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Foot Ankle Surg. 2019 Apr 24. pii: S1268-7731(19)30061-X. doi: 10.1016/j.fas.2019.04.008. [Epub ahead of print]

Anatomical structures at risk in the arthroscopic Broström-Gould procedure: A cadaver study.

Author information

1
Dept of Orthopedic Surgery, UAB School of Medicine, 1802 6th Avenue South, Birmingham, AL, 35233, USA. Electronic address: ccpitts@uabmc.edu.
2
Dept of Orthopedic Surgery, UAB School of Medicine, 1201 11th Ave, Birmingham, AL, 35294, USA. Electronic address: hmckissack@uabmc.edu.
3
Dept of Orthopedic Surgery, UAB School of Medicine, 1201 11th Ave, Birmingham, AL, 35294, USA. Electronic address: mca18@uab.edu.
4
Dept of Orthopedic Surgery, UAB School of Medicine, 1201 11th Ave, Birmingham, AL, 35294, USA. Electronic address: kmbudd@uab.edu.
5
Dept of Orthopedic Surgery, UAB School of Medicine, 1201 11th Ave, Birmingham, AL, 35294, USA. Electronic address: crb1621@jagmail.southalabama.edu.
6
Dept of Orthopedic Surgery, UAB School of Medicine, 1802 6th Avenue South, Birmingham, AL, 35233, USA. Electronic address: snaranje@uabmc.edu.
7
Dept of Orthopedic Surgery, UAB School of Medicine, 1802 6th Avenue South, Birmingham, AL, 35233, USA. Electronic address: ashishshah@uabmc.edu.

Abstract

BACKGROUND:

The Broström Gould procedure is the gold standard for repair of lateral ankle ligament injury and ankle instability. This procedure has demonstrated excellent short- and long-term outcomes in the orthopedic literature. Arthroscopic Broström Gould techniques have become increasingly popular among some foot and ankle orthopedic surgeons. Typically, this technique requires standard anteromedial and anterolateral portals along with an accessory lateral working portal. The exact location of this portal is variable within the available described surgical techniques. The objective of this cadaveric study is to establish a standard entry point for and to assess the safety of the accessory lateral portal with respect to nearby anatomical structures.

METHODS:

Ten fresh-frozen below-knee cadaver specimens were used. The location of the accessory lateral portal was created 1.5 cm anterior to the distal tip of the fibula. A small vertical incision was made at this point, followed by insertion of a Kirschner wire into the joint. The wire was then gently impacted into the fibula. Superficial dissection was subsequently carried out around the entry point to identify the peroneal tendons, superficial peroneal nerve branches, and sural nerve branches. Structures were marked with colored push pins, and distance was measured between the nearest edge of the Kirschner wire and each of the three anatomic structures listed. Any instances of structural contact or damage were documented.

RESULTS:

The average distance from the Kirschner wire to the peroneal tendon was 16.1 (±4.41) mm. The average distance from the wire to the superficial peroneal nerve and sural nerve was 13.11 (±6.79) mm and 12.33 (±4.08) mm, respectively. There were no instances of injury to any of the studied structures. However, there was a notable amount of variability in the proximity of structures in question for each cadaver. A branch of the superficial peroneal nerve was measured as close as 2 mm and as far as 24 mm in separate cadaver specimens.

CONCLUSION:

Arthroscopic Broström Gould procedures are a safe and effective method for lateral ankle ligamentous repair but are not without