In-Office Needle Arthroscopy for Anterior Ankle Impingement

Abstract

Anterior ankle impingement is a common cause of chronic ankle pain characterized by altered joint mechanics with considerable deficits in range of motion. The benefits of in-office nano arthroscopy (IONA) include the ability to diagnosis and treat anterior ankle impingement, quicker patient recovery, reduced cost, and improved patient satisfaction. The purpose of this technical report is to describe the technique for performing in-office nano arthroscopy for anterior ankle impingement, with special consideration of the technique for obtaining adequate local anesthesia, proper indications, adequate visualization, and the advantages of performing these procedures in the office rather than the operating room.

Fig 1

Arthroscopic approach to the left ankle via the anterolateral and anteromedial portals. Relevant surface anatomy markings, including the anterior joint line and portal locations, are shown. The anteromedial portal, which is the primary viewing portal, is placed lateral to the medial malleolus and medial to tibialis anterior tendon. One should be cautious to avoid the saphenous nerve and vein, as well as the tibialis anterior tendon. The anterolateral portal is made under direct visualization medial to the lateral malleolus. One should be cautious to avoid the superficial peroneal nerve, which is the most common neurovascular injury from ankle arthroscopy.

Fig 2

This is an arthroscopic view of the left ankle. Identification of superficial cartilage defect from repeated impingement from a hypertrophic AITFL is pictured here. A 2.0-mm shaver is used to remove scar, soft tissue synovial hyperplasia, and scar tissue in order to optimize visualization of the anterior aspect of the joint. AITFL, anterior inferior tibiofibular ligament.

Fig 3

This is an arthroscopic view of the left ankle from the anterolateral portal site. Inflamed and hypertrophic synovium and scar tissue are pictured here. One may be able to appreciate the hypertrophic and inflamed tissue entering the joint space with active dorsiflexion of the ankle. The patient's ability to stay engaged permits them to actively range the ankle joint, allowing visualization of any area of impingement.

Fig 4

This is an arthroscopic view of the anterior left ankle joint. Osteophyte and hypertrophic overgrowth causing impingement can be appreciated in this figure. A 3.0-mm burr can be introduced to resect the bony source of impingement.

Fig 5

This is an arthroscopic view of the anterior left ankle joint. This figure demonstrates burring of the anterior tibia with the goal of resecting to the anterior border of the medial malleolus.