AANA Lab Course 908-Foot and Ankle Arthroscopy (APEx)-Anterior Arthroscopy_ Portals, Soft Tissue Impingement, Bony Impingement, Loose Bodies-Richard Ferkel, M.D.

Anterior Arthroscopy_ Portals, Soft Tissue Impingement, Bony Impingement, Loose Bodies-Richard Ferkel, M.D.

Pdf Summary

This document presents a comprehensive overview of anterior ankle arthroscopy, including portals, soft tissue and bony impingement, and management of loose bodies, authored by Richard D. Ferkel, M.D. It details the surgical techniques, tools, and anatomical considerations for effective arthroscopy.<br /><br />Key surgical equipment includes 2.7 mm and 1.9 mm arthroscopes, interchangeable cannulas, and various shavers, curettes, and microfracture picks designed for different applications like cartilage trimming or fusion preparation. Soft tissue and bone distraction methods are described to optimize visualization, with fluid management ideally performed by gravity inflow through a dedicated cannula.<br /><br />Portals commonly utilized are anterolateral, anteromedial, and posterolateral, among others, with emphasis on careful identification of superficial peroneal nerve branches to reduce nerve injury risk. Arthroscopic anatomy includes identification of eight anterior, six central, and seven posterior points, with attention to posterior ankle ligaments such as the posterior inferior tibiofibular ligament (PITF) and transverse tibiofibular ligament (TTL).<br /><br />Postoperative care involves outpatient management with sutures and splints, non-weight bearing initially, then rapid rehabilitation once normal range of motion and strength return. Loose bodies, often from chondral trauma or synovial chondromatosis, require careful extraction through enlarged portals.<br /><br />The document discusses types of ankle impingement: soft tissue impingement (STI) from fibrosis and synovitis and bony impingement (BI) due to osteophytes or loose bodies, often occurring anteriorly or posteriorly, sometimes combined. Chronic ankle sprains and syndesmotic impingement are highlighted as common sources of persistent pain.<br /><br />Diagnostic imaging includes specialized X-ray views (anteromedial impingement view), MRI, and CT to detect osteophytes, cartilage damage, and synovitis. Classification systems for degenerative joint disease and impingement guide assessment.<br /><br />Treatment focuses on careful osteophyte excision without damaging articular surfaces, with options including osteotomes, ronguers, or burrs. A cam-type impingement affecting talar dome contour is noted, requiring thorough debridement. Proper portal placement, anesthesia, and instrumentation protocols are stressed. Techniques for safely retrieving broken instruments using magnetic “golden retrievers” are included.<br /><br />Overall, this detailed guide integrates anatomical knowledge, diagnostic strategies, and operative tips to optimize outcomes in ankle arthroscopy for impingement and loose body management.

Keywords

anterior ankle arthroscopy

arthroscopic portals

soft tissue impingement

bony impingement

loose body management

arthroscopic surgical techniques

ankle anatomy

postoperative rehabilitation

diagnostic imaging ankle

osteophyte excision