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Inoue J, Yasui Y, Sasahara J, Takenaga T, Wakabayashi K, Nozaki M, Kobayashi M, Ha M, Fukushima H, Kato J, Miyamoto W, Kawano H, Murakami H, Yoshida M. Comparison of Visibility and Risk of Neurovascular Tissue Injury Between Portals in Needle Arthroscopy of the Anterior Ankle Joint: A Cadaveric Study. Orthop J Sports Med 2023; 11:23259671231174477. [PMID: 37332532 PMCID: PMC10273784 DOI: 10.1177/23259671231174477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 02/22/2023] [Indexed: 06/20/2023] Open
Abstract
Background For needle arthroscopy with 0° viewing, the visible range of intra-articular structures and the difference between portals remain unknown, as do the risks for neurovascular tissue at each portal. Purpose To clarify the visibility and safety of needle arthroscopy. Study Design Descriptive laboratory study. Methods Ten cadaveric ankle specimens were used. A needle arthroscope with a 1.9-mm diameter was inserted from 4 portals (anteromedial [AM], anterolateral [AL], medial midline [MM], and anterocentral [AC]). Visibility was assessed using a 15-point ankle arthroscopy checklist. In addition, the ankles were dissected to measure the distance between each portal and neurovascular tissues. The visibility of the ankle joint was compared between portals. Results The success rate of visibility in the deltoid ligament and the tip of the medial malleolus was 100% from the AM, MM, and AC portals and 10% from the AL portal, with significant differences between the portals (P < .01). The visibility success rates in the origin of the anterior talofibular ligament and the tip of the lateral malleolus were 20% for the AM portal, 90% for the MM and AC portals, and 100% for the AL portal, with significant differences between the portals (P < .01). All other points of the ankle joint were visualized from all the portals with a 100% success rate. The AC portal was in contact with the anterior neurovascular bundle in 4 of the 10 specimens. Conclusion When needle arthroscopy was performed from the AM or AL portal, the site opposite to the portal in the ankle joint was difficult to visualize. Conversely, most points of the ankle joint could be visualized from the MM and AC portals. Care should be taken when creating an AC portal because of its proximity to the anterior neurovascular bundle. Clinical Relevance The present study provides information regarding which portal should be selected to perform needle arthroscopy in the ankle joint, which will be beneficial for management of ankle injuries.
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Affiliation(s)
- Jumpei Inoue
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Youichi Yasui
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Jun Sasahara
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Tetsuya Takenaga
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Kenjiro Wakabayashi
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Masahiro Nozaki
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Makoto Kobayashi
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Myongsu Ha
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Hiroaki Fukushima
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Jiro Kato
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Wataru Miyamoto
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Hirotaka Kawano
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Hideki Murakami
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Masahito Yoshida
- Department of Musculoskeletal Sports Medicine, Research and Innovation, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
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Lughi M, Cevolani M, Testi G, Piraccini E, Lijoi F. Anterior Ankle Arthroscopy: Advantage of a Preoperative Ultrasound Mapping to Prevent Neurovascular Complications. J Ultrasound 2022; 25:831-836. [PMID: 35294770 PMCID: PMC9705666 DOI: 10.1007/s40477-021-00611-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 06/21/2021] [Indexed: 11/24/2022] Open
Abstract
PURPOSE The aim of this study is to verify the usefulness of ultrasound-assisted mapping of the vascular and neurological structures in the anterior compartment of the ankle just before an anterior arthroscopic procedure to reduce these kinds of complications. METHODS Various complications can be present in anterior arthroscopy of the ankle. The structures most prone to iatrogenic damage are vessels and nerves. They are macroscopically visible and palpable in a little more than 50% of cases, but arterial ramifications are not visible because they are located deeper. RESULTS The authors have investigated how to reduce potential iatrogenic damage to the complex and variable neuro-vascular network of the anterior aspect of the ankle. They have completed the classic routine marking of the bony and tendinous structures with an ultrasound mapping of the neurovascular structures. CONCLUSIONS The authors concluded that ultrasound-assisted mapping is a non-invasive, fast, and safe procedure that can help to reduce potential iatrogenic damage when performing anterior arthroscopic surgery.
