Department of Orthopedics and Traumatology, LK Baden-Mödling, Baden, Austria.
Faculty of Health and Medicine, Department for Health Sciences, Medicine and Research, Center for Regenerative Medicine, Danube University Krems, Krems, Austria.
Foot Ankle Int. 2020 Sep;41(9):1133-1142. doi: 10.1177/1071100720931095. Epub 2020 Jun 17.
The anterocentral portal is not a standard portal in anterior ankle arthroscopy due to its proximity to the anterior neurovascular bundle. However, it provides certain advantages, including a wide field of vision, and portal changes become redundant. The purpose of this study was to evaluate the neurovascular complications after anterior ankle arthroscopy using the anterocentral portal.
We retrospectively identified patients who had undergone anterior ankle arthroscopy with an anterocentral portal at our institution from 2013 to 2018. Medical record data were reviewed and patients were invited for clinical follow-up, where a clinical examination, quantitative sensory testing for the deep peroneal nerve, and ultrasonography of the structures at risk were performed. A total of 101 patients (105 arthroscopies) were identified and evaluated at a mean follow-up of 31.5 ± 17.7 months.
Leading indications to surgery were heterogeneous and included anterior impingement (48.6%), osteochondral lesions of the talus (24.8%), chronic ankle instability (14.3%), and fractures (8.6%). The overall complication rate was 7.6%, and no major complications were observed. In 1.9% (2/105) of the cases, the complications were associated with the anterocentral portal and included injury to the medial branch of the superficial nerve (1/105) and to the deep peroneal nerve (1/105). Injury to the deep peroneal nerve was associated with a loss of detection and nociception. There were no injuries to the anterior tibial artery. In 41.9% (44/105) of the cases, only 1 working portal was used in addition to the anterocentral portal, and in 19% (20/105) the anterolateral portal could be avoided. Ultrasonography confirmed the integrity of the deep peroneal nerve, the medial branch of the superficial peroneal nerve, and the anterior tibial artery in all patients. Patients with nerve injuries associated with the anterocentral portal showed no signs of neuroma or pseudoaneurysm.
Using a standardized technique, the anterocentral portal in ankle arthroscopy is safe with a low number of neurovascular injuries and can be recommended as a standard portal. The anterolateral portal remains associated with a high number of injuries to the superficial peroneal nerve.
Level III, retrospective cohort study.
由于前正中神经血管束的邻近关系，前正中入路在踝关节前关节镜检查中并不是一个标准的入路。然而，它具有某些优势，包括广泛的视野，并且入路变化变得多余。本研究旨在评估使用前正中入路进行踝关节前关节镜检查后的神经血管并发症。
我们回顾性地确定了 2013 年至 2018 年期间在我们机构接受前正中入路踝关节前关节镜检查的患者。对病历数据进行了回顾，并邀请患者进行临床随访，对患者进行了临床检查、腓深神经的定量感觉测试和风险结构的超声检查。共确定并评估了 101 例患者（105 例关节镜检查），平均随访 31.5±17.7 个月。
手术的主要指征是异质的，包括前撞击（48.6%）、距骨骨软骨病变（24.8%）、慢性踝关节不稳定（14.3%）和骨折（8.6%）。总体并发症发生率为 7.6%，未观察到严重并发症。在 1.9%（2/105）的病例中，并发症与前正中入路有关，包括浅神经内侧支（1/105）和腓深神经（1/105）损伤。腓深神经损伤与感觉和痛觉检测丧失有关。没有前胫动脉损伤。在 41.9%（44/105）的病例中，除了前正中入路外，仅使用了 1 个工作入路，在 19%（20/105）的病例中，可以避免前外侧入路。超声检查确认了所有患者的腓深神经、浅腓总神经内侧支和前胫动脉的完整性。与前正中入路相关的神经损伤患者没有神经瘤或假性动脉瘤的迹象。
使用标准化技术，踝关节关节镜检查中的前正中入路安全，神经血管损伤数量少，可以作为标准入路推荐。前外侧入路仍与腓浅神经损伤数量多有关。
三级，回顾性队列研究。
