Using a Direct Lateral Incision as an Instrumentation Portal During Ankle Arthroscopy: A Retrospective Cohort...

Area of Science:

• Orthopedic surgery
• Minimally invasive procedures

Background:

• Ankle arthroscopy (AA) commonly uses anteromedial (AM) and anterolateral (AL) portals.
• The AL portal is near the superficial peroneal nerve (SPN), increasing risk of neuropraxic injury.
• Combining AA with lateral procedures like Brostrom-Gould repair or ORIF traditionally requires a direct lateral incision.

Purpose of the Study:

• To compare complication rates, specifically SPN injury, between a novel lateral incision (LI) approach and conventional arthroscopy with a lateral incision (AA+).
• To evaluate a new technique for combining AA with lateral adjunct procedures that avoids the AL portal.

Main Methods:

• Retrospective chart review of patients undergoing AA with adjunct procedures (Brostrom-Gould repair or ORIF) from January 2020 to October 2024.
• Comparison between patients using the LI approach versus the conventional AA+ approach.
• Analysis of demographic data, intraoperative details, postoperative complications, and reoperations using descriptive statistics and t-tests.

Main Results:

• Ninety-two patients were included; no significant differences in procedural or tourniquet duration between the LI and AA+ groups.
• Complication and reoperation rates were statistically similar between the two groups (P=.94 and P=.40, respectively).
• No significant difference in the rate of SPN neuropathy or neurapraxia between the LI and AA+ groups (P=.37).

Conclusions:

• The novel lateral incision approach for ankle arthroscopy with adjunct procedures showed comparable complication rates to the traditional 3-portal method.
• While infection or wound dehiscence might decrease with fewer portals, the current sample size is too small to confirm.
• Larger, multicenter studies are needed to definitively assess the complication risk of the lateral approach.