Lateral Endoscopy of the Ankle

Abstract

Hindfoot endoscopy has long been limited to anterior arthroscopy of the ankle. More recently, the posterior approach has resulted in a great step forward by making it possible to reach the posterior intra-articular as well as the extra-articular structures. However, tendoscopy of the peroneal tendons remains little used to date. Nevertheless, this latter technique offers an exceptionally good view of the lateral part of the hindfoot. By following the peroneal tendons, and using accessory portals, it can be used to find, explore, and reach the lateral ligaments of the ankle, the rear side of the lateral malleolus, the entire lateral side of the anterior and posterior subtalar joints, the sinus tarsi, as well as the upper side of the calcaneus to its apophyseal edge. Therefore, building on tendoscopy, by considering the container but not the content, this new concept of lateral ankle endoscopy hence emerged that, in addition to the lateral approach to the bone and joint elements of the hindfoot, allows for full exposure of the external ligaments and tendons. Therefore, it is a minimally invasive way to treat many diseases in this region. It can be used for targeted treatment via à la carte endoscopic dissection. There are more indications nowadays with the treatment of lateral impingement, avulsion fractures (resection), subtalar arthrodesis, peroneal instability, and the treatment of ankle instability in particular.