Elsevier

Foot and Ankle Surgery

Volume 25, Issue 5, October 2019, Pages 553-558
Foot and Ankle Surgery

Review
A literature review of the complications following anterior and posterior ankle arthroscopy

https://doi.org/10.1016/j.fas.2018.06.007Get rights and content

Highlights

  • Ankle arthroscopy is growing in popularity and is generally regarded as a safe procedure.

  • Complications from this procedure do exist and this paper highlights the frequency of these as reported in the literature.

  • Damage to the superficial peroneal nerve is the most common complication following anterior ankle arthroscopy.

  • Temporary Achilles tendon tightness is the most common complication following posterior ankle arthroscopy.

Abstract

Introduction

There is a wealth of studies reporting the complications of anterior and posterior ankle arthroscopy. The aim of this study is to summarise and review the complication rate(s) associated with both anterior and posterior ankle arthroscopy, as described in the literature.

Material and methods

The authors carried out a comprehensive review of the literature up until March 2018. An extensive search of the MEDLINE, Cochrane library and EMBASE databases was undertaken using the following keywords: complications of ankle arthroscopy, anterior ankle arthroscopy, and posterior ankle arthroscopy.

Results

A total of 107 papers were identified and 55 were deemed appropriate for analysis. The overall complication rate of ankle arthroscopy was found to be between 3.4– 9%.

Conclusions

No life threatening complications were identified in the literature with both anterior and posterior ankle arthroscopy. The commonest complication after anterior and posterior ankle arthroscopy is superficial peroneal nerve injury and temporary Achilles tendon tightness, respectively.

Introduction

Ankle arthroscopy is a procedure with increased popularity among foot and ankle surgeons. As indications for ankle arthroscopy increases, complications associated with this procedure must be re-evaluated [1]. In 1931, Burman was convinced that arthroscopy of the ankle joint is impossible because of the limited space and close relationship of the delicate anatomical structures [2]. In 1939 a standard technique of ankle arthroscopy was published by Takagi in Tokyo, Japan [3].

Complications are defined in the medical literature as “impairment(s) of a normally manageable illness or surgical intervention caused by unpredictable circumstances” [4]. The rate of complications following ankle arthroscopy had been cited in the pre-distraction era as up to 24.6%, this dropped dramatically to 13.6% after the introduction of invasive distraction [5]. Non-invasive distractors include a disposable clove-hitch-type device wrapped over the midfoot and the heel that can be either attached to an ankle distractor or a waist band for variable distraction [6], [7]. Surgical techniques have evolved as practice of ankle arthroscopy has matured. Anteromedial and anterolateral portals are the most commonly used portals for anterior ankle arthroscopy [6]. In 2000, Van Dijk et al. introduced the concept of a two portal posterior ankle arthroscopy with the patient in a prone position – with portals placed just laterally and medially to the Achilles tendon [8] (Fig. 1). The purpose of this literature review is to identify the complication rates of both anterior and posterior ankle arthroscopies as documented in the literature.

Section snippets

Material and methods

The authors carried out a comprehensive review of the literature up to March 2018. An extensive search of the MEDLINE, Cochrane, and EMBASE databases was undertaken using the following keywords; complications of ankle arthroscopy, anterior ankle arthroscopy, and posterior ankle arthroscopy. Non-English language literature without English translation was excluded. The studies from these searches were evaluated to segregate literature that described therapeutic studies investigating the outcomes

Results

A total of 107 papers were identified and 55 were deemed appropriate for analysis. Fig. 2 shows the strategy of the literature search. The largest studies assessing the complications of ankle arthroscopy are listed in Table 1.

Neurological injury

Neurological injury is the most common complication post ankle arthroscopy. Ferkel et al. published a comprehensive analysis of complications of ankle arthroscopy in 612 patients citing an overall complication rate of 9%, with neurological injury accounting for 49% of those complications [9]. In 2011, Young et al. found that after 294 ankle arthroscopies, they saw a complication rate of 6.8%, with 80% of those being made up of neurological injury [10].

