ankle arthroscopy

indications

Diagnostic

· pain

· stiffness

· instability

· locking

· popping

Therapeutic

· soft tissue lesions

· post-traumatic or post-operative scars

· synovitis

· arthrofibrosis

· osseous lesions

· loose bodies

· osteochondral defects

· tibiotalar impingement spurs

Portals

· ankle distended first

Anteromedial

· just medial to tibialis anterior

· just proximal to joint line

Anterolateral

· just lateral to peroneus tertius

· just proximal to joint line

Posterolateral

· usually made once anteromedial portal established

· just lateral to tendo Achilles

neurological complications

Direct injury

Portals

· anterolateral portal

· superficial peroneal nerve

· anteromedial portal

· saphenous nerve

· posterolateral portal

· sural nerve

· other less used portals

· anterocentral (deep peroneal nerve)

· posteromedial (posterior tibial nerve)

· can be minimised by

· marking of skin prior to arthroscopy

· transillumination to visualise nerves

· use of blunt trocar

Other

· penetration

· neural structures close to capsule

· anterior penetration by chondrotome may injure deep peroneal nerve

· traction device

· pins in talus and calcaneus may injure sural nerve

Compartment syndrome

· from extravasation of fluid into calf