Appropriate instrumentation, technique may lead to successful ankle arthroscopy
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SAN FRANCISCO — In his discussion on performing a successful ankle arthroscopy, James W. Stone, MD, FAANA, said surgeons should use ankle joint distraction when performing the procedure.
“The problem with the ankle joint, of course, is it’s a complex curved articular surface, [has] tightly held ligaments and, certainly, using the older-fashioned instrumentation of 4-mm scopes is tough to get into the joint,” Stone said in his presentation at the Arthroscopy Association of North America Annual Meeting. “The combination of using ankle distraction and smaller joint arthroscopes has been, I think, revolutionary.”
In addition to using smaller scopes, he said it is also important to use appropriate hand instruments and appropriate-sized motorized instruments, including shavers.
“We have our instruments for the big joints, knee and shoulder, and then we have the small instruments for wrist, which are too small,” Stone said. “Most of the instrumentation companies now have instrumentation that is appropriate for the ankle joint, [it is] the same set they use for elbow arthroscopy, and there are medium-sized basket forceps. There are body forceps and various angulations are available.”
Surgeons should also become facile with their portals, according to Stone. He noted anteromedial portals should be made immediately adjacent to the extensor hallucis longus and not made too close to the medial malleolus as it will impair visualization of the joint. Stone added the lateral portal is close to the superficial peroneal nerve, while posterolateral portals are placed immediately adjacent to the lateral portal of the Achilles tendon.
“The other thing that I think is important, especially when you are locating your first portal medially, is to use proper technique,” Stone said. “The most common complication after ankle arthroscopy is superficial nerve injury, usually associated with the anterolateral portal, and this complication could be minimized by using proper technique.”
Stone noted surgeons should always perform a complete systematic joint examination, and learn posterior ankle arthroscopy and subtalar arthroscopy.
“The final thing I would say is [to] practice,” Stone said. “If you want to learn some of this stuff that you haven’t done before, come to the Orthopedic Learning Center or have someplace else to practice on cadavers and learn how to do it and become a good ankle arthroscopist.”
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Stone JW. Ankle arthroscopy: Pearls for success. Presented at: Arthroscopy Association of North America Annual Meeting. May 18-21, 2022; San Francisco.
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