Complications of Ankle Arthroscopy Utilizing a Contemporary Noninvasive Distraction Technique
Reference: Brett H. Young, MD, Ryan M. Flanigan, and Benedict F. DiGiovanni, MD. The Journal of Bone and Joint Surgery (American). 2011;93:963-968.
Scientific Literature Review
Reviewed by: Yevgeniy Shagas, DPM
Residency Program: Roxborough Memorial Hospital
Ankle arthroscopy holds several advantages over the traditional arthrotomy procedure including limited dissection and disruption of soft tissues, which in turn lead to reduced post-operative pain and swelling and increased post-operative recovery. This article reviews a single surgeon’s experience with ankle arthroscopy.
This article reviewed ankle arthroscopies performed by single surgeon between September 1999 and December 2007. Complications were identified as being any problem that resulted from the ankle arthroscopy itself, the intraoperative positioning, or the associated postoperative management. In addition to complications, the following were recorded for each patient: age and sex, preoperative and postoperative diagnoses, procedure(s) performed, duration of follow-up, weight-bearing restriction, tourniquet location and duration, and an active Workers’ Compensation claim. All patients underwent the same intraoperative noninvasive distraction protocol.
Between September 1999 and December 2007, 307 ankle arthroscopies were performed on 294 patients. One hundred forty-two patients were men (48.3%), and the average age was thirty-seven years (range, twelve to seventy-seven years).There were a total of twenty complications, resulting in an overall complication rate of 6.8%. There were sixteen neurologic complications, which accounted for 80% of the total number of complications and resulted in an overall neurologic complication rate of 5.4% for all ankle arthroscopies. There were four non-neurologic complications, which included two superficial infections, one deep venous thrombosis, and one prolonged synovial-fluid drainage from a portal.
Of the sixteen neurologic complications, six were related to the anterolateral portal, and the authors believed that this represented an injury to the intermediate cutaneous branch of the superficial peroneal nerve. Five of the six patients with anterolateral portal nerve injury had complete resolution of signs and symptoms, typically within two to three months after surgery. Eight of the sixteen patients experienced nerve hypersensitivity or dysesthesias localized to the dorsal part of the midfoot, where the foot strap had been applied over the sensory cutaneous nerve branches.
There were four non-neurologic complications, which provided a non-neurologic complication rate of 1.4% for all ankles in the study.
Of the 294 total cases reviewed, there were thirty-eight Workers’ Compensation-associated cases. There was a 21% (8/38) complication rate in this group of patients versus a 4.7% (12/256) complication rate for the group of patients who were not involved in an active Workers’ Compensation claim.
The findings reaffirm that nerve injury is the most common complication associated with ankle arthroscopy. It is important to note that the use of noninvasive distraction carries a risk of neurologic injury beyond the risk associated with the arthroscopic portals, with this risk being particularly high in the patients with Workers’ Compensation claims. These findings invite future investigation regarding the optimal design of the foot strap and the safest magnitude and duration of distraction force across the ankle joint.