synonyms: ankle ATS, ankle scope, ankle arthroscopy
Ankle Scope CPT
|29891(with excision and drilling of OCD
||29897(with limited debridement)
|29892(with repair large OCD/tib plafond fx)
||29898(with extensive debridement)
|29894(with loose body removal)
|29895(with partial synovectomy
Ankle Scope Anatomy
- anterolateral portal risks superficial peroneal nerve
- anterocentral portal risks deep peroneal nerve or dorsalis pedis artery
- anteromedial is just medial to the anterior tibial tendon, risks saphenous nerve
- posterolateral portal risks sural nerve
Ankle Scope Indications
- meniscoid lesions(fiborcartilaginous mass develops laterally after inversion ankle sprain causing chronic arterolateral ankle pain.
- synovial chondromatosis
- loose bodies
Ankle Scope Contraindications
Ankle Scope Alternatives
- Non-operative treatment
- Open procedures
Ankle Scope Pre-op Planning / Special Considerations
- Ankle ATS case card.
- Allows visualization of: transverse ligament, anterior tibiofibular ligament, deep deltoid ligament, deep portion of posterior tibiofibular ligament. Anterior talofibular ligament is poorly visualized.
Ankle Scope Technique
- Pre-operative antibiotics, +/- regional block
- supine position. All bony prominences well-padded.
- Examination under anesthesia.
- prep and drape standard sterile fashion
- noninvasive ankle distractor
- anatomic landmarks marked on skin (talus, medial mal, lateral mal, anterior tibial tendon, peroneous tertius, lateral Achilles tendon, subq course of superficial peroneal nerve dorsal intermediate branch ( invert foot and ankle, plantarflex lateral toes)), dorsalis pedis artery,
- anteromedial portal site medial to anterior tibial tendon at the joint line localized with 18-gauge spinal needle
- skin incised, subq tissues blunted dissected to level of capsule using fine hemostat (mosquito)
- portal created with blunt obturator and cannula
- anterolateral portal site determined with spinal needle lateral to peroneus tertius tendon
- posterolateral portal created under arthroscopic visualization. Spinal needle lateral to Achilles tendon (generally 2cm distal to anterior portals)
- resect synovium
- Anterior 8:deltoid ligament, medial gutter, medial talus, central talus, lateral talus, talofibular articulation, lateral gutter, anterior gutter
- Posterior 3 from anterior portal: posteroinferior tibiofibular ligament, transverse tibiofibular ligament, capsular reflection of FHL, medial & lateral synovial recesses.
- Posterior: medial gutter, medial central and lateral talus, talofibular articulation, lateral gutter, posterior gutter.
- OCD lesions drilled with 0.062mm K-wire at 3mm interval to a depth of @ 10mm.
- portal sites closed with 4-0 nylon,
- bulky compressive dressing
- well-padded posterior splint
Articular Cartilage Grading
- A=smooth, intact but soft or ballotable
- B=rough surface
- D=Flap present or bone exposed
- E=Loose, undisplaced fragment
- F=Displaced fragment
Ankle Scope Complications
- overall 9% complication rate (Ferkel Arthroscopy 1994 10:352)
- neurologic: most common (primarily superficial branch of peroneal N, saphenous N or sural N. (Ferkel RD, Arthroscopy 1996;12:200).
- vascular injury
- superficial/deep infection
- ligament injur
- incisional pain
Ankle Scope Follow-up care
Ankle Scope Outcomes
Ankle Scope Review References
- Feiwell, Foot Ankle 1993;14:142-147