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

  • J. VegaEmail author
  • F. Malagelada
  • J. Karlsson
  • G. M. Kerkhoffs
  • M. Guelfi
  • M. Dalmau-Pastor
ANKLE

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.

Keywords

Arthroscopy Anatomy Ankle Anterior talofibular ligament Deltoid ligament Intermalleolar ligament 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Funding

No funding was received for the study.

Ethical approval

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

References

  1. 1.
    Acevedo JI, Busch MT, Ganey TM, Hutton WC, Odgen JA (2000) Coaxial portals for posterior ankle arthroscopy: an anatomic study with clinical correlation on 29 patients. Arthroscopy 16:836–842CrossRefGoogle Scholar
  2. 2.
    Bedi A, Dines J, Dines DM, Kelly BT, O’Brien SJ, Altchek DW, Allen AA (2010) Use of the 70º arthroscope for improved visualization with common arthroscopic procedures. Arthroscopy 26:1684–1696CrossRefGoogle Scholar
  3. 3.
    Dalmau-Pastor M, Malagelada F, Kerkhoffs GM, Karlsson J, Guelfi M, Vega J (2019) Redefining anterior ankle arthroscopic anatomy: medial and lateral ankle collateral ligaments are visible through dorsiflexion and non-distraction anterior ankle arthroscopy. Knee Surg Sports Traumatol Arthrosc.  https://doi.org/10.1007/s00167-019-05603-2 CrossRefPubMedGoogle Scholar
  4. 4.
    de Leeuw PA, Golanó P, Clavero JA, van Dijk CN (2010) Anterior ankle arthroscopy, distraction or dorsiflexion? Knee Surg Sports Traumatol Arthrosc 18(5):594–600CrossRefGoogle Scholar
  5. 5.
    Ferkel RD, Fischer SP (1989) Progress in ankle arthroscopy. Clin Orthop Relat Res 240:210–220Google Scholar
  6. 6.
    Ferkel RD, Scranton PE (1993) Current concepts review: arthroscopy of the ankle and foot. J Bone Joint Surg Am 75:1233–1245CrossRefGoogle Scholar
  7. 7.
    Ferkel RD (1996) Diagnostic arthroscopic anatomy. In: Whipple TL (ed) Arthroscopic surgery. The foot and ankle. Lippincott-Raven, Philadelphia, pp 103–118Google Scholar
  8. 8.
    Golanó P, Vega J, Pérez-Carro L, Götzens V (2006) Ankle anatomy for the arthroscopist. Part I: The portals. Foot Ankle Clin 11(2):253–723CrossRefGoogle Scholar
  9. 9.
    Golanó P, Vega J, Pérez-Carro L, Götzens V (2006) Ankle anatomy for the arthroscopist. Part II: Role of the ankle ligaments in soft tissue impingement. Foot Ankle Clin 11(2):275–296CrossRefGoogle Scholar
  10. 10.
    Guyton GP, DeFontes K 3rd, Barr CR, Parks BG, Camire LM (2017) Arthroscopic correlates of subtle syndesmotic injury. Foot Ankle Int 38(5):502–506CrossRefGoogle Scholar
  11. 11.
    Kumai T, Takakura Y, Rufai A, Milz S, Benjamin M (2002) The functional anatomy of the human anterior talofibular ligament in relation to ankle sprains. J Anat 200(5):457–465CrossRefGoogle Scholar
  12. 12.
    Phisitkul P, Akoh CC, Rungprai C, Barg A, Amendola A, Dibbern K, Anderson D (2017) Optimizing arthroscopy for osteochondral lesions of the talus: the effect of ankle positions and distraction during anterior and posterior arthroscopy in a cadaveric model. Arthroscopy 33:2238–2245CrossRefGoogle Scholar
  13. 13.
    Shaffler GJ, Tirman PF, Stoller DW, Genant HK, Ceballos C, Dillingham MF (2003) Impingement syndrome of the ankle following supination external rotation trauma: MR imaging findings with arthroscopic correlation. Eur Radiol 13(6):1357–1362Google Scholar
  14. 14.
    Spennacchio P, Randelli P, Arrigoni P, van Dijk N (2013) Improved visualization of the 70º arthroscope in the treatment of talar osteochondral defects. Arthrosc Tech 2(2):e129–e133CrossRefGoogle Scholar
  15. 15.
    Takao M, Ochi M, Naito K, Iwata A, Kawasaki K, Tobita M, Miyamoto W, Oae K (2001) Arthroscopic diagnosis of tibiofibular syndesmosis disruption. Arthroscopy 17(8):836–843CrossRefGoogle Scholar
  16. 16.
    Takao M, Ochi M, Oae K, Naito K, Uchio Y (2003) Diagnosis of a tear of the tibiofibular syndesmosis. The role of arthroscopy of the ankle. J Bone Joint Surg Br 85(3):324–329CrossRefGoogle Scholar
  17. 17.
    van Bergen CJ, Tuijthof GJ, Maas M, Sierevelt IN, van Dijk CN (2012) Arthroscopic accessibility of the talus quantified by computed tomography simulation. Am J Sports Med 40:2318–2324CrossRefGoogle Scholar
  18. 18.
    van Bergen CJ, Tuijthof GJ, Blankevoort L, Maas M, Kerkhoffs GM, van Dijk CN (2012) Computed tomography of the ankle in full plantar flexion: a reliable method for preoperative planning of arthroscopic access to osteochondral defects of the talus. Arthroscopy 28(7):985–992CrossRefGoogle Scholar
  19. 19.
    van Dijk CN, Scholte D (1997) Arthroscopy of the ankle joint. Arthroscopy 13(1):90–96CrossRefGoogle Scholar
  20. 20.
    van Dijk CN, Tol JL, Verheyen CCPM (1997) A prospective study of prognostic factors concerning the outcome of arthroscopic surgery for anterior ankle impingement. Am J Sports Med 25:737–745CrossRefGoogle Scholar
  21. 21.
    Vega J, Golanó P, Pellegrino A, Rabat E, Peña F (2013) All-inside arthroscopic lateral collateral ligament repair for ankle instability with a knotless suture anchor technique. Foot Ankle Int 34(12):1701–1709CrossRefGoogle Scholar
  22. 22.
    Vega J, Peña F, Golanó P (2016) Minor or occult ankle instability as a cause of anterolateral pain after ankle sprain. Knee Surg Sports Traumatol Arthrosc 24(4):1116–1123CrossRefGoogle Scholar
  23. 23.
    Vega J, Golanó P, Peña F (2016) Iatrogenic articular cartilage injury during ankle arthroscopy. Knee Surg Sports Traumatol Arthrosc 24(4):1304–1310CrossRefGoogle Scholar
  24. 24.
    Vega J, Dalmau M, Malagelada F, Fargues-Polo B, Peña F (2017) Ankle arthroscopy: an update. J Bone Joint Surg Am 99:1395–1407CrossRefGoogle Scholar
  25. 25.
    Vega J, Allmendinger J, Malagelada F, Guelfi M, Dalmau M (2017) Combined arthroscopic all-inside repair of lateral and medial ankle ligaments is an effective treatment for rotational ankle instability. Knee Surg Sports Traumatol Arthrosc.  https://doi.org/10.1007/s00167-017-4736-y CrossRefPubMedGoogle Scholar
  26. 26.
    Vega J, Malagelada F, Manzanares MC, Dalmau M (2018) The lateral fibulotalocalcaneal ligament complex: an ankle stabilizing isometric structure. Knee Surg Sports Traumatol Arthrosc.  https://doi.org/10.1007/s00167-018-5188-8 CrossRefPubMedGoogle Scholar

