Ankle Anatomy for the Arthroscopist. Part I: The Portals

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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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References (64)

  • S.E. Cameron

    Noninvasive distraction for ankle arthroscopy. Technical note

    Arthroscopy

    (1997)
  • H. Lohrer et al.

    Posterior approach for arthroscopic treatment of posterolateral impingement syndrome of the ankle in a top-level field hockey player

    Arthroscopy

    (2004)
  • F. Lijoi et al.

    Posterior arthroscopic approach to the ankle: an anatomic study

    Arthroscopy

    (2003)
  • M. Takao et al.

    A case of superficial peroneal nerve injury during ankle arthroscopy

    Arthroscopy

    (2001)
  • U. Sayli et al.

    The course of the superficial peroneal nerve: an anatomical cadáver study

    Foot Ankle Surg

    (1998)
  • C.J. Salgado et al.

    Anterior tibial artery pseudoaneurysm after ankle arthroscopy

    Cardiovasc Surg

    (1998)
  • P.P. Mariani et al.

    Pseudoaneurysm as a complication of ankle arthroscopy. Case report

    Arthroscopy

    (2001)
  • P. Golanó et al.

    Arthroscopic anatomy of the posterior ankle ligaments

    Arthroscopy

    (2002)
  • L.S. Matthews et al.

    Anterior portal selection for shoulder arthroscopy

    Arthroscopy

    (1985)
  • C.N. Van Dijk

    Arthroscopy of the ankle

    Arthroscopy

    (1997)
  • F.A. Pena Gómez et al.

    The ankle

  • R.D. Ferkel

    Arthroscopic surgery. The foot and ankle

    (1996)
  • R. Zini

    Artroscopia della caviglia

    Manuale pratico di tecnica chuirurgica [Arthroscopy of the ankle. Practical manual of the surgical technique]

    (1996)
  • M.S. Burman

    Arthroscopy or the direct visualization of joints. An experimental cadaver study

    Am J Bone Joint Surg

    (1931)
  • M. Watanabe

    Selfoc-Arthroscopy (Watanabe no. 24 arthroscope). Monograph

    (1972)
  • Ikehuchi H. Arthroscopy of the ankle. Presented at the International Arthroscopy Association Meeting....
  • Y.C. Chen

    Clinical and cadaver studies on the ankle joint arthroscopy

    J Jpn Orthop Assoc

    (1976)
  • D. Drez et al.

    Ankle arthroscopy: technique and indications

    Foot Ankle

    (1981)
  • J.S. Parisien et al.

    The role of arthroscopy in the diagnosis and treatment of disorders of the ankle

    Foot Ankle

    (1981)
  • J.S. Parisien et al.

    Operative arthroscopy of the ankle. Three years' experience

    Clin Orthop Rel Res

    (1985)
  • J.S. Parisien et al.

    Diagnostic and operative arthroscopy of the ankle. An experimental approach

    Clin Orthop Rel Res

    (1987)
  • J.R. Andrews et al.

    Arthroscopy of the ankle: technique and normal anatomy

    Foot Ankle

    (1985)
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