Anatomic study of arthroscopic debridement of the ankle

To this date, there have been no published studies correlating gross intra-articular anatomy and the compartments of the ankle that can be instrumented under arthroscopic visualization. The purpose of this study was to demonstrate which areas of intra-articular surface were accessible to the standard portals using a technique that allows direct anatomic correlation. Six fresh cadaver specimens and 12 fresh-frozen, below-knee amputations were used in this study. The 18 ankles were divided into six groups using only one arthroscopic portal site and one instrumentation site per group. Arthroscopic curettes were used to debride only the visualized talar, tibial, and fibular articular cartilage surfaces. After debridement, excision of the distal tibiofibular joint and the talus was performed. The total area of articular cartilage removed with each combination of arthroscope and instrument portal sites was noted, photographed, and recorded graphically. Use of the various combinations of the anteromedial, anterolateral, and posterolateral portals allowed complete access to all surfaces of the tibial plafond, anterior and posterior rims, and the talar dome. Areas that were not accessible by any portal combination were the distal half of the anterior colliculus of medial malleolus, the majority of the lateral talar articular surface, and the inferior half of the lateral malleolar articular surface.