Conclusion

No life threating complications were identified in the literature both with anterior and posterior ankle arthroscopy. The commonest complication after anterior and posterior ankle arthroscopy is superficial peroneal nerve injury and temporary Achilles tendon tightness, respectively. The use of non-invasive distraction, preoperative identification of the SPN and careful portal placement will all help to reduce the rate of complications following ankle arthroscopy.

Declarations of interest

None.

References (62)

  • C.J. Salgado et al.

    Anterior tibial artery pseudoaneurysm after ankle arthroscopy

    Cardiovasc Surg

    (1998)
  • E. Jacobs et al.

    Pseudoaneurysm of the anterior tibial artery after ankle arthroscopy

    J Foot Ankle Surg

    (2011)
  • R.S. Kotwal et al.

    Anterior tibial artery pseudoaneurysm in a patient with hemophilia: a complication of ankle arthroscopy

    J Foot Ankle Surg

    (2007)
  • J.L. Yu et al.

    Pseudoaneurysms around the foot and ankle: case report and literature review

    Foot Ankle Surg

    (2013)
  • A. Kashir et al.

    Pseudoaneurysm of the dorsalis pedis artery after ankle arthroscopy

    Foot Ankle Surg

    (2010)
  • S.J. Voto et al.

    Ankle arthroscopy: neurovascular and arthroscopic anatomy of standard and trans-achilles tendon portal placement

    Arthrosc J Arthrosc Relat Surg

    (1989)
  • R.D. Ferkel et al.

    Arthroscopic treatment of ankle injuries

    Orthop Clin North Am

    (1994)
  • J.C. DeLee

    Complications of arthroscopy and arthroscopic surgery: results of a national survey

    Arthroscopy

    (1985)
  • N.C. Small

    Complications in arthroscopic surgery performed by experienced arthroscopists

    Arthroscopy

    (1988)
  • J.C. Kass et al.

    Extensor hallucis longus tendon injury: an in-depth analysis and treatment protocol

    J Foot Ankle Surg

    (1997)
  • B.C. Navadgi et al.

    Rupture of the extensor hallucis longus tendon after ankle arthroscopy – an unusual complication

    J Foot Ankle Surg

    (2007)
  • D.M. Epstein et al.

    Anterior ankle arthroscopy: indications, pitfalls, and complications

    Foot Ankle Clin

    (2015)
  • W.J. Ribbans et al.

    The management of posterior ankle impingement syndrome in sport: a review

    Foot Ankle Surg

    (2015)
  • A.H. Gomoll et al.

    Chondrolysis after continuous intra-articular bupivacaine infusion: an experimental model investigating chondrotoxicity in the rabbit shoulder

    Arthrosc – J Arthrosc Relat Surg

    (2006)
  • D.C. Simonson et al.

    Safety of ankle arthroscopy for the treatment of anterolateral soft-tissue impingement

    Arthrosc – J Arthrosc Relat Surg

    (2014)
  • R.G. Schmidt et al.

    An unusual complication of an ankle arthroscopy and its management

    J Foot Ankle Surg

    (1999)
  • T. Blázquez Martín et al.

    Complicaciones tras la artroscopia de tobillo yretropié (Complications after ankle and hindfoot arthroscopy)

    Rev Esp Cir Ortop Traumatol

    (2016)
  • M.S. Burman

    Arthroscopy or the direct visualization of joints: an experimental cadaver study. 1931

    Clin Orthop

    (2001)
  • K. Takagi

    The classic. Arthroscope. Kenji Takagi. J. Jap. Orthop. Assoc., 1939

    Clin Orthop Relat Res

    (1982)
  • N.F. Sprague et al.

    Specific complications: elbow, wrist, hip, and ankle

    Complications in arthroscopy

    (1989)
  • R.D. Ferkel et al.

    Complications in foot and ankle arthroscopy

    Clin Orthop Relat Res

    (2001)
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