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Affiliation(s)
- Marcello Lughi
- Orthopaedic and Traumatologic Department, AUSL of Romagna, Forlì Hospital, Italy, Via Bellaria 7, 47521, Cesena, FC, Italy.
| | - Mauro Cevolani
- Vascular Surgery Department, AUSL of Romagna, Forlì Hospital, Forli, Italy
| | - Gabriele Testi
- Vascular Surgery Department, AUSL of Romagna, Forlì Hospital, Forli, Italy
| | - Emanuele Piraccini
- Surgery and Anaesthesia, Intensive Care Section Department AUSL of Romagna, Forlì Hospital, Forli, Italy
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Correia AGDS, Vieira JGS, Rodrigues BCM, Fortes LHS, Garção DC. Branching patterns of the superficial fibular nerve: an anatomical study with meta-analysis. Surg Radiol Anat 2022. [DOI: 10.1007/s00276-022-03039-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
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Kim WJ, Seo TB, Lee JB. The effect of limitation of joint motion range due to ankle taping on the evaluation of functional motion of high school Judo athletes. J Exerc Rehabil 2021; 17:175-183. [PMID: 34285895 PMCID: PMC8257437 DOI: 10.12965/jer.2142218.109] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 05/08/2021] [Indexed: 12/26/2022] Open
Abstract
The purpose of this study is to investigate the effect of ankle injury preventative C-tape on the ankle range of motion, Y-balance test (YBT), and functional movement screening (FMS) test in Judo athletes. Participants in this study were 15 male judo athletes in high school. The angle of the ankle joint, YBT, and FMS were examined with and without the application of C-tape on each athlete's dominant foot. In YBT, ankle range of motion, and anterior reach distance were significantly lower in the taped ankle compared to the other (P<0.01). Moreover, the overhead deep squat and the FMS total score were significantly decreased after the C-tape application (P<0.05). The taping's limitation on the ankle joint range of motion may impose adverse effects on the other relevant joints, therefore a proper guideline on long-term usage is advised.
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Affiliation(s)
- Won-Jin Kim
- Department of Physical Education, Graduate School, Youngin University, Youngin, Korea
| | - Tae-Beom Seo
- Department of Physical Education, Jeju National University, Jeju, Korea
| | - Jong-Baek Lee
- Department of Exercise & Sport Science, Center for Sport Science in Gangwon, Chuncheon, Korea
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Pietramaggiori G, Sapino G, De Santis G, Bassetto F, Scherer S. Chronic Knee and Ankle Pain Treatment through Selective Microsurgical Approaches: A Minimally Invasive Option in the Treatment Algorithm for Refractory Lower Limb Pain. J Reconstr Microsurg 2020; 37:234-241. [PMID: 33027830 DOI: 10.1055/s-0040-1717100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Injury or compression of a sensory nerve is an under-reported source of disabling pain in the lower limb. It is known that peripheral nerve microsurgeons can reconstruct and rewire injured nerves to relieve chronic pain but this option remains not completely understood and ignored by most orthopaedic surgeons, neurologists, and pain therapists. In this paper, we describe our experience with knee and ankle peripheral nerve surgery to improve the condition of patients suffering from chronic, posttraumatic lower limb pain. PATIENTS AND METHODS Between 2015 and 2018, a retrospective investigation was performed including patients who underwent ankle and knee nerve surgery for posttraumatic chronic pain with at least 1 year of follow-up. Previous surgeries or type of trauma, pain location and characteristics, type of operation (reconstruction, decompression, or denervation), and number of nerves operated were listed. Selective neuropathy was confirmed by ultrasound-guided nerve blocks. Outcome was assessed combining the visual analogue scale (VAS) score at rest and during movement, functional indexes, drug use, and ability to work. RESULTS A total of 34 patients (14 knee and 20 ankle) were included in this study. A statistically significant difference (p < 0.05%) in postoperative pain at rest and during activity was seen in both groups of patients. Good to excellent outcomes were recorded in 92 and 80% of patients treated, respectively, at the knee and the ankle levels. No major complications occurred, while a secondary procedure due to neuroma recurrence was necessary in seven patients (three knees and four ankles). CONCLUSION Peripheral nerve microsurgery is a useful and minimally invasive tool to be added in the algorithm of treatment of chronic knee and ankle pain. Physicians should be trained to suspect a neuropathic origin of pain in absence of musculoskeletal signs of pathology, especially following trauma or surgeries.