Copyright information

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

Authors and Affiliations

  1. 1.Human Anatomy and Embryology Unit, Department of Pathology and Experimental TherapeuticsUniversity of BarcelonaBarcelonaSpain
  2. 2.Foot and Ankle UnitOrthopedic DepartmentBarcelonaSpain
  3. 3.GRECMIP–MIFAS (Groupe de Recherche et d’Etude en Chirurgie Mini-Invasive du Pied–Minimally Invasive Foot and Ankle Society)MerignacFrance
  4. 4.Department of Trauma and Orthopaedic SurgeryRoyal London Hospital, Barts Health NHS TrustLondonUK
  5. 5.Department of Orthopaedics, Sahlgrenska University Hospital, Sahlgrenska AcademyGothenburg UniversityGothenburgSweden
  6. 6.Department of Orthopedic Surgery, Amsterdam Movement SciencesAmsterdam University Medical CentersAmsterdamThe Netherlands
  7. 7.Academic Center for Evidence-Based Sports Medicine (ACES)Academic Medical CenterAmsterdamThe Netherlands
  8. 8.Amsterdam Collaboration On Health and Safety in Sports (ACHSS)AMC/VUmc IOC Research CenterAmsterdamThe Netherlands
  9. 9.Foot and Ankle UnitClinica MontallegroGenoaItaly
  10. 10.Human Anatomy and Embryology Unit, Department of Morphological SciencesUniversitad Autònoma de BarcelonaBarcelonaSpain

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