Posteromedial tendinous and neurovascular structures of the ankle: the correlation between arthroscopic and open dissection in a cadaveric study

OBJECTIVES: Posterior ankle arthroscopy has advanced considerably in recent years. A large number of posteromedial pathologies can now be treated by arthroscopy on an outpatient basis. The purpose of this study was to evaluate the feasibility and safety of a posteromedial ankle arthroscopy with an open control procedure. METHODS: Twenty cadavers were dissected (twenty-four ankles). We first performed a posterior ankle arthroscopy using the classical ankle approaches: posteromedial and posterolateral. A third approach was created at the base of the posterior tibial tendon, posterior to the colliculus of the medial malleolus. Through this opening a hook was introduced to protect the posteromedial neurovascular bundle. A posteromedial arthroscopy was then performed, from the flexor hallucis longus tendon to the medial malleolus, as far as possible. The second part consisted of performing an open posteromedial dissection of the ankle to determine whether there were lesions of the posteromedial neurovascular bundle. RESULTS: Tenolysis of the flexor hallucis longus, flexor digitorum longus and posterior tibial tendons was successfully performed. Exposure of the posteromedial ankle junction was satisfactory enough to enable the performance of various surgical procedures in this zone: such as tenolysis, a posteromedial intra-articular procedure. During the open procedure, no lesions were noted in the neurovascular bundle as all the structures were intact. CONCLUSION: We arthroscopically dissected the posteromedial ankle junction. A safe reproducible technique to explore the posteromedial ankle that enables arthrolysis, posterior tibial nerve exploration, tendon surgery, and treatment of talar dome lesions was described.