Journal of Foot and Ankle Surgery (Asia Pacific)

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VOLUME 11 , ISSUE 3 ( July-September, 2024 ) > List of Articles


Ultrasound Guidance vs Anatomical Landmark for Ankle Arthroscopic Portal Insertions: A Randomized Cadaveric Study

Wei L Cheong, Yet Y Yan, Kinjal V Mehta

Keywords : Ankle arthroscopy, Nerve injury, Ultrasound

Citation Information : Cheong WL, Yan YY, Mehta KV. Ultrasound Guidance vs Anatomical Landmark for Ankle Arthroscopic Portal Insertions: A Randomized Cadaveric Study. J Foot Ankle Surg Asia-Pacific 2024; 11 (3):121-126.

DOI: 10.5005/jp-journals-10040-1343

License: CC BY-NC 4.0

Published Online: 03-07-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Background: To determine the safety and efficacy of using ultrasound in topographic marking of the neurovascular structures and tendons in the foot and ankle and identification of a safe zone for arthroscopic portal creation, compared to using anatomical landmarks. Materials and methods: Twelve cadaveric samples were randomly divided into two groups of six. The first group underwent ultrasound assessment by a board-certified radiologist, who identified zones of safety for ultrasound-guided insertion of anteromedial, anterolateral, and posteromedial arthroscopic portals. Ankle arthroscopy was then performed. The other group underwent similar ankle arthroscopy assessment utilizing conventional anatomical landmarks. Straws were used to delineate arthroscopy portal tracts. The cadaveric samples were then dissected. The following distances were measured between the portals and important anatomical structures—the anterolateral portal and superficial peroneal nerve (SPN) as well as extensor digitorum longus (EDL); anteromedial portal and the great saphenous vein (GSV) as well as tibialis anterior (TA); and the posteromedial portal and the flexor hallucis longus (FHL). Results: No neurovascular structures or tendons were injured in all 12 cadaveric samples. Compared with the nonultrasonography group, the group that underwent ultrasonography assessment had statistically significant larger distance of the SPN, EDL, and TA from the anterolateral and anteromedial arthroscopic portals (p-values = 0.045, 0.046, and 0.025, respectively). No difference was found between the distance of the GSV from the anteromedial arthroscopic portal as well as the distance of the FHL from the posteromedial arthroscopic portal. Conclusion: Ultrasound assessment and topographic identification of the safe zone for ankle arthroscopic portal creation are a safe and effective processes that may reduce the risk of iatrogenic injury to neurovascular structures and tendons in anterior and posterior ankle arthroscopy. Level of evidence: IV; cadaveric study.

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