ReviewA literature review of the complications following anterior and posterior ankle arthroscopy
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.
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