title: Is the anterior tibial artery safe during ankle arthroscopy?: anatomic analysis of the anterior tibial artery at the ankle joint by magnetic resonance imaging.
abstract: BACKGROUND
  Pseudoaneurysm of the anterior tibial artery (ATA) after ankle arthroscopy is an uncommon complication but can cause unexpected consequences. However, its contributing factor is not fully understood.
  
  
  OBJECTIVE
  Anatomic factors, such as ATA variations and the distance between the ATA and joint capsule, may contribute to the occurrence of pseudoaneurysm.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  The magnetic resonance images and medical records of 358 ankle cases were analyzed. According to locations of the ATA in relation to the peroneus tertius (PT) and the extensor digitorum longus (EDL) tendon on axial magnetic resonance imaging, patients were classified as type 1 (safe type), type 2 (increased risk type), or type 3 (high-risk type). In addition, distances between the anterior joint capsule and the ATA were measured to evaluate the thickness of the anterior fat pad, which contains the ATA and anterior compartment tendons.
  
  
  RESULTS
  In 336 cases (93.8%), the ATA was located medial to the EDL (type 1, safe). In 7 cases (2.0%), the ATA was located lateral to the EDL and PT tendon (type 2, increased risk); and in 15 cases (4.2%), the branching artery was observed lateral to the EDL and PT tendon and the ATA was in the normal position (type 3, high risk). The mean distance between the anterior joint capsule and the ATA was 2.3 ± 1.1 mm.
  
  
  CONCLUSIONS
  In 22 (6.2%) of the 358 cases, the ATA and its branches were located near the anterolateral ankle portal, which introduces the risk of vascular damage during arthroscopic surgery. Furthermore, the mean distance between the ATA and the joint capsule was only 2.3 ± 1.1 mm, and thus the ATA is very close to the anterior working space of the ankle joint. Careful preoperative evaluation and an intra-articular procedure may reduce the risk of vascular complications attributable to ankle arthroscopy.
authors.affiliation: Department of Orthopaedic Surgery, Ajou University School of Medicine, San 5, Woncheon-Dong, Youngtong-Gu, Suwon, South Korea. osmedic@ajou.ac.kr
authors.forename: Kwang-Hyun
authors.initials: KH
authors.lastname: Son
authors.forename: Jae Ho
authors.initials: JH
authors.lastname: Cho
authors.forename: Jin Woo
authors.initials: JW
authors.lastname: Lee
authors.forename: Kyu-Sung
authors.initials: KS
authors.lastname: Kwack
authors.forename: Seung Hwan
authors.initials: SH
authors.lastname: Han
mesh_terms: D000273:Adipose Tissue / Q000033:anatomy & histology / Q000098:blood supply / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000842:Ankle / Q000033:anatomy & histology / Q000098:blood supply* / Q000601:surgery*; D001182:Arthroscopy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016909:Tibial Arteries / Q000033:anatomy & histology / Q000293:injuries / Q000601:surgery*; D057772:Vascular System Injuries / Q000209:etiology*; D055815:Young Adult