Summary
We studied the anatomy of the anterolateral and anterocentral portal sites for ankle arthroscopy with reference to the superficial peroneal nerve (SPN) in 29 cadavers (51 ankles) and the deep peroneal nerve (DPN) in 11 cadavers (21 ankles). In relation to the level of division into the medial and intermediate cutaneous nerves and their terminal branches, we classified the structure of the SPN surrounding the ankle into five types. We also identified the point where the SPN and the DPN cross the level of the talocrural joint. 32% of specimens had different SPN division types on the two sides and there was an average of 2 nerves at the level of the talocrural joint. Branches of the SPN were found lateral to the edge of the peroneus tertius tendon in 11.8% of specimens, and at its lateral edge in 27.5%. The DPN and some branches of the SPN were positioned around the lateral edge of the extensor hallucis longus tendon. We consider that the anterolateral portal should be made at least 2 mm lateral to the peroneus tertius tendon to avoid injury to the SPN, since the diameter of the scope is 2.7 mm. The anterocentral portal is unsuitable for arthroscopy due to a high risk of injury to the DPN and branches of the SPN.
Résumé
Nous avons étudié l'anatomie des voies antéro-latérale et antéro-centrale pour arthroscopie de la cheville, et notamment leur rapport avec le n. fibulaire superficiel (NFS) sur 29 cadavres (51 chevilles) et le n. fibulaire profond (NFP) sur 11 cadavres (21 chevilles). Par rapport au niveau de division des nn. cutanés médial et intermédiaire et de leurs branches terminales, nous avons classé la disposition du NFS en regard de la cheville dans 5 types. Nous avons identifié le point où le NFS et le NFP croisaient l'interligne articulaire talo-jambier. 32% des spécimens présentaient un site de division du NFS différent à droite et à gauche, et il y avait en moyenne deux nerfs en regard de l'art. talo-jambière. Les branches du NFS étaient latérales au bord du tendon du m. troisième fibulaire dans 11,8 % des cas, en regard de son bord latéral dans 27,5% des cas. Le NFP et quelques branches du NFS se trouvaient en regard du bord latéral du tendon du m. long extenseur de l'hallux. Nous pensons que la voie antéro-latérale devrait être réalisée au moins 2 mm latéralement au tendon du m. troisième fibulaire pour éviter la blessure du NFS, car le diamètre de l'endoscope est de 2,7 mm. La voie antéro-centrale est, pour nous, inappropriée pour l'arthroscopie de la cheville en raison d'un risque élevé de la blessure du NFP et des branches du NFS.
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Takao, M., Uchio, Y., Shu, N. et al. Anatomic bases of ankle arthroscopy: study of superficial and deep peroneal nerves around anterolateral and anterocentral approach. Surg Radiol Anat 20, 317–320 (1998). https://doi.org/10.1007/BF01630612
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DOI: https://doi.org/10.1007/BF01630612