Anterior and Posterior Ankle Arthroscopy in Prone Position: Description of Technique

CATEGORY: Arthroscopy; Ankle INTRODUCTION/PURPOSE: The ankle arthroscopy has many advantages compared to open surgery and it is possible to access the ankle anteriorly and posteriorly. The pathologies localized in the anterior and posterior aspects of the ankle may coexist and demand the combination of these approaches. The objective is to describe the anterior and posterior ankle arthroscopic access, keeping the patient in prone position, reducing the risks of contamination, surgical time and favoring the operative strategy. METHODS: Patients diagnosed with chronic ankle instability and posterior ankle impingement, who failed conservative treatment for 3 months were selected. These patients were positioned in ventral decubitus and performed arthroscopic resection of posterior impingement followed by a Brostrom-Gould procedure, without decubitus change. RESULTS: Patients were positioned in prone position, with spinal block performed and application of pneumatic tourniquet on the thigh. The posterior arthroscopic approach was first stablished through the posterolateral and posteromedial portals. The Os Trigonum could be identified and then removed. Maintaining the decubitus, the anterior approach was performed through 90° knee flexion, enabling the creation of the anteromedial and anterolateral portals. At this time, the lateral ankle instability could be treated by a Broström-Gould procedure in a upside down manner. CONCLUSION: The anterior and posterior approach by arthroscopy may provide a faster rehabilitation associated with lesser soft tissue trauma and lesser post-operative comorbities compared to open techniques. Also the combination of these approaches without decubitus change may reduce the surgery time and contamination risks. Disadvantages should also be considered and these includes the risk of compartimental syndrome and its severe complications. In addition, the arthroscopic images can be difficult to understand at first and the Broström-Gould procedure performed in a upside down manner will require a experienced staff in the surgery.