title: Posterior ankle and hindfoot endoscopy: A cadaveric study.
abstract: BACKGROUND
  The list of indications of posterior ankle endoscopy is expanding and includes various soft tissue and bony pathologies of the posterior ankle. Some of the indications, e.g. release of frozen ankle, debridement of posteromedial soft tissue impingement of the ankle and debridement or fixation of the posteromedial osteochondral lesion of the talus, require approach to the posterior ankle medial to the flexor hallucis longus tendon. The purpose of this study was to assess the risk of injury to the posterior tibial neurovascular bundle during posterior ankle endoscopy.
  
  
  METHODS
  Fourteen fresh frozen foot and ankle specimens were used. A metal rod was inserted into the posteromedial, posterolateral and modified posteromedial portals and touched the medial border of the posterolateral talar tubercle and the posteromedial corner of the ankle mortise in turn. The neurovascular bundle and FHL tendon were examined for any kink.
  
  
  RESULTS
  The neurovascular bundle was kinked in all specimens (100%) with the rod at the posteromedial corner of the ankle mortise through the posteromedial portal and was kinked in 11 specimens (79%) with the rod through the modified posteromedial portal. The neurovascular bundle was kinked in 1 specimen (7%) with the rod through the posterolateral portal.
  
  
  CONCLUSIONS
  The neurovascular bundle was at risk during instrumentation of the posteromedial ankle through the posteromedial portal but was safe through the posterolateral portal.
authors: Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong SAR, China. Electronic address: luithderek@yahoo.co.uk.
authors: T H
authors: TH
authors: Lui
authors: Institute of Medical and Health Sciences Education and Department of Anatomy, The University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong SAR, China. Electronic address: lapki@hkucc.hku.hk.
authors: L K
authors: LK
authors: Chan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000843:Ankle Joint / Q000033:anatomy & histology* / Q000000981:diagnostic imaging / Q000601:surgery; D002102:Cadaver; D019723:Endoscopes; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005528:Foot / Q000033:anatomy & histology* / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity
keywords: Ankle; Endoscopy; Hindfoot; Posteromedial