Anatomical principles of ankle denervation - An update

Area of Science:

• Anatomy
• Orthopedic Surgery
• Neuroscience

Background:

• Denervation is a surgical treatment for ankle arthrosis when conservative methods fail.
• Successful denervation necessitates sectioning all articular nerve branches to the ankle joint.
• The precise anatomical locations of articular branches from the saphenous (Sa), tibial (Ti), sural (Su), superficial peroneal (Ps), and deep peroneal (Pp) nerves are crucial.

Purpose of the Study:

• To precisely map the articular branches of the key nerves supplying the ankle joint.
• To establish a reproducible intraoperative reference system for nerve branch identification and sectioning.
• To guide surgical technique for denervation, potentially minimizing skin incisions.

Main Methods:

• Dissection and preparation of nerves and their articular branches in 16 cryopreserved human ankle specimens.
• Identification and documentation of articular branch locations using a novel reference system.
• Measurement of nerve branch courses from the foot sole.

Main Results:

• Articular branches to the ankle joint were located between 5 and 30 cm from the foot sole.
• Specific transection levels were determined: saphenous (Sa) at 22.5 cm, sural (Su) at 20 cm, and deep peroneal (Pp) at 15 cm.
• Recommended surgical approaches include skeletonizing the tibial (Ti) nerve up to 25 cm and epifascial dissection of the superficial peroneal (Ps) nerve below 15 cm.

Conclusions:

• The study provides a detailed anatomical map of ankle articular nerve branches within an intraoperatively reproducible reference system.
• This precise anatomical data can guide surgeons in performing denervation, potentially leading to reduced skin incision size.
• The findings contribute to optimizing surgical techniques for ankle arthrosis denervation.