Ankle Anatomy for the Arthroscopist. Part I: The Portals
Section snippets
Landmarks
The anatomic landmarks of bone and tissue in the ankle joint are easily palpated and should be delimited on the patient's skin with a dermographic marker. Landmarks are essential for proper positioning of the portals and facilitate orientation during the procedure despite the edema associated with the technique. The following landmarks are the most important: (1) both malleoli (lateral and medial); (2) the anterior joint line, which is easily palpated by moving the joint in dorsiflexion–plantar
Arthroscopic portals
The numerous arthroscopic portals described for the ankle can be grouped into anterior, posterior, transmalleolar, and transtalar. The use of some of these portals involves considerable technical difficulty or an elevated potential for neurovascular lesion, and for these reasons, they have fallen into disuse.
The first description of the anteromedial, anterolateral, and posterior portals of the ankle was reported by Watanabe in 1972 [6]. In later years, investigators such as Ikehuchi [7], Chen
Summary
Although a large number of portals have been described, in most cases, only three—the anteromedial, the anterolateral, and the posterolateral—are required to perform diagnostic and therapeutic arthroscopy.
According to the recommendations of van Dijk and colleagues [59], [60], [61], clinicians should consider abandoning simultaneous use of anterior and posterior portals because of the difficulty involved in performing this combined technique that increases the risk of injury to vascular
Acknowledgments
The authors thank Celine Cavallo for the English translation of the text.
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2022, Foot and Ankle ClinicsCitation Excerpt :A sterile tourniquet may be placed if performing a supramalleolar osteotomy, open arthrotomy, or arthroscopy, but should be released when attention is turned to the external fixator.28 The authors prefer to resect anterior osteophytes via arthroscopy performed through standard anterior portals using a 4.0 mm arthroscope.32,33 Bulky osteophytes unable to be resected with arthroscopy should be removed with a mini-open incision through the extension of the arthroscopic portals.