Anatomic lectures on structures at risk prior to cadaveric courses reduce injury to the superficial peroneal nerve, the commonest complication in ankle arthroscopy

  • F. MalageladaEmail author
  • J. Vega
  • M. Guelfi
  • G. Kerkhoffs
  • J. Karlsson
  • M. Dalmau-Pastor



To assess the effectiveness of cadaveric ankle arthroscopy courses in reducing iatrogenic injuries.


A total of 60 novice surgeons enrolled in a basic cadaveric ankle arthroscopy course were divided into two groups. Group A (n = 32) was lectured on portal placement and use of the arthroscope, whereas group B (n = 28) was in addition lectured on specific portal-related complications. Following the performance of anterior ankle arthroscopy and hindfoot endoscopy, the specimens were dissected and carefully assessed for detection of any iatrogenic injuries.


The rate of injury to the superficial peroneal nerve (SPN) was reduced from 25 to 3.6%, in group A compared with B (p = 0.033). Injuries to the peroneus tertius or extensor digitorum longus, the flexor hallucis longus and the tibial nerve or the Achilles tendon were also reduced in group B. Overall, the number of uninjured specimens was 50% (n = 30) and higher in group B (57%) than group A (44%). Lesions to the plantaris tendon, the sural nerve or the posterior tibial artery were more common in group B, however, without reaching statistical significance. Overall, 25 (13.9%) anatomic structures were injured in anterior arthroscopy compared to 18 (5%) in hindfoot endoscopy, out of a potential total of 180 and 360, respectively (p = 0.001).


Dedicated lectures on portal-related complications have proven useful in reducing the risk of injury to the SPN, the commonest iatrogenic injury encountered in ankle arthroscopy. Hindfoot endoscopy is significantly safer than anterior ankle arthroscopy in terms of injury to anatomical structures.


Arthroscopic education Cadaveric Ankle Anatomy Complications Iatrogenesis 



The authors would like to thank GRECMIP for providing the cadaveric specimens used during its courses and giving permission to investigate them. We are grateful for its constant pursue of scientific knowledge that helps advance the research in minimally invasive foot and ankle techniques. Special thanks to Lynne Mackie and the Knowledge and Library Services at Barts Health NHS Trust for their assistance and continued support on the literature search and providing bibliography.


No external funding was used.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures were performed at the Dissection Room of the University of Bordeaux, and ethical approval was obtained with IRB Number: IRB00003099.


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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  • F. Malagelada
    • 1
    • 2
    Email author
  • J. Vega
    • 1
    • 3
    • 4
  • M. Guelfi
    • 5
    • 6
  • G. Kerkhoffs
    • 7
    • 8
    • 9
  • J. Karlsson
    • 10
  • M. Dalmau-Pastor
    • 1
    • 3
  1. 1.Human Anatomy and Embryology Unit, Department of Pathology and Experimental TherapeuticsUniversity of BarcelonaBarcelonaSpain
  2. 2.Department of Trauma and Orthopaedic SurgeryRoyal London Hospital, Barts Health NHS TrustLondonUK
  3. 3.GRECMIP (Groupe de Recherche et d’Etude en Chirurgie Mini-Invasive du Pied)MerignacFrance
  4. 4.Foot and Ankle UnitHospital Quirón and Clinica Tres TorresBarcelonaSpain
  5. 5.Foot and Ankle UnitClinica MontallegroGenoaItaly
  6. 6.Human Anatomy and Embryology Unit, Department of Morphological SciencesUniversitad Autònoma de BarcelonaBarcelonaSpain
  7. 7.Department of Orthopedic SurgeryAmsterdam University Medical Centers, Amsterdam Movement SciencesAmsterdamThe Netherlands
  8. 8.Academic Center for Evidence-Based Sports medicine (ACES)Academic Medical CenterAmsterdamThe Netherlands
  9. 9.Amsterdam Collaboration on Health and Safety in Sports (ACHSS)AMC/VUmc IOC Research CenterAmsterdamThe Netherlands
  10. 10.Department of Orthopaedics, Sahlgrenska University Hospital, Sahlgrenska AcademyGothenburg UniversityGothenburgSweden

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