Herbel Cole, Lopez Ramiro, Wellings Elizabeth P, Haupt Edward T
Department of Orthopedic Surgery, Mayo Clinic Jacksonville, Jacksonville, FL, USA.
Foot Ankle Orthop. 2025 Sep 28;10(3):24730114251371722. doi: 10.1177/24730114251371722. eCollection 2025 Jul.
Ankle arthroscopy (AA) is a commonly used operative technique to diagnose and treat a variety of intraarticular pathologies of the ankle joint. In AA, 2 portals are commonly established to achieve visualization of the joint: the anteromedial (AM) and anterolateral (AL) portals. However, the superficial peroneal nerve (SPN) runs near the anterolateral portal site; thus, creation of the AL portal is associated with neuropraxic injuries to the SPN.When AA is combined with additional procedures, such as a Brostrom-Gould ligament repair or open reduction internal fixation (ORIF), the use of a direct lateral incision is required. We present a novel approach to combining AA with lateral adjunct procedures which avoids creation of the AL portal; the AM portal and lateral incision are used for instrumentation instead. The primary objective of this study is to compare complication rates, such as SPN injury, between the lateral incision (LI) approach and conventional arthroscopy plus a lateral incision approach.
Following IRB approval, a retrospective chart review was conducted spanning a time frame from January 2020 to October 2024. Patients were included if they underwent AA plus either a Brostrom-Gould repair or ORIF (AA+) or if they underwent AA plus adjunct procedures using the lateral portal instrumentation method (LI). Ninety-four patients were initially identified; 2 were excluded per criteria. Demographic information, intraoperative details, and any postoperative complications or reoperations were recorded. Descriptive statistics were used to describe demographics and operative data, and 2-tailed Student tests were used to identify statistical differences between group metrics.
Ninety-two patients were included in the study. No statistical differences were observed between cohorts in either of the intraoperative metrics considered (procedural duration and tourniquet duration; = .44 and .89, respectively). In addition, complication and reoperation rates were not statistically different between the LI and AA+ groups ( = .94 and .40, respectively). The rate of SPN neuropathy or neurapraxia were also compared between groups, resulting in no statistical differences ( = .37).
In this retrospective cohort study, we observed no differences when only anteromedial and lateral portals are used for an ankle arthroscopy with adjunct procedures compared with the traditional 3-incision approach. We hypothesize that instances of infection or wound dehiscence would decrease given a large enough cohort because of the creation of 1 fewer portal. However, given the small, underpowered sample, we cannot determine whether the lateral approach alters complication risk; larger multicenter studies are needed.
Level III, retrospective cohort study.
踝关节镜检查（AA）是一种常用的手术技术，用于诊断和治疗踝关节的各种关节内病变。在踝关节镜检查中，通常建立两个通道以实现关节可视化：前内侧（AM）通道和前外侧（AL）通道。然而，腓浅神经（SPN）在前外侧通道部位附近走行；因此，建立AL通道与SPN的神经失用性损伤相关。当踝关节镜检查与其他手术联合进行时，如Brostrom-Gould韧带修复或切开复位内固定（ORIF），则需要使用直接外侧切口。我们提出了一种将踝关节镜检查与外侧辅助手术相结合的新方法，该方法避免了建立AL通道；而是使用AM通道和外侧切口进行器械操作。本研究的主要目的是比较外侧切口（LI）入路与传统关节镜检查加外侧切口入路之间的并发症发生率，如SPN损伤。
在获得机构审查委员会（IRB）批准后，进行了一项回顾性病历审查，时间跨度为2020年1月至2024年10月。纳入的患者为接受AA联合Brostrom-Gould修复或ORIF（AA+）的患者，或接受使用外侧通道器械操作方法（LI）进行AA联合辅助手术的患者。最初确定了94例患者；根据标准排除2例。记录人口统计学信息、术中细节以及任何术后并发症或再次手术情况。使用描述性统计来描述人口统计学和手术数据，并使用双侧t检验来确定组间指标的统计学差异。
92例患者纳入本研究。在所考虑的任何术中指标（手术持续时间和止血带持续时间；分别为P = 0.44和0.89）方面，两组之间均未观察到统计学差异。此外，LI组和AA+组之间的并发症和再次手术率在统计学上也没有差异（分别为P = 0.94和0.40）。还比较了两组之间SPN神经病变或神经失用的发生率，结果无统计学差异（P = 0.37）。
在这项回顾性队列研究中，我们观察到，与传统的三切口入路相比，仅使用前内侧和外侧通道进行踝关节镜检查联合辅助手术时，没有差异。我们推测，由于减少了一个通道的建立，如果队列足够大，感染或伤口裂开的情况会减少。然而，鉴于样本量小且效能不足，我们无法确定外侧入路是否会改变并发症风险；需要进行更大规模的多中心研究。
III级，回顾性队列研究。
