an-anatomical-study-nerves-at-risk-during-minimally-invasive-hallux

An Anatomical Study of Nerves at Risk During Minimally Invasive Hallux Valgus Surgery

The growing popularity of minimally invasive surgical (MIS) procedures makes it necessary that new anatomical references arise, to aid in tridimensional ...

University of Barcelona

Hospital Quirón Barcelona

Proper portal placement is critical to performing good diagnostic and therapeutic arthroscopy. When the portals are positioned improperly, visualization can be impaired, making diagnosis and treatment more difficult. Three main anterior portals are available in arthroscopy of the ankle: anteromedial, anterolateral, and anterocentral. Posterior portals are also routinely used in ankle arthroscopy and can be established at a posterolateral or posteromedial position or directly through the Achilles tendon. Because of the potential for serious complications, the anterocentral and transAchilles portals are no longer used. Other portals have been described to obtain more complete access, particularly to the posterior compartment of the ankle joint. This work reviews the relationships that exist between the most important anatomic structures and arthroscopic portals of the ankle.

Ankle anatomy for the arthroscopist. Part I: The portals.

The biomechanical anatomy of the ankle ligaments continues to be a subject of interest because detailed knowledge of these structures is essential for proper diagnosis and treatment of the injuries affecting them. Lesions to the ankle ligaments are one of the most common sports injuries and the origin of soft tissue impingement syndrome. Together with the ligaments of the tibiofibular syndesmosis, two large ligamentous complexes are the main static stabilizers of the ankle joint: the lateral collateral ligament and the medial collateral (or deltoid) ligament. This article provides an anatomic description of the various ligaments of the ankle joint, with particular emphasis on specific anatomic details that are often omitted or little known and that have considerable clinical interest because of their involvement in soft tissue syndrome.

Ankle anatomy for the arthroscopist. Part II: Role of the ankle ligaments in soft tissue impingement.

Understanding the anatomy of the ankle ligaments is important for correct diagnosis and treatment. Ankle ligament injury is the most frequent cause of acute ankle pain. Chronic ankle pain often finds its cause in laxity of one of the ankle ligaments. In this pictorial essay, the ligaments around the ankle are grouped, depending on their anatomic orientation, and each of the ankle ligaments is discussed in detail.

Anatomy of the ankle ligaments: a pictorial essay.

Posterior ankle impingement is a clinical syndrome characterized by posterior ankle pain that is mainly presented on plantar flexion. The aim of this study is to compare and evaluate the results of posterior ankle impingement treated by endoscopic hindfoot posterior portals.

Hindfoot endoscopy for the treatment of posterior ankle impingement syndrome: a safe and reproducible technique.

The purpose of this study was to assess the incidence of iatrogenic articular cartilage injuries during ankle arthroscopy and to determine the factors that caused them. The hypothesis of this study was that the incidence of iatrogenic cartilage injuries produced during ankle arthroscopic procedures is high and directly related to the arthroscopic technique.

Iatrogenic articular cartilage injuries during ankle arthroscopy.

Lesser toe deformities are one of the most common conditions faced by orthopedic surgeons. Knowledge of the anatomy of the lesser toes is important for ensuring correct diagnosis and treatment of deformities, which are caused by factors such as muscle imbalance between the extensor apparatus and flexor tendons. However, this apparatus has not received sufficient attention in the literature. In addition, the large number of inaccurate and erroneous descriptions means that gaining an understanding of these structures is problematic. The objective of the present article is to clarify the anatomy of the extensor apparatus by means of a pictorial essay, in which the structures involved will be grouped and discussed in detail. The most relevant clinical implications will be addressed.

Extensor apparatus of the lesser toes: anatomy with clinical implications--topical review.

The aim of this study was to determine which intra-articular injuries are associated with chronic anterolateral pain and functional instability after an ankle sprain.

Minor or occult ankle instability as a cause of anterolateral pain after ankle sprain.

Gastrocnemius contracture has recently gained relevance owing to its suggested relationship with foot disorders such as metatarsalgia, plantar fasciopathy, hallux valgus, and others. Consequently this has induced a renewed interest in surgical lengthening techniques, including proximal gastrocnemius release, to resolve gastrocnemius contracture in patients with foot disorders. This article describes and discusses the general anatomy of the triceps surae and the surgical anatomy of the gastrocnemius.

Anatomy of the triceps surae: a pictorial essay.

