Skip to main content

Arthroscopic Anatomy

  • Chapter
  • First Online:
  • 2902 Accesses

Abstract

With the introduction of arthroscopy, we learned to avoid the anatomy. Knowledge of the anatomy however is mandatory for any surgical procedure. This chapter provides the anatomical basis for correct portal placement. It also contains a detailed description of the ligaments of the ankle.

Keywords

These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  • Acevedo JI, Busch MT, Ganey TM et al (2000) Coaxial portals for posterior ankle arthroscopy: an anatomic study with clinical correlations on 29 patients. Arthroscopy 16:836–842

    Article  PubMed  CAS  Google Scholar 

  • Adkison DP, Bosse MJ, Gaccione DR et al (1991) Anatomic variations in the course of the superficial peroneal nerve. J Bone Joint Surg Am 73:112–114

    PubMed  CAS  Google Scholar 

  • Adrews JR, Previte WJ, Carson WG (1985) Arthroscopy of the ankle: technique and normal anatomy. Foot Ankle 6:29–33

    Article  Google Scholar 

  • Akseki D, Pinar H, Bozkurt M et al (1999) The distal fascicle of the anterior inferior tibiofibular ligament as a cause of anterolateral ankle impingement. Results of arthroscopic resection. Acta Orthop Scand 70:478–482

    Article  PubMed  CAS  Google Scholar 

  • Akseki D, Pinar H, Yaldiz K et al (2002) The anterior inferior tibiofibular ligament and talar impingement: a cadaveric study. Knee Surg Sports Traumatol Arthrosc 10:321–326

    Article  PubMed  Google Scholar 

  • Amis A, de Leeuw L, van Dijk CN (2010) Surgical anatomy of the foot and ankle. Knee Surg Sports Traumatol Arthrosc 18:555–556

    Article  PubMed Central  PubMed  Google Scholar 

  • Aydin AT, Ozcanli H, Soyuncu Y et al (2006) A new noninvasive controlled intra-articular ankle distraction technique on a cadaver model. Arthroscopy 22:905.e1–905.e3

    Article  Google Scholar 

  • Barber FA, Britt BT, Ratliff HW et al (1988) Arthroscopy surgery of the ankle. Orthop Rev 17:446–451

    PubMed  CAS  Google Scholar 

  • Barber FA, Click J, Britt BT (1990) Complications of ankle arthroscopy. Foot Ankle 10:263–266

    Article  PubMed  CAS  Google Scholar 

  • Bartonícek J (2003) Anatomy of the tibiofibular syndesmosis and its clinical relevance. Surg Radiol Anat 25:379–386

    Article  PubMed  Google Scholar 

  • Basarir K, Esmer AF, Tuccar E et al (2007) Medial and lateral malleolar arteries in ankle arthroscopy: a cadaver study. J Foot Ankle Surg 46(3):181–184

    Article  PubMed  Google Scholar 

  • Bassett FH 3rd, Gates HS 3rd, Billys JB et al (1990) Talar impingement by the anteroinferior tibiofibular ligament. A cause of chronic pain in the ankle after inversion sprain. J Bone Joint Surg Am 72:55–59

    PubMed  Google Scholar 

  • Beals TC, Junko JT, Amendola A et al (2010) Minimally invasive distraction technique for prone posterior ankle and subtalar arthroscopy. Foot Ankle 31(4):316–319

    Article  PubMed  Google Scholar 

  • Blair JM, Botte MJ (1994) Surgical anatomy of the superficial peroneal nerve in the ankle and foot. Clin Orthop Relat Res 305:229–238

    Article  PubMed  Google Scholar 

  • Boruta PM, Bishop JO, Braly WG et al (1990) Acute ankle ligament injuries: a literature review. Foot Ankle 11:107–113

    Article  PubMed  CAS  Google Scholar 

  • Boss AP, Hintermann B (2002) Anatomical study of the medial ankle ligament complex. Foot Ankle Int 23:547–553

    PubMed  Google Scholar 

  • Broström L (1966) Sprained ankles V. Treatment and prognosis in recent ligament ruptures. Acta Chir Scand 132:537–550

    PubMed  Google Scholar 

  • Buckingham RA, Winson IG, Kelly AJ (1997) An anatomical study of a new portal for ankle arthroscopy. J Bone Joint Surg Br 79:650–652

    Article  PubMed  CAS  Google Scholar 

  • Burks RT, Morgan J (1994) Anatomy of the lateral ankle ligaments. Am J Sports Med 22:72–77

