Intra-articular lesions in the ankle can be treated with open or arthroscopic techniques. Knowledge of the local anatomy is important to avoid damage to vital structures. The medial and lateral malleoli, long extensor tendons, and the tibialis anterior are readily visualized and palpated over the anterior ankle and can serve as a guide to identifying neurovascular structures. The superficial peroneal nerve divides into the medial and intermediate dorsal cutaneous nerves approximately 6 to 7 cm above the tip of the fibula. The intermediate dorsal cutaneous nerve courses laterally and passes over the inferior extensor retinacu-lum near the level of the joint, then crosses the extensor digi-torum longus tendons to the fourth and fifth toes distally. The medial dorsal cutaneous nerve is more centrally located and passes superficial to the common extensor digitorum longus tendon at or just distal to the joint line. These two nerves supply the bulk of the sensation to the dorsum of the foot and are at risk with placement of an anterolateral arthroscopic portal or with an anterolateral arthrotomy. The anterior tibial artery and deep peroneal nerve pass deep to the extensor retinaculum over
the central aspect of the anterior ankle. These structures usually run in the interval between the extensor hallucis longus and extensor digitorum longus tendons at the level of the ankle joint and should be palpated and marked prior to making a skin incision. The saphenous nerve and vein can have a variable course but usually cross the ankle just anterior to the medial malleo-lus. The saphenous nerve is a frequent site of neuroma formation when it is damaged and is at risk with placement of an anteromedial arthroscopic portal or with anteromedial arthro-tomy (Fig. 67-3).
The posterior surface anatomy is defined by the posterior aspects of the medial and lateral malleoli and the Achilles tendon. The sural nerve and small saphenous vein travel over the posterolateral ankle and are at risk with posterolateral arthro-scopic portal placement and posterolateral approaches to the ankle. The sural nerve is also a frequent site of neuroma formation when it is damaged. The tibialis posterior tendon, flexor digitorum longus tendon, posterior neurovascular bundle, and flexor hallucis longus tendon pass in sequential order from anterior to posterior behind the medial malleolus and are at risk with posteromedial arthroscopic portal placement and posteromedial approaches to the ankle. Damage to neurovascular structures in this area is particularly devastating due to significant loss of blood supply as well as the loss of protective sensation over the plantar aspect of the foot (Fig. 67-4).
Was this article helpful?
Everything you wanted to know about. How To Cure Tennis Elbow. Are you an athlete who suffers from tennis elbow? Contrary to popular opinion, most people who suffer from tennis elbow do not even play tennis. They get this condition, which is a torn tendon in the elbow, from the strain of using the same motions with the arm, repeatedly. If you have tennis elbow, you understand how the pain can disrupt your day.