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A step-by-step arthroscopic examination of the anterior ankle compartment

Journal article
Authors J. Vega
F. Malagelada
Jón Karlsson
G. M. Kerkhoffs
M. Guelfi
M. Dalmau-Pastor
Published in Knee Surgery Sports Traumatology Arthroscopy
Volume 28
Pages 24–33
ISSN 0942-2056
Publication year 2020
Published at Institute of Clinical Sciences, Department of Orthopaedics
Pages 24–33
Language en
Keywords Arthroscopy, Anatomy, Ankle, Anterior talofibular ligament, Deltoid, ligament, Intermalleolar ligament, tibiofibular syndesmosis, computed-tomography, distraction, instability, diagnosis, ligament, talus
Subject categories Orthopedics


PurposeDespite 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.MethodsAnkle 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.ResultsAnatomic 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.ConclusionThe 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.Level of evidenceV.

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