    Article  PubMed  CAS  Google Scholar 

  • Cameron SE (1997) Noninvasive distraction for ankle arthroscopy. Technical note. Arthroscopy 13:366–369

    Article  PubMed  CAS  Google Scholar 

  • Casteleyn PP, Handelberg F (1993) A simple distraction technique for ankle arthroscopy. J Bone Joint Surg Br 75(Suppl II):138

    Google Scholar 

  • Casteleyn PP, Handelberg F (1995) Distraction for ankle arthroscopy. Technical note. Arthroscopy 11:633–634

    Article  PubMed  CAS  Google Scholar 

  • Chen YC (1976) Clinical and cadaver studies on the ankle joint arthroscopy. J Jpn Orthop Assoc 50:631–651

    Google Scholar 

  • de Leeuw PAJ, Golanó P, Sierevelt IN et al (2010) The course of the superficial nerve in relation to the ankle position: anatomical study with ankle arthroscopic implications. Knee Surg Sports Traumatol Arthrosc 18:612–617

    Article  PubMed Central  PubMed  Google Scholar 

  • Delfaut EM, Demondion X, Boutry N et al (2003) Multi-fasciculated anterior talo-fibular ligament: reassessment of normal findings. Eur Radiol 13:1836–1842

    Article  PubMed  CAS  Google Scholar 

  • Drez D, Guhl JF, Gollehon DL (1981) Ankle arthroscopy: technique and indication. Foot Ankle 2:138–143

    Google Scholar 

  • Drez D Jr, Guhl JF, Gollehon DL (1982) Ankle arthroscopy: technique and indication. Clin Sports Med 1:35–45

    Google Scholar 

  • Ebraheim NA, Taser F, Shafiq Q et al (2006) Anatomical evaluation and clinical importance of the tibiofibular syndesmosis ligaments. Surg Radiol Anat 28:142–149

    Article  PubMed  Google Scholar 

  • Feiwell LA, Frey C (1993) Anatomic study of arthroscopic portal sites of the ankle. Foot Ankle 14:142–147

    Article  PubMed  CAS  Google Scholar 

  • Ferkel RD (1994) Differential diagnosis of the chronic ankle sprain pain in the athlete. Sports Med Arthrosc Rev 2:274–283

    Google Scholar 

  • Ferkel RD (1996) Arthroscopic surgery. The foot and ankle. Lippincott-Raven, Philadelphia

    Google Scholar 

  • Ferkel RD, Fischer SP (1989) Progress in ankle arthroscopy. Clin Orthop Relat Res 240:210–220

    PubMed  Google Scholar 

  • Ferkel RD, Guhl JF, Heath DD (1996) Neurological complications of ankle arthroscopy. Arthroscopy 12(35):200–208

    Article  PubMed  CAS  Google Scholar 

  • Fiorella D, Helms CA, Nunley JA II (1999) The MR imaging features of the posterior intermalleolar ligament in patients with posterior impingement syndrome of the ankle. Skeletal Radiol 28:573–576

    Article  PubMed  CAS  Google Scholar 

  • Golanó P, Mariani PP, Rodrıguez-Niedenfuhr M et al (2002) Arthroscopic anatomy of the posterior ankle ligaments. Arthroscopy 18:353–358

    Article  PubMed  Google Scholar 

  • Golanó P, Vega J, Pérez-Carro L, Götzens V (2006a) Ankle anatomy for the arthroscopist. Part I: the portals. Foot Ankle Clin N Am 11:253–273

    Article  Google Scholar 

  • Golanó P, Vega J, Pérez-Carro L, Götzens V (2006b) Ankle anatomy for the arthroscopist. Part I: role of the ankle ligaments in soft tissue impingement. Foot Ankle Clin N Am 11:275–296

    Article  Google Scholar 

  • Guhl JF (1988) New concepts (distraction) in an ankle arthroscopy. Arthroscopy 4:160–167

    Article  PubMed  CAS  Google Scholar 

  • Guhl JF (1993) Foot and ankle arthroscopy, 2nd edn. Slack Inc., New York

    Google Scholar 

  • Hamilton WG, Gepper MJ, Thompson FM (1996) Pain in the posterior aspect of the ankle in dancers. Differential diagnosis and operative treatment. J Bone Joint Surg Am 78:1491–1500

    PubMed  CAS  Google Scholar 

  • Harty M (1985) Ankle arthroscopy, anatomical features. Orthopaedics 8:1538–1540

