Two-millimetre diameter operative arthroscopy of the ankle is safe and effective

Tobias Stornebrink,Daniel Appelt,Sjoerd A S Stufkens,Coen A Wijdicks,J Nienke Altink,Gino M M J Kerkhoffs

doi:10.1007/s00167-020-05889-7

Abstract

PurposeTechnical innovation now offers the possibility of 2-mm diameter operative arthroscopy: an alternative to conventional arthroscopy that no longer uses inner rod-lenses. The purpose of this study was to assess whether all significant structures in the ankle could be visualized and surgically reached during 2-mm diameter operative arthroscopy, without inflicting iatrogenic damage.MethodsA novel, 2-mm diameter arthroscopic system was used to perform a protocolled arthroscopic procedure in 10 fresh-frozen, human donor ankles. Standard anteromedial and anterolateral portals were utilized. Visualization and reach with tailored arthroscopic instruments of a protocolled list of articular structures were recorded and documented. A line was etched on the most posterior border of the talar and tibial cartilage that was safely reachable. The specimens were dissected and distances between portal tracts and neurovascular structures were measured. The articular surfaces of talus and tibia were photographed and inspected for iatrogenic damage. The reachable area on the articular surface was calculated and analysed.ResultsAll significant structures were successfully visualized and reached in all specimens. The anteromedial portal was not in contact with neurovascular structures in any specimen. The anterolateral portal collided with a branch of the superficial peroneal nerve in one case but did not cause macroscopically apparent harm. On average, 96% and 85% of the talar and tibial surfaces was reachable respectively, without causing iatrogenic damage.Conclusion2-mm diameter operative arthroscopy provides safe and effective visualization and surgical reach of the anterior ankle joint. It may hold the potential to make ankle arthroscopy less invasive and more accessible.

Highlights

Arthroscopy is gaining importance in the treatment of ankle pathology [17]
Passive range of motion was unrestricted in all ankles, with the exception of two specimens where plantar flexion was decreased to < 15°
A borderline was successfully etched on the cartilage of the articular surface of the talus and tibia in every specimen

Summary

Introduction

Arthroscopy is gaining importance in the treatment of ankle pathology [17] It is still a relatively invasive procedure, with hyp(er)aesthesia of the superficial peroneal nerve and iatrogenic damage to articular cartilage as possible complications [16, 19]. Most procedures require spinal or general anaesthesia, which is associated with the risk of additional complications [9, 10] and the need for an operating theatre. All this causes the barrier to resort to a simple arthroscopic intervention to remain high. These, as they were called, needle arthroscopes yielded images of inferior quality and

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Results

Conclusion