Risk Area in Anterior and Posterior Ankle Arthroscopic Portals Placement: Long-term Retrospective Follow-up on Local Complications (SS-58)

Abstract

Introduction Over the past two decades arthroscopy of the ankle joint has been considered a procedure well and widely accepted by orthopaedic surgeons, forming their opinion as an easy tool and an easy-to-use technique. Advancing technology, equipment, and instrumentation improved, and new and advanced techniques has been developed for those joints considered small in dimension but not in importance. Increasing novel procedures lead out in time the opportunity for significant complications to develop. Many studies described by more than twenty years ago the involvement of vascular and nervous structures, addressing various rates of overall complications between 0.7% to 33% and focusing different problems related to the procedure and to the surgical technique itself. Because their position close to the areas of portal placement and to deep instruments direction, many of them has been considered at risk. Nevertheless they lie very superficial, making it easy to feel artery pulse and making it easy to palpate tendons and bony edges which are in their strict proximity. Despite neurovascular structures can present anatomic variations widely described in origin and in course, the risk of their lesion still remain low. Methods Authors present a long-term retrospective follow-up on ankle arthroscopy. From January 1999 to February 2009, 542 patients were submitted to ankle arthroscopy addressed both to anterior and posterior compartment. Only 485 have been enrolled and 57 have been lost to the survey. All the patients were evaluated with AOFAS score scale for the final results of the different surgical procedures. Results The overall complication rate was 8.6% for a total of 37 complications. The neurovascular ones were 20, twelve related to vascular problems and 8 to neurological ones. Specifically in 4 cases anteromedial portal placement was too close to saphenous vein origin, in 5 posteromedial approach was too close to posterior tibial artery branches, in 1 lateral portal was opened on a branch of peroneal artery, 2 had persistent wound bleeding for three days after surgery because of a too aggressive procedure. The peroneal nerve was involved in six cases, proximally for the compression of distraction and distally because the placement of the portal too medial, the saphenous nerve appeared compressed in two cases. All these complications were recovered in a few days, except three cases of high peroneal compression which needed a long period of rehabilitation. In five patients was recorded superficial ankle pain because non-invasive joint distraction at the heel and dorsal foot. Despite the tourniquet has been always used, only four patients referred pain at calf because long time use. Three cases were affected with a reflex sympathetic dystrophy totally recovered after four months of therapy. Two patients had a delay in wound healing because of diabetes. In one patient an instrument that broke was promptly removed by the surgeon during surgery, one presented with a superficial infection, and one was submitted to a subsequent procedure. Conclusion Understanding the anatomy of ankle compartments helps in avoiding injuries to neurovascular structures. Following step by step the correct anterior and posterior surgical procedures permits to respect vessels and nerves along their paths, limiting problems and complications.