    CAS  Google Scholar 

  • Hedley D, Geary NPJ, Meda P (2001) Ankle arthroscopy: a new technique for non-invasive ankle distraction. Foot Ankle Surg 7:137–139

    Article  Google Scholar 

  • Hoefnagels EM, Waites MD, Wing I et al (2007) Biomechanical comparison of the interosseous tibiofibular ligament and the anterior tibiofibular ligament. Foot Ankle Int 28:602–604

    Article  PubMed  Google Scholar 

  • Horner G, Liu S (1996) Arthroscopic treatment of talar impingement by the accessory anteroinferior tibiofibular ligament. Arthroscopy 12:384–385

    Google Scholar 

  • Ikehuchi H (1977) Arthroscopy of the ankle. In: Presented at the international arthroscopy association meeting

    Google Scholar 

  • Johnson EE, Markolf KL (1983) The contribution of the anterior talofibular ligament to ankle laxity. J Bone Joint Surg Am 65:81–88

    PubMed  CAS  Google Scholar 

  • Kapanji IA (1982) Cuadernos de fisiología articular. Cuaderno III. Masson, Barcelona, pp 174–177

    Google Scholar 

  • Katchis SD, Smith R (1997) A simple way to establish the posterolateral portal in ankle arthroscopy. Technique tip. Foot Ankle 18:178–179

    Article  PubMed  CAS  Google Scholar 

  • Kumar VP, Satku K (1994) The A-O femoral distractor for ankle arthroscopy. Technical note. Arthroscopy 10:118–119

    Article  PubMed  CAS  Google Scholar 

  • Lijoi F, Lughi M, Baccarani G (2002) Patologia del comparto posteriore della caviglia: Trattamento artroscopico per via posteriore. Artroscopia 3:30–35

    Google Scholar 

  • Lijoi F, Lughi M, Baccarani G (2003) Posterior arthroscopic approach to the ankle: an anatomic study. Arthroscopy 19:62–67

    Article  PubMed  Google Scholar 

  • Liu SH, Raskin A, Osti L et al (1994) Arthroscopic treatment of anterolateral ankle impingement. Arthroscopy 10:215–218

    Article  PubMed  CAS  Google Scholar 

  • Lohrer H, Arentz S (2004) Posterior approach for arthroscopic treatment of posterolateral impingement syndrome of the ankle in a top-level field hockey player. Arthroscopy 20:e15–e21

    Article  PubMed  Google Scholar 

  • Mandrino A, Chabaud B, Moyen B et al (1994) Arthroscopie de la cheville: un nouveau point d’entrée postéro-interne. Note de technique. Rev Chir Orthop 80:342–345

    PubMed  CAS  Google Scholar 

  • Martin DF, Baker CL, Curl W et al (1989) Operative ankle arthroscopy. Am J Sports Med 17:16–23

    Article  PubMed  CAS  Google Scholar 

  • Matthews LS, Zarins B, Michael RH et al (1985) Anterior portal selection for shoulder arthroscopy. Arthroscopy 1:33–39

    Article  PubMed  CAS  Google Scholar 

  • McKeon KE, Wright RW, Johnson JE et al (2012) Vascular anatomy of the tibiofibular syndesmosis. J Bone Joint Surg 94:931–938

    Article  PubMed  Google Scholar 

  • Milner CE, Soames RW (1997) Anatomical variations of the anterior talofibular ligament of the human ankle joint. J Anat 191:457–458

    Article  PubMed Central  PubMed  Google Scholar 

  • Milner CE, Soames RW (1998) Anatomy of the collateral ligaments of the human ankle joint. Foot Ankle 19:757–760

    Article  PubMed  CAS  Google Scholar 

  • Miyamoto W, Takao M, Komatu F et al (2008) Technique tip: the bandage distraction technique for arthroscopic arthrodesis of the ankle joint. Foot Ankle Int 29(2):251–253

    Article  PubMed  Google Scholar 

  • Nikolopoulos CE (1982) Anterolateral instability of the ankle joint. An anatomical, experimental and clinical study. Thesis, University of Athens, Athens

    Google Scholar 

  • Nikolopoulus CE, Tsirikos AI, Sourmelis S et al (2004) The accessory anteroinferior tibiofibular ligament as a cause of talar impingement. A cadaveric study. J Sports Med 32:389–395

    Article  Google Scholar 

  • Ögüt T, Akgüm H, Kesmezacar H et al (2004) Pathology of the posterior compartment of the ankle. Arthroscopic treatment by the posterior approach. Surg Radiol Anat 26:268–274