Endoscopy for the posterior region of the ankle through two portals is becoming more widespread for the treatment of a large number of conditions which used to be treated with open surgery years ago. The tendon of the flexor hallucis longus (FHL) travels along an osteofibrous tunnel between the posterolateral and posteromedial tubercles of the talus. Chronic inflammation of this tendon may lead to painful stenosing tenosynovitis. The aim of this report is to describe two cases depicting an accessory tendon which is an anatomical variation of the flexor hallucis longus in patients with posterior friction syndrome due to posterior ankle impingement and associated with a posteromedial osteochondral lesion of the talus. The anatomical variation (FDAL) described was a finding during an endoscopy of the posterior region of the ankle, and we have spared it by sectioning the superior flexor retinaculum only. The accessory flexor digitorum longus is an anatomical variation and should be taken into account when performing an arthroscopy of the posterior region of the ankle. We recommend this treatment on this type of injury although we admit this does not make a definite conclusion.

Flexor Digitorum Accessorius Longus: Importance of Posterior Ankle Endoscopy.

The flexor hallucis longus (FHL) tendon is the main anatomical landmark during hindfoot endoscopy, and anatomical variations related to the FHL can pose a risk to the tibial nerve and posterior tibial vessels during hindfoot endoscopy. The aim of this study was to determine the distance between the FHL tendon and the tibial neurovascular bundle in the posterior ankle joint when an anatomical variant of the FHL is present. The hypothesis was that the shortest distance between the tibial neurovascular bundle and the FHL tendon in the working area of the hindfoot endoscopy is increased when an anatomical variant of the FHL is present.

Anatomical variations of flexor hallucis longus tendon increase safety in hindfoot endoscopy.

Ankle Arthroscopy: An Update.

When the anterior fascicle of the deltoid ligament is injured in patients with chronic ankle instability, the diagnosis of rotational ankle instability is supported. The aim of this study was to report the results of an all-arthroscopic technique to concomitantly repair the lateral collateral and deltoid ligaments to treat patients with rotational ankle instability.

Combined arthroscopic all-inside repair of lateral and medial ankle ligaments is an effective treatment for rotational ankle instability.

The purpose of this study is to describe a simple and reproducible method to localize the neurological structures at risk and to describe a safe zone for hallux minimally invasive surgery (MIS) procedures.

Article	Year
Ankle anatomy for the arthroscopist. Part I: The portals. Foot and ankle clinics\| PubMed ID: 16798511	2006
Ankle anatomy for the arthroscopist. Part II: Role of the ankle ligaments in soft tissue impingement. Foot and ankle clinics\| PubMed ID: 16798512	2006
Anatomy of the ankle ligaments: a pictorial essay. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA\| PubMed ID: 20309522	2010
Hindfoot endoscopy for the treatment of posterior ankle impingement syndrome: a safe and reproducible technique. Foot and ankle surgery : official journal of the European Society of Foot and Ankle Surgeons\| PubMed ID: 25103704	2014
Iatrogenic articular cartilage injuries during ankle arthroscopy. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA\| PubMed ID: 25151362	2016
Extensor apparatus of the lesser toes: anatomy with clinical implications--topical review. Foot & ankle international\| PubMed ID: 25228309	2014
Minor or occult ankle instability as a cause of anterolateral pain after ankle sprain. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA\| PubMed ID: 25429765	2016
Anatomy of the triceps surae: a pictorial essay. Foot and ankle clinics\| PubMed ID: 25456712	2014
Flexor Digitorum Accessorius Longus: Importance of Posterior Ankle Endoscopy. Case reports in orthopedics\| PubMed ID: 26060592	2015
Anatomy of the ankle ligaments: a pictorial essay. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA\| PubMed ID: 27052302	2016
Anatomical variations of flexor hallucis longus tendon increase safety in hindfoot endoscopy. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA\| PubMed ID: 28220191	2017
Ankle Arthroscopy: An Update. The Journal of bone and joint surgery. American volume\| PubMed ID: 28816902	2017
Combined arthroscopic all-inside repair of lateral and medial ankle ligaments is an effective treatment for rotational ankle instability. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA\| PubMed ID: 28983653	2017
Increasing the safety of minimally invasive hallux surgery-An anatomical study introducing the clock method. Foot and ankle surgery : official journal of the European Society of Foot and Ankle Surgeons\| PubMed ID: 29413772	2018

Jordi Vega

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