title: Percutaneous lateral ankle stabilization: an anatomical investigation.
abstract: BACKGROUND
  The current study investigated the topographic anatomy of the percutaneous anatomical lateral ankle stabilization in relation to the neurovascular hindfoot structures. The study should serve as an aid for performance of this new minimally invasive technique.
  
  
  METHODS
  Eleven cadaver specimens were dissected exposing the nerves, vessels, ligaments and tendons. The portals and transosseous tunnels were performed with Kirschner wires. All distances of the Kirschner wires and the neurovascular structures were measured with reference to clearly identifiable bony landmarks.
  
  
  RESULTS
  On the medial side the average distance of the Kirschner wire to the medial calcaneal branch of the tibial nerve was found to be 7 mm (SD±4). The medial calcaneal branch was hit twice by the transosseous Kirschner wire. On the lateral side the mean distance of the fibular exit point of the Kirschner wire to the sural nerve was 13 mm (SD±4). The closest distance of the superficial peroneal nerve to the footprint of the ATFL averaged 11.5 mm (SD±3) and its anterior location in relation to the tip of the fibula was 28 mm (SD±8). The posterior tibial artery was found at a mean distance of 41 mm from the perforating Kirschner wire (SD±6).
  
  
  CONCLUSIONS
  The current study introduced a novel percutaneous approach to treat chronic ankle instability that had minimal risk to neurovascular structures in a cadaver model.
  
  
  CONCLUSIONS
  Further clinical studies must be undertaken to identify whether this technique would also be superior when compared with open surgery.
authors.affiliation: University of Zurich, Department of Orthopaedics, Zurich, Switzerland.
authors.forename: Georg
authors.initials: G
authors.lastname: Klammer
authors.forename: Gudrun
authors.initials: G
authors.lastname: Schlewitz
authors.forename: Christiane
authors.initials: C
authors.lastname: Stauffer
authors.forename: Magdalena
authors.initials: M
authors.lastname: Vich
authors.forename: Norman
authors.initials: N
authors.lastname: Espinosa
mesh_terms: D000843:Ankle Joint / Q000098:blood supply / Q000294:innervation / Q000601:surgery; D001864:Bone Wires; D002102:Cadaver; D005471:Fluoroscopy; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D008023:Ligaments, Articular / Q000601:surgery; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D019637:Orthopedic Procedures; D010543:Peroneal Nerve / Q000033:anatomy & histology; D013497:Sural Nerve / Q000033:anatomy & histology; D013710:Tendons / Q000637:transplantation; D016909:Tibial Arteries / Q000033:anatomy & histology; D013979:Tibial Nerve / Q000033:anatomy & histology