    Article  PubMed  Google Scholar 

  • Oh CS, Won HS, Chung IH et al (2006) Anatomic variations and MRI of intermalleolar ligament. AJR Am J Roentgenol 186:943–947

    Article  PubMed  Google Scholar 

  • Pankovich AM, Shivaram MS (1979) Anatomical basis of variability in injuries of the medial malleolus and the deltoid ligament. I. Anatomical studies. Acta Orthop Scand 50:217–223

    Article  PubMed  CAS  Google Scholar 

  • Pariesien JS, Vangsness T, Feldman R (1987) Diagnostic and operative arthroscopy of the ankle. An experimental approach. Clin Orthop Relat Res 224:228–236

    Google Scholar 

  • Paturet G (1951) Traité d’anatomie humaine. Masson, Paris, pp 704–711

    Google Scholar 

  • Peace KAL, Hillier JC, Hulme A et al (2004) MRI features of posterior ankle impingement syndrome in ballet dances: a review of 25 cases. Clin Radiol 59:1025–1033

    Article  PubMed  CAS  Google Scholar 

  • Rasmussen O, Tovborg-Jensen I, Boe S (1982) Distal tibiofibular ligaments, analysis of function. Acta Orthop Scand 53:681–686

    Article  PubMed  CAS  Google Scholar 

  • Ray RG, Kriz BM (1991) Anterior inferior tibiofibular ligament. Variations and relationship to the talus. J Am Podiatr Med Assoc 81:479–485

    Article  PubMed  CAS  Google Scholar 

  • Reinmann R (1981) Der variable Streckapparat der Kleinen Zehe. Gegenbaurs Morphol Jahrb 127:188–209

    Google Scholar 

  • Resch H (1993) Einfache extensionsbandage für die sprunggelenkarthroskopie. Arthroskopie 6:93–94

    Google Scholar 

  • Rosenberg ZS, Cheung YY, Beltran J et al (1995) Posterior intermalleolar ligament of the ankle: normal anatomy and MR imaging features. AJR Am J Roentgenol 165:387–390

    Article  PubMed  CAS  Google Scholar 

  • Rouvière H, Canela-Lazaro M (1932) Le ligament peronéo-astragalo-calacanéen [The fibulotalocalcaneal ligament]. Ann Anat Pathol (Paris) 9:745–750

    Google Scholar 

  • Saito A, Kikuchi S (1998) Anatomic relations between ankle arthroscopic portal sites and the superficial peroneal and saphenous nerves. Foot Ankle 10:748–752

    Article  Google Scholar 

  • Sarrafian SK (1993) Anatomy of the foot and ankle. Descriptive, topographic, functional, 2nd edn. J.B. Lippincott Company, Philadelphia, pp 159–217

    Google Scholar 

  • Sartoretti C, Sartoretti-Schefer S, Duff C et al (1996) Angioplasty balloon catheters used for distraction of the ankle joint. Arthroscopy 12:82–86

    Article  PubMed  CAS  Google Scholar 

  • Sayli U, Tekdemyr Y, Cubuk HE et al (1998) The course of the superficial peroneal nerve: an anatomical cadaver study. Foot Ankle Surg 4:63–69

    Article  Google Scholar 

  • Sim JA, Lee BK, Kwak JH (2006) New posteromedial portal for ankle arthroscopy. Arthroscopy 22:799e1–799e2

    Article  Google Scholar 

  • Sitler DF, Amendola A, Bailey CS et al (2002) Posterior ankle arthroscopy: an anatomic study. J Bone Joint Surg Am 84:763–769

    PubMed  Google Scholar 

  • Solomon LB, Ferris L, Henneberg M (2006) Anatomical study of the ankle with view to the anterior arthroscopic portals. ANZ J Surg 76(10):932–936

    Google Scholar 

  • Stephens MM, Kelly PM (2000) Fourth toe in flexion sign: a new clinical sign for identification of the superficial nerve. Foot Ankle Int 21:860–863

    PubMed  CAS  Google Scholar 

  • Takao M, Uchio Y, Shu N et al (1998) Anatomic bases of ankle arthroscopy: study of superficial and deep peroneal nerves around anterolateral and anterocentral approach. Surg Radiol Anat 20:317–320

    Article  PubMed  CAS  Google Scholar 

  • Takao M, Ochi M, Shu N et al (2001) A case of superficial peroneal nerve injury during ankle arthroscopy. Arthroscopy 17:403–404

    Article  PubMed  CAS  Google Scholar 

  • Taylor DC, Englehardt DL, Bassett FH (1992) Syndesmosis sprains of the ankle. The influence of heterotopic ossification. Am J Sports Med 20:146–150

