal.
- Only 7% of specimens showed kinking with the posterolateral portal.
Conclusions:
- Instrumentation through the posteromedial portal for posterior ankle procedures presents a significant risk to the neurovascular bundle.
- The posterolateral portal is a safer alternative for accessing the posterior ankle, minimizing neurovascular compromise.
