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A step-by-step arthroscopic examination of the anterior ankle compartment

  • ANKLE
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Despite the increased use of ankle dorsiflexion without distraction, no reports have specifically addressed the arthroscopic anatomy of the ankle in this position. The purpose of this study was to describe the normal arthroscopic anatomy of the ankle joint, when using the ankle dorsiflexion and the dynamic distraction technique, and to propose an arthroscopic examination system for the anterior ankle compartment.

Methods

Ankle arthroscopy was performed in 20 fresh frozen specimens. Arthroscopic examination was performed with the arthroscope introduced through the anteromedial portal. The anterior compartment was examined in ankle dorsiflexion without distraction. The compartment was examined in four steps: (1) lateral area including the lateral gutter; (2) the central area of the anterior tibial rim; (3) the medial area including the medial gutter; (4) the talar neck. Next, distraction was applied to visualise the anterior compartment again and to examine the central and posterior ankle compartments.

Results

Anatomic intra-articular structures were visualised in all specimens. Four intra-articular fat pads, one anteromedial, two syndesmotic and another posteromedial, were constantly observed. A description of the normal arthroscopic anatomy of the ankle using the ankle dorsiflexion and the dynamic distraction technique is detailed for the anterior, central and posterior compartments.

Conclusion

The ankle arthroscopic procedure without distraction allows constant visualisation of the ATFL’s superior fascicle on the floor of the lateral gutter, the ATiFL’s distal fascicle laterally and the most anterior margin of the deltoid ligament in the medial gutter (anterior tibiotalar ligament). However, ankle distraction is required to observe the central and posterior compartments, but it does not provide optimal visualisation of the anterior ankle compartment structures.

Level of evidence

V.

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Authors and Affiliations

  1. Human Anatomy and Embryology Unit, Department of Pathology and Experimental Therapeutics, University of Barcelona, Barcelona, Spain

    J. Vega, F. Malagelada & M. Dalmau-Pastor

  2. Foot and Ankle Unit, Orthopedic Department, iMove Tres Torres Barcelona 76, Dr Roux st, Barcelona, Spain

    J. Vega

  3. GRECMIP–MIFAS (Groupe de Recherche et d’Etude en Chirurgie Mini-Invasive du Pied–Minimally Invasive Foot and Ankle Society), Merignac, France

    J. Vega & M. Dalmau-Pastor

  4. Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London, UK

    F. Malagelada

  5. Department of Orthopaedics, Sahlgrenska University Hospital, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden

    J. Karlsson

  6. Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam University Medical Centers, Amsterdam, The Netherlands

    G. M. Kerkhoffs

  7. Academic Center for Evidence-Based Sports Medicine (ACES), Academic Medical Center, Amsterdam, The Netherlands

    G. M. Kerkhoffs

  8. Amsterdam Collaboration On Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands

    G. M. Kerkhoffs

  9. Foot and Ankle Unit, Clinica Montallegro, Genoa, Italy

    M. Guelfi

  10. Human Anatomy and Embryology Unit, Department of Morphological Sciences, Universitad Autònoma de Barcelona, Barcelona, Spain

    M. Guelfi

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  1. J. Vega
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  4. G. M. Kerkhoffs
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  6. M. Dalmau-Pastor
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Correspondence to J. Vega.

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The authors declare that they have no competing interests.

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No funding was received for the study.

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The study was approved by the Ethical committee of the institution.

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Vega, J., Malagelada, F., Karlsson, J. et al. A step-by-step arthroscopic examination of the anterior ankle compartment. Knee Surg Sports Traumatol Arthrosc 28, 24–33 (2020). https://doi.org/10.1007/s00167-019-05756-0

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  • DOI: https://doi.org/10.1007/s00167-019-05756-0

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