Our Summary

This research paper investigates a type of ankle surgery procedure known as anterior ankle arthroscopy using the anterocentral portal. This is not a common procedure due to its closeness to certain nerve and blood vessel bundles. However, it has certain benefits like a better view during surgery and fewer changes in surgical approach.

The study looked back at patients who had this procedure between 2013 and 2018, and studied their medical records. The doctors also invited these patients for a check-up where they conducted a physical examination, a nerve sensitivity test, and an ultrasound of the area at risk.

Out of 101 patients (105 procedures), the most common reasons for surgery were conditions causing a blockage in the front of the ankle (48.6%), damage to the cartilage and underlying bone in the ankle joint (24.8%), recurring ankle instability (14.3%), and fractures (8.6%). The overall rate of complications was 7.6%, but none were severe. In 1.9% (2/105) of the procedures, complications were associated with the anterocentral portal approach. These complications included injuries to certain nerves, resulting in loss of touch and pain sensation. There were no injuries to the main artery in the front of the ankle.

In 41.9% (44/105) of the procedures, only one additional working portal was used along with the anterocentral portal, and in 19% (20/105) the anterolateral portal (a different surgical approach) could be avoided. Ultrasound confirmed the health of the nerves and artery in all patients. Patients with nerve injuries from the anterocentral portal did not show signs of nerve tumors or false aneurysms.

The conclusion of the study is that this type of ankle surgery using the anterocentral portal is safe, with a low risk of nerve and blood vessel injuries, and can be recommended as a standard approach. The anterolateral portal approach is associated with a higher risk of nerve injuries.

FAQs

  1. What is anterior ankle arthroscopy using the anterocentral portal and why is it not a common procedure?
  2. What were the common reasons for patients to undergo this type of ankle surgery according to the study?
  3. What were the findings regarding the safety and risk of nerve and blood vessel injuries of the anterocentral portal approach in the study?

Doctor’s Tip

A doctor might tell a patient considering arthroscopy that while there is a low risk of complications, it is important to discuss all potential risks and benefits with their surgeon before proceeding with the procedure. They may also advise the patient to follow post-operative care instructions carefully to ensure optimal recovery.

Suitable For

Typically, patients who are recommended for arthroscopy procedures are those with conditions causing blockage in the ankle, damage to cartilage and bone in the ankle joint, recurring ankle instability, and fractures. In the case of anterior ankle arthroscopy using the anterocentral portal, this study found that the procedure is safe and effective with a low risk of nerve and blood vessel injuries, making it a viable option for patients with these specific conditions.

Timeline

Before arthroscopy:

  1. Patient experiences symptoms such as blockage in the front of the ankle, cartilage and bone damage, recurring ankle instability, or fractures.
  2. Doctor recommends arthroscopy as a treatment option.
  3. Patient undergoes pre-operative evaluations and tests to determine the suitability for the procedure.
  4. Surgery is scheduled, and the patient is informed about the procedure and possible risks.

After arthroscopy:

  1. Patient undergoes arthroscopy using the anterocentral portal approach.
  2. Post-operative care and rehabilitation are provided to the patient.
  3. Follow-up appointments are scheduled to monitor the recovery process.
  4. Patients may experience complications such as nerve injuries, but these are typically not severe.
  5. Patients undergo physical examination, nerve sensitivity tests, and ultrasound to assess the outcomes of the surgery.
  6. Study concludes that the anterocentral portal approach is safe and effective for ankle surgery.

What to Ask Your Doctor

  1. What are the specific benefits of anterior ankle arthroscopy using the anterocentral portal compared to other surgical approaches?
  2. What are the potential risks and complications associated with this procedure, particularly in relation to nerve and blood vessel injuries?
  3. How experienced is the surgeon in performing anterior ankle arthroscopy using the anterocentral portal?
  4. What is the expected recovery time and rehabilitation process following this surgery?
  5. Are there any alternative treatment options available for my condition that do not involve surgery?
  6. How will the surgeon monitor and assess the health of my nerves and blood vessels during and after the procedure?
  7. What are the success rates and long-term outcomes for patients who have undergone this type of ankle surgery?
  8. What steps can I take to minimize the risk of complications and promote a successful recovery post-surgery?
  9. Are there any specific lifestyle changes or precautions I should take following the procedure to ensure optimal healing?
  10. Will I need physical therapy or other forms of rehabilitation after the surgery, and if so, what will that entail?

Reference

Authors: Stotter C, Klestil T, Chemelli A, Naderi V, Nehrer S, Reuter P. Journal: Foot Ankle Int. 2020 Sep;41(9):1133-1142. doi: 10.1177/1071100720931095. Epub 2020 Jun 17. PMID: 32546005