Ankle position affects dorsalis pedis artery exposure in anterior ankle arthroscopy.
BACKGROUND
In anterior ankle arthroscopy, the anterior working area (AWA) is restricted by the presence of the dorsalis pedis artery (DPA) and tendons. Pseudoaneurysms caused by iatrogenic damage to the DPA are difficult to identify intraoperatively. In knee arthroscopy, risk of popliteal artery damage is reduced in the flexed position [1]. This study investigates how DPA movement is affected by dorsiflexion and plantarflexion with the aim of identifying the positions providing the greatest AWA.


METHODS
Twelve cadaveric ankles were dissected to access the DPA. While distracted, ankles were progressively dorsiflexed at 5° intervals from maximum plantarflexion. DPA and tibialis anterior tendon (TA) movement at each 5° interval was measured by their respective distances from the inferior border of the medial malleolus.


RESULTS
Mean ankle dorsiflexion was 24.58±1.30° with all specimens showing anterior DPA and TA movement as dorsiflexion increased. Mean DPA and TA movement at maximum dorsiflexion was 3.58±0.29mm and 2.92±0.34mm respectively. A ratio of 1:1.23 relates TA and DPA movement (inmm), and a ratio of 10:1.46 relates dorsiflexion angle to DPA movement (inmm).


CONCLUSIONS
Anterior movement of the dorsalis pedis artery during dorsiflexion increases the AWA for anterior arthroscopy. Increasing the AWA with maximal dorsiflexion may prove to be a valuable method for lowering the risk of iatrogenic DPA damage. Additionally, increased AWA may allow the use of larger diameter surgical instruments allowing greater control and a reduction in operation time.
Division of Biomedical Sciences, St. George's University of London, Cranmer Terrace, London SW17 0RE, United Kingdom. Electronic address: priyesh1988@hotmail.com.
Priyesh Ashok
PA
Karia
Nevill Hall Hospital, Brecon Road, Abergavenny NP7 7EG, United Kingdom. Electronic address: nathdwara@yahoo.co.uk.
Yogesh
Y
Nathdwarawala
Division of Biomedical Sciences, St. George's University of London, Rm 0130, Jenner Wing Basement, Cranmer Terrace, London SW17 0RE, United Kingdom. Electronic address: mszarko@sgul.ac.uk.
Matthew
M
Szarko
D000843:Ankle Joint / Q000601:surgery*; D001182:Arthroscopy / Q000379:methods*; D002102:Cadaver; D005260:Female; D005528:Foot / Q000098:blood supply*; D006801:Humans; D008297:Male; D011187:Posture
Ankle arthroscopy; Dorsalis pedis artery