By Ned Amendola
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Extra resources for AANA Advanced Arthroscopy. The Foot and Ankle
The anterolateral portal is located lateral to the lateral border or the peroneus tertius tendon. Accessory medial or lateral portals may be placed to approach the particular pathology found at surgery, and the location is guided using an 18-gauge needle intraoperatively. B, Posterolateral and posteromedial portal positions are shown in relation to significant anatomic structures. Branches of deep peroneal nerve Dorsalis pedis artery A Flexor digitorum longus tendon Small saphenous vein Sural nerve Tibialis posterior tendon Posterior tibial artery and vein Tibial nerve Posteromedial portal Flexor hallucis longus tendon Flexor retinaculum Peroneus longus tendon Peroneus brevis tendon Posterolateral portal Accessory posterolateral portal Superior peroneal retinaculum Peroneal artery Tendo calcaneus (Achilles tendon) B PITFALLS ● ● Avoid injury to superficial neurovascular structures using the nick and spread technique for portal creation: 1.
Spinal anesthesia is used if there is a contraindication to general anesthesia. Ankle arthroscopy with local anesthesia alone has been used only in rare circumstances. We prefer to position the patient supine with the hip flexed 45 degrees and the patient’s thigh supported by a well-padded thigh holder (Fig. 3-7A). The foot is attached to a sterile foot strap, which is fixed to a sterile tensioning device (see Fig. 3-7B). Although the posterolateral portal is accessible, we prefer to use this position for anterior ankle arthroscopy alone.
Philadelphia, PA: Lippincott; 1983:35-106. C H A P T E R 3 Instrumentation and Operative Setup for Ankle and Subtalar Arthroscopy Bradley E. Slagel ● Kevin R. Willits Although ankle arthroscopy was described in the 1930s by Takagi in Japan and Burman in the United States, there was little interest due to limited joint space accessibility. Improvements in instrumentation during the 1970s resulted in renewed interest in ankle arthroscopy. This chapter explores operating room setup and instrumentation and describes our current practice with regard to anterior ankle arthroscopy and subtalar arthroscopy.
AANA Advanced Arthroscopy. The Foot and Ankle by Ned Amendola