Human Anatomy and Embryology Unit, Department of Pathology and Experimental Therapeutics, University of Barcelona, Barcelona, Spain.
Foot and Ankle Unit, Orthopedic Department, iMove Tres Torres Barcelona 76, Dr Roux st, Barcelona, Spain.
Knee Surg Sports Traumatol Arthrosc. 2020 Jan;28(1):24-33. doi: 10.1007/s00167-019-05756-0. Epub 2019 Oct 30.
Despite the increased use of ankle dorsiflexion without distraction, no reports have specifically addressed the arthroscopic anatomy of the ankle in this position. The purpose of this study was to describe the normal arthroscopic anatomy of the ankle joint, when using the ankle dorsiflexion and the dynamic distraction technique, and to propose an arthroscopic examination system for the anterior ankle compartment.
Ankle arthroscopy was performed in 20 fresh frozen specimens. Arthroscopic examination was performed with the arthroscope introduced through the anteromedial portal. The anterior compartment was examined in ankle dorsiflexion without distraction. The compartment was examined in four steps: (1) lateral area including the lateral gutter; (2) the central area of the anterior tibial rim; (3) the medial area including the medial gutter; (4) the talar neck. Next, distraction was applied to visualise the anterior compartment again and to examine the central and posterior ankle compartments.
Anatomic intra-articular structures were visualised in all specimens. Four intra-articular fat pads, one anteromedial, two syndesmotic and another posteromedial, were constantly observed. A description of the normal arthroscopic anatomy of the ankle using the ankle dorsiflexion and the dynamic distraction technique is detailed for the anterior, central and posterior compartments.
The ankle arthroscopic procedure without distraction allows constant visualisation of the ATFL's superior fascicle on the floor of the lateral gutter, the ATiFL's distal fascicle laterally and the most anterior margin of the deltoid ligament in the medial gutter (anterior tibiotalar ligament). However, ankle distraction is required to observe the central and posterior compartments, but it does not provide optimal visualisation of the anterior ankle compartment structures.
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尽管越来越多地使用不分离的踝关节背屈，但尚无专门针对该位置踝关节关节镜解剖结构的报告。本研究的目的是描述在使用踝关节背屈和动态分离技术时踝关节关节的正常关节镜解剖结构，并提出一种前踝关节间隙的关节镜检查系统。
对 20 个新鲜冷冻标本进行踝关节关节镜检查。关节镜检查通过前内侧入路引入关节镜进行。在不分离的情况下进行踝关节背屈进行前间室检查。该间隙分为四步进行检查：（1）外侧区域包括外侧隐窝；（2）胫骨前嵴的中央区域；（3）内侧区域包括内侧隐窝；（4）距骨颈。然后，施加分离力以再次可视化前间室，并检查中央和后踝关节间隙。
所有标本均能观察到关节内解剖结构。始终观察到四个关节内脂肪垫，一个前内侧，两个联合韧带和另一个后内侧。详细描述了使用踝关节背屈和动态分离技术的前、中、后踝关节间隙的正常关节镜解剖结构。
无分离的踝关节关节镜检查程序可使外侧隐窝底部 ATFL 的上束、ATiFL 的远端束以及内侧隐窝中三角韧带的最前缘（前胫距韧带）始终保持可视化。然而，需要踝关节分离才能观察中央和后踝关节间隙，但它不能提供前踝关节间隙结构的最佳可视化。
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