Matteo Guelfi1,2,3, Jordi Vega4,5,6, Francesc Malagelada4,7, Miki Dalmau-Pastor4,5,8. 1. Foot and Ankle Unit, Clinica Montallegro, Genoa, Italy. matteogue@hotmail.com. 2. Department of Orthopaedic Surgery "Gruppo Policlinico di Monza", Clinica Salus, Alessandria, Italy. matteogue@hotmail.com. 3. Human Anatomy and Embryology Unit, Department of Morphological Sciences, Universitad Autònoma de Barcelona, Barcelona, Spain. matteogue@hotmail.com. 4. Human Anatomy and Embryology Unit, Department of Pathology and Experimental Therapeutics, University of Barcelona, Barcelona, Spain. 5. GRECMIP (Groupe de Recherche et d'Etude en Chirurgie Mini-Invasive du Pied), Merignac, France. 6. Foot and Ankle Unit, Hospital Quirón Barcelona, and iMove Traumatology Tres Torres, Barcelona, Spain. 7. Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London, UK. 8. Manresa Health Science School, University of VIC-Central University of Catalonia, Barcelona, VIC, Spain.
Abstract
PURPOSE: Neurovascular structures around the ankle are at risk of injury during arthroscopic all-inside lateral collateral ligament repair for the treatment of chronic ankle instability. This study aimed to evaluate the risk of damage to anatomical structures and reproducibility of the technique amongst surgeons with different levels of expertise in the arthroscopic all-inside ligament repair. METHODS: Twelve fresh-frozen ankle specimens were used for the study. Two foot and ankle surgeons with different level of experience in the technique performed the procedure on 6 specimens each. The repair was performed following a standardized procedure as originally described. Then, an experienced anatomist dissected all the specimens to evaluate the outcome of the ligament repair, any injuries to anatomical structures and the distance between arthroscopic portals and the superficial peroneal nerve (SPN) and sural nerve. RESULTS: Dissections revealed no injury to the nerves assessed. Mean distance from the anterolateral portal and the SPN was of 4.8 (range 0.0-10.4) mm. The mean distance from the accessory anterolateral portal to the SPN and sural nerve was of 14.2 (range 7.1-32.9) mm and 28.1 (range 2.8-39.6) mm, respectively. The difference between the 2 surgeons' groups was non-statistically significant for any measurement (mm). In all specimens both fascicles of the anterior talofibular ligament were reattached onto its original fibular footprint. The calcaneofibular ligament was not penetrated in any specimen. CONCLUSIONS: The all-inside arthroscopic lateral collateral ligament repair is a safe and reproducible technique. The clinical relevance of this study is that this technique provides a safe and anatomic reattachment of the anterior talofibular ligament, with minimal risk of injury to surrounding anatomical structures regardless of the level of experience with the technique.
PURPOSE: Neurovascular structures around the ankle are at risk of injury during arthroscopic all-inside lateral collateral ligament repair for the treatment of chronic ankle instability. This study aimed to evaluate the risk of damage to anatomical structures and reproducibility of the technique amongst surgeons with different levels of expertise in the arthroscopic all-inside ligament repair. METHODS: Twelve fresh-frozen ankle specimens were used for the study. Two foot and ankle surgeons with different level of experience in the technique performed the procedure on 6 specimens each. The repair was performed following a standardized procedure as originally described. Then, an experienced anatomist dissected all the specimens to evaluate the outcome of the ligament repair, any injuries to anatomical structures and the distance between arthroscopic portals and the superficial peroneal nerve (SPN) and sural nerve. RESULTS: Dissections revealed no injury to the nerves assessed. Mean distance from the anterolateral portal and the SPN was of 4.8 (range 0.0-10.4) mm. The mean distance from the accessory anterolateral portal to the SPN and sural nerve was of 14.2 (range 7.1-32.9) mm and 28.1 (range 2.8-39.6) mm, respectively. The difference between the 2 surgeons' groups was non-statistically significant for any measurement (mm). In all specimens both fascicles of the anterior talofibular ligament were reattached onto its original fibular footprint. The calcaneofibular ligament was not penetrated in any specimen. CONCLUSIONS: The all-inside arthroscopic lateral collateral ligament repair is a safe and reproducible technique. The clinical relevance of this study is that this technique provides a safe and anatomic reattachment of the anterior talofibular ligament, with minimal risk of injury to surrounding anatomical structures regardless of the level of experience with the technique.
Authors: Kyung-Tai Lee; Jung Il Lee; Ki Sun Sung; J-Young Kim; Eung Soo Kim; Sang-Heon Lee; Joon Ho Wang Journal: Knee Surg Sports Traumatol Arthrosc Date: 2008-06-17 Impact factor: 4.342
Authors: Mark Drakos; Steve B Behrens; Mary K Mulcahey; David Paller; Eve Hoffman; Christopher W DiGiovanni Journal: Arthroscopy Date: 2013-04-13 Impact factor: 4.772
Authors: Peter A J de Leeuw; Pau Golanó; Inger N Sierevelt; C Niek van Dijk Journal: Knee Surg Sports Traumatol Arthrosc Date: 2010-03-12 Impact factor: 4.342