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



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.


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.


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.


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



Arthroscopy Anatomy Ankle Anterior talofibular ligament Deltoid ligament Intermalleolar ligament 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.


No funding was received for the study.

Ethical approval

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


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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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