Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
Academic Center for Evidence-based Sports medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands.
Knee Surg Sports Traumatol Arthrosc. 2020 Oct;28(10):3080-3086. doi: 10.1007/s00167-020-05889-7. Epub 2020 Feb 17.
Technical 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.
A 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.
All 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.
2-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.
技术创新现在提供了 2 毫米直径手术关节镜的可能性：这是一种替代传统关节镜的方法，不再使用内棒透镜。本研究的目的是评估在 2 毫米直径手术关节镜下是否可以观察和手术到达所有踝关节的重要结构，而不会造成医源性损伤。
使用新型 2 毫米直径关节镜系统在 10 个新鲜冷冻的人捐赠踝关节中进行了协议规定的关节镜检查。使用标准的前内侧和前外侧入路。记录和记录了专门设计的关节镜器械对关节结构列表的可视化和到达情况。在安全可达的距骨和胫骨软骨的最后缘刻划一条线。对标本进行解剖，并测量了门控通道和神经血管结构之间的距离。对距骨和胫骨的关节表面进行拍照，并检查有无医源性损伤。计算和分析关节表面的可到达区域。
所有标本中的所有重要结构均成功观察到并到达。在前内侧入路中，没有一个标本的神经血管结构与入路接触。在前外侧入路中，有一个标本的浅层腓侧神经分支发生碰撞，但没有造成明显的宏观损伤。平均而言，分别有 96%和 85%的距骨和胫骨表面可到达，而不会造成医源性损伤。
2 毫米直径手术关节镜可安全有效地观察和手术到达踝关节前部。它有可能使踝关节镜检查更具侵入性和更易于获得。