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Affiliation(s)
- Giorgio Pietramaggiori
- Department of Plastic, Reconstructive and Aesthetic Surgery, Global Plastic Surgery, Lausanne, Switzerland.,Department of Plastic and Reconstructive Surgery, University Hospital of Padova, Padova, Italy
| | - Gianluca Sapino
- Department of Plastic and Reconstructive Surgery, University Hospital of Modena, Modena, Italy
| | - Giorgio De Santis
- Department of Plastic and Reconstructive Surgery, University Hospital of Modena, Modena, Italy
| | - Franco Bassetto
- Department of Plastic and Reconstructive Surgery, University Hospital of Padova, Padova, Italy
| | - Saja Scherer
- Department of Plastic, Reconstructive and Aesthetic Surgery, Global Plastic Surgery, Lausanne, Switzerland.,Department of Plastic and Reconstructive Surgery, University Hospital of Padova, Padova, Italy
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Abstract
BACKGROUND The anterocentral portal is not a standard portal in anterior ankle arthroscopy due to its proximity to the anterior neurovascular bundle. However, it provides certain advantages, including a wide field of vision, and portal changes become redundant. The purpose of this study was to evaluate the neurovascular complications after anterior ankle arthroscopy using the anterocentral portal. METHODS We retrospectively identified patients who had undergone anterior ankle arthroscopy with an anterocentral portal at our institution from 2013 to 2018. Medical record data were reviewed and patients were invited for clinical follow-up, where a clinical examination, quantitative sensory testing for the deep peroneal nerve, and ultrasonography of the structures at risk were performed. A total of 101 patients (105 arthroscopies) were identified and evaluated at a mean follow-up of 31.5 ± 17.7 months. RESULTS Leading indications to surgery were heterogeneous and included anterior impingement (48.6%), osteochondral lesions of the talus (24.8%), chronic ankle instability (14.3%), and fractures (8.6%). The overall complication rate was 7.6%, and no major complications were observed. In 1.9% (2/105) of the cases, the complications were associated with the anterocentral portal and included injury to the medial branch of the superficial nerve (1/105) and to the deep peroneal nerve (1/105). Injury to the deep peroneal nerve was associated with a loss of detection and nociception. There were no injuries to the anterior tibial artery. In 41.9% (44/105) of the cases, only 1 working portal was used in addition to the anterocentral portal, and in 19% (20/105) the anterolateral portal could be avoided. Ultrasonography confirmed the integrity of the deep peroneal nerve, the medial branch of the superficial peroneal nerve, and the anterior tibial artery in all patients. Patients with nerve injuries associated with the anterocentral portal showed no signs of neuroma or pseudoaneurysm. CONCLUSION Using a standardized technique, the anterocentral portal in ankle arthroscopy is safe with a low number of neurovascular injuries and can be recommended as a standard portal. The anterolateral portal remains associated with a high number of injuries to the superficial peroneal nerve. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Christoph Stotter
- Department of Orthopedics and
Traumatology, LK Baden-Mödling, Baden, Austria,Faculty of Health and Medicine,
Department for Health Sciences, Medicine and Research, Center for Regenerative
Medicine, Danube University Krems, Krems, Austria,Christoph Stotter, MD, PhD, Faculty of
Health and Medicine, Department for Health Sciences, Medicine and Research,
Center for Regenerative Medicine, Danube University Krems, Dr. Karl-Dorrek-Str.
30, Krems, A-3500 Austria.
