CHAPTER 35 Armen S. Kelikian 1. Loose bodies 2. Anterior tibiotalar osteophytes 3. Soft tissue impingement 4. Osteochondritis dessicans 5. Synovectomy 6. Arthritis 1. Soft tissue infection (cellulitis) 2. End stage arthritis 3. Peripheral vascular disease 4. Marked limitation of motion 5. Sympathetic dystrophy 1. Thorough history and physical examination 2. Check for instability patterns 3. Examine subtalar joint 4. Weight-bearing anteroposterior/lateral radiographs of 5. ankle 5. Optional views include mortise, Broden’s, and stress X-rays 6. CT/MRI for osteochondral lesion staging 1. Regional/general anesthesia 2. Place the patient supine on a standard operating room table. Secure the opposite limb. 3. Flex the hip and knee 45 degrees with a soft bump or use a thigh holder proximal to the popliteal fossa (Fig. 35–1). 4. 4.0- and 2.7-mm (short) arthroscopes with 30- and 70-degree obliquity 5. Small arthroscopy instruments: probes, basket forceps, graspers, awls, and curettes 6. Motorized 3.5- and 2.9-mm shaver tips 7. High flow-inflow system 8. Noninvasive soft tissue distraction system 1. Mark and identify anatomical landmarks such as the dorsalis pedis artery, superficial and deep peroneal nerves, peroneus tertius and anterior tibial tendons, and both malleoli (Fig. 35–2). 2. The patient should be as far cephalad on the operating room table as possible to allow for optimal utilization of the distal distraction device. 3. Invert the foot to visualize the superficial peroneal nerve. 4. The foot and ankle should be freely suspended. 5. Manually attach the foot strap and then pull the distraction lever bar out to length and clamp it. Now begin distraction. 6. Suck all air bubbles out of the high-inflow line.
Ankle Arthroscopy
Indications
Contraindications
Preoperative Preparation
Special Instruments, Position, and Anesthesia
Tips and Pearls
What To Avoid
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