title: Branching patterns of the superficial peroneal nerve: implications for ankle arthroscopy and for anterolateral surgical approaches to the ankle.
abstract: Ankle arthroscopic procedures offer less postoperative morbidity with faster healing times than open surgical procedures but still have associated risks. Complication rates as high as 17% have been reported. One of the most commonly reported complications is iatrogenic damage to the superficial peroneal nerve, which can result in numbness, tingling, or painful neuralgia. In the present study, we attempted to better assess the location of the superficial peroneal nerve at the ankle to improve preoperative planning and reduce complication rates. Fifty ankle specimens were dissected. A concerted effort was made to classify the location of the superficial peroneal nerve according to the Takao branching pattern, zones of the ankle, and distance to anatomic landmarks. Through our dissections, we found that most ankles have 2 nerve branches at the level of the ankle joint (Takao type II) and that the location of the superficial peroneal nerve branches at the ankle correlated directly with the ankle width. Additionally, 68% of specimens contained a nerve branch located in zone 1, where the anterolateral portal is placed, and 12% had a branch in zone 5, the location of the anteromedial portal site. The results of the present study have confirmed the wide variation in nerve location at the level of the ankle joint and serve to highlight the need for extreme caution during surgical procedures at the ankle.
authors.affiliation: Fourth Year Medical Student, University of Michigan Medical School, Ann Arbor, MI.
authors.forename: Allison M
authors.initials: AM
authors.lastname: Darland
authors.affiliation: Department of Orthopaedic Surgery, University of Michigan Health System, Ann Arbor, MI.
authors.forename: Anish R
authors.initials: AR
authors.lastname: Kadakia
authors.affiliation: Departments of Orthopaedic Surgery and Emergency Medicine, University of Michigan Health System; and Division of Anatomical Sciences, Department of Medical Education, University of Michigan Medical School, Ann Arbor, MI. Electronic address: jlzeller@umich.edu.
authors.forename: John L
authors.initials: JL
authors.lastname: Zeller
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000843:Ankle Joint / Q000294:innervation* / Q000601:surgery*; D001182:Arthroscopy; D002102:Cadaver; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010543:Peroneal Nerve / Q000033:anatomy & histology* / Q000293:injuries; D011183:Postoperative Complications
keywords: ankle arthroscopy; complication; intermediate dorsal cutaneous nerve; medial dorsal cutaneous nerve; superficial peroneal nerve; surgical incision