| | - Thomas Klestil
- Department of Orthopedics and
Traumatology, LK Baden-Mödling, Baden, Austria,Faculty of Health and Medicine,
Department for Health Sciences, Medicine and Research, Center for Regenerative
Medicine, Danube University Krems, Krems, Austria
| | | | - Vahid Naderi
- Department of Radiology, LK
Baden-Mödling, Baden, Austria
| | - Stefan Nehrer
- Faculty of Health and Medicine,
Department for Health Sciences, Medicine and Research, Center for Regenerative
Medicine, Danube University Krems, Krems, Austria
| | - Philippe Reuter
- Department of Orthopedics and
Traumatology, LK Baden-Mödling, Baden, Austria
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Yammine K. Published Human Cadaveric Measurements Are Strongly Biased Toward the Elderly Population. Clin Anat 2019; 33:804-808. [PMID: 31637769 DOI: 10.1002/ca.23509] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 10/15/2019] [Indexed: 01/15/2023]
Abstract
Understanding of anatomy is based on the study of anatomical variations. Morphometric variations can have important implications in surgical practice. The sizes of some anatomical structures are affected by age; however, cadavers used in anatomical research are usually of advanced age. The main aim of this study is to quantify the mean age of samples in cadaveric studies reporting morphometric values. PubMed was searched for the last 3 years to locate cadaveric studies reporting size values, excluding histological, forensic, and osteological collections. Out of the 390 potentially relevant papers, 109 (28%) studies did not report the ages of their samples. In total, 177 studies were included for analysis comprising 4,807 subjects. The most studied structures were those of the musculoskeletal system. The mean age of the pooled sample was 71.1 ± 11.0 years. The lowest reported age was 16 while the highest was 104 years. Univariate and multivariate analyses showed no correlation with any of the following variables: country of study, anatomical region, anatomical structure, or journal type. The mean age of cadavers used to measure the sizes of human anatomical structures falls largely within the senior age category. The reported values in an aging population will not necessarily mirror other populations such as the pediatric. The outcomes of surgeries that depend to some extent on tight morphometric values such as flap surgeries, microsurgery, tendon transfer, or mini-invasive procedures could differ when they are performed on other age categories. More anatomical research is needed for better reporting of age-related morphometric changes. Clin. Anat., 33:804-808, 2020. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Kaissar Yammine
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University, School of Medicine, Lebanon.,Sport & Orthopedics Research, Center for Evidence-Based Anatomy
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Yammine K, Kheir N, Daher J, Naoum J, Assi C. Pseudoaneurysm following ankle arthroscopy: a systematic review of case series. Eur J Orthop Surg Traumatol 2018; 29:689-696. [PMID: 30361987 DOI: 10.1007/s00590-018-2324-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 10/22/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND/OBJECTIVE Pseudoaneurysms (PA) are rare complications following ankle arthroscopy (AA). Delay in diagnosis is reported to be frequent and could lead to serious complications. Evidence synthesis on the clinical context of such complication lacks in the literature. METHODS A systematic review is conducted to locate all relevant papers. In total, 23 case reports were included in the review. Data of 23 patients with a mean of 40.9 ± 10.3 years were extracted and analyzed. Outcomes included comorbidities, portals and procedure types performed during AA, PA location and size, time to diagnosis and treatment, and therapeutic modalities. RESULTS The results showed that d-ATA and the dorsal pedis artery (DPA) were involved in 18 and 4 cases, respectively. A single case of PA of the fibular artery was described. The mean PA size was found to be 4.2 × 3.9 × 2.1 cm. Five of the 14 patients (35.7%) with a reported detailed medical history were treated for a cardiovascular or hemostasis condition. Delay in PA diagnosis was found to be at a mean time of 50.45 ± 74.6 days. The most commonly reported surgical indications were anterior synovectomy and removal of anterior osteophytes. Ligation was the most common procedure in treating PA. CONCLUSION While portal placement might be a minor factor, the variability of the d-ATA and/or DPA anatomical position and its affection with foot position and distraction during AA could play a role in the arterial injury. Synovectomy and removal of anterior, particularly big-sized, osteophytes could be considered as risk factors as well. A state of hypocoagulability might affect injury healing and consequently PA formation. PA diagnosis should be raised whenever a non-resolving or pulsatile swelling over a portal incision is observed.
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Affiliation(s)
- Kaissar Yammine
- Orthopedic Department, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Achrafieh, Lebanon. .,Center for Evidence-Based Anatomy Sports and Orthopedic Research, Beirut, Lebanon.
| | - Nadim Kheir
- Orthopedic Department, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Achrafieh, Lebanon
| | - Jimmy Daher
- Orthopedic Department, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Achrafieh, Lebanon
| | - Joseph Naoum
- Vascular Department, Lebanese American University Medical Center-Rizk Hospital, Achrafieh, Lebanon
| | - Chahine Assi
- Orthopedic Department, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Achrafieh, Lebanon
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