    Article  PubMed  CAS  Google Scholar 

  • Testut L, Latarjet A (1985) Tratado de anatomía humana (A treatise on human anatomy). Salvat Editores, Barcelona, pp 704–719

    Google Scholar 

  • Tol JL, van Dijk CN (2004) Etiology of the anterior ankle impingement syndrome: a descriptive anatomical study. Foot Ankle 25:382–386

    PubMed  Google Scholar 

  • Trager S, Frederick LD, Seligson D (1989) Ankle arthroscopy. Orthopaedics 12:1317–1320

    CAS  Google Scholar 

  • Trouilloud P, Dia A, Grammont P et al (1988) Variations du ligament calcaneo-fibulaire. Aplications à la cinématique de la cheville (Variations in the calcaneofibular ligament. Applications to ankle kinetics). Bull Assoc Anat 72:31–35

    CAS  Google Scholar 

  • Tryfonidis M, Whitfield CG, Charalambous CP et al (2008) Posterior ankle arthroscopy portal safety regarding proximity to the tibial and sural nerves. Acta Orthop Belg 74(3):370–373

    PubMed  Google Scholar 

  • Ürgüden M, Çevikol C, Dabak TK et al (2009) Effect of joint motion on safety of portals in posterior ankle arthroscopy. Arthroscopy 25(12):1442–1446

    Article  PubMed  Google Scholar 

  • van den Bekerom MPJ, Raven EEJ (2007) The distal fascicle of the anterior inferior tibiofibular ligament as a cause of tibiotalar impingement syndrome: a current concepts review. Knee Surg Sports Traumatol Arthrosc 15:465–471

    Article  PubMed Central  PubMed  Google Scholar 

  • van den Bekerom MPJ, Oostra RJ, Golanó P et al (2008) The anatomy in relation to injury of the lateral collateral ligaments of the ankle: a current concepts review. Clin Anat 21:619–626

    Article  PubMed  Google Scholar 

  • van Dijk C (2001) Ankle joint arthroscopy. Surg Tech Orthop Traumatol 55(630):A10

    Google Scholar 

  • van Dijk CN, Scholten PE, Krips R (2000) A 2-portal endoscopic approach for diagnosis and treatment of posterior ankle pathology. Technical note. Arthroscopy 16:871–876

    Article  PubMed  Google Scholar 

  • van Dijk CN, Verhagen RAW, Tol HJ (2001) Resterilizable non-invasive ankle distraction device. Technical note. Arthroscopy 17:e1–e5

    Article  Google Scholar 

  • van Dijk CN, de Leeuw PA, Scholten PE (2009) Hindfoot endoscopy for posterior ankle impingement. Surgical technique. J Bone Joint Surg Am 2:287–298

    Google Scholar 

  • Voto SJ, Ewing JW, Fleissner PR et al (1989) Ankle arthroscopy: neurovascular and arthroscopic anatomy of standard and trans-Achilles tendon portal placement. Arthroscopy 5:41–46

    Article  PubMed  CAS  Google Scholar 

  • Wang L, Gui J, Gao F et al (2007) Modified posterior portals for hindfoot arthroscopy. Arthroscopy 23:1116–1123

    Article  PubMed  Google Scholar 

  • Waseem M, Barrie JL (2002) A new distraction method in difficult ankle arthroscopy. J Foot Ankle Surg 41:412–413

    Article  PubMed  CAS  Google Scholar 

  • Watanabe M (1972) Selfoc-arthroscopy (Watanabe nº 24 arthroscope) monograph. Teishin Hospital, Tokyo

    Google Scholar 

  • Woo S-B, Wong T-M, Chan W-L et al (2010) Anatomic variations of neurovascular structures of the ankle in relation to arthroscopic portals: a cadaveric study of Chinese subjects. J Orthop Surg 18:71–75

    Google Scholar 

  • Yates CK, Grana WA (1988) A simple distraction technique for ankle arthroscopy. Arthroscopy 4:103–105

    Article  PubMed  CAS  Google Scholar 

  • Zengerink M, van Dijk CV (2012) Complications in ankle arthroscopy. Knee Surg Sports Traumatol Arthrosc 20:1420–1431

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Golanó, P., van Dijk, C.N. (2014). Arthroscopic Anatomy. In: Ankle Arthroscopy. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-35989-7_3

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-35989-7_3

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-35988-0

  • Online ISBN: 978-3-642-35989-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics