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New Arthroscopic Entrance to the Ankle Described

Arthroscopy has changed the way surgeons treat joints. With a tiny TV camera on the end of a long, thin needle (scope), the doctor can see and work inside the joint. Smaller and smaller skin incisions are needed now because of this improved technology.

The point of entry into the joint is called the portal. Surgeons have had to find places to enter the joint without causing damage. They must avoid blood vessels and nerves. Two or three portals are used most often during arthroscopic ankle surgery. In this report, doctors describe a new (posteromedial) (PM) ankle portal.

Posteromedial means the scope enters from the back and side of the joint. A small incision is made alongside the posterior tibial tendon. It's located just behind the medial or inner ankle bone called the medial malleolus. In this article, position of the patient during surgery and the exact method of entry are described along with a patient case report using this technique.

For this one patient, the PM portal was used to remove bone spurs along the bottom of the lower leg bone (tibia). A loose fragment inside the joint space was also taken out during the arthroscopy. Three months later, the patient was pain free and there were no further problems.

The PM method described is safe and avoids neurologic damage. It offers the surgeon easy access to the joint with a good view of the posterior compartment of the ankle. Care must be taken to avoid damage to the posterior tibial tendon.

Jae Ang Sim, MD, et al. New Posteromedial Portal for Ankle Arthroscopy. In The Journal of Arthroscopic and Related Surgery. July 2006. Vol. 22. No. 7. Pp. 799.e1-799.e2.

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