Instructional Course Lecture Posterior Ankle Arthroscopy: What Are the Limits?

Abstract

In 1931, Burman found the ankle joint unsuitable for arthroscopy because of its typical anatomy [1]. Tagaki and later Watanabe made considerable contributions to arthroscopic surgery, and the latter published a series of 28 ankle arthroscopies in 1972 [2]. Since the late 1970s, numerous publications have followed. Over the last 30 years, arthroscopy of the ankle joint has become an important procedure with numerous indications for both anterior as well as posterior pathology and pathology of tendons. Endoscopic surgery offers the possible advantages of direct visualization of structures, improved assessment of articular cartilage, less postoperative morbidity, faster and functional rehabilitation, earlier resumption of sports and outpatient treatment [3–5]. The value of diagnostic arthroscopy nowadays is considered limited [6, 7]. Posterior ankle problems pose a diagnostic and therapeutic challenge because of their nature and the deep location of hindfoot structures. This makes direct access more difficult. Historically, the hindfoot was approached by a three-portal technique, i.e. the anteromedial, anterolateral and posterolateral portals, with the patient in the supine position [8–10]. The traditional posteromedial portal is associated with potential damage to the tibial nerve, the posterior tibial artery and local tendons [11]. A two-portal endoscopic approach with the patient in the prone position was introduced in 2000 [12]. This technique has shown to give excellent access to the posterior ankle compartment, the subtalar joint and extra-articular structures [12–14].

Chapter edited by C.N. van Dijk and P.A.J de Leeuw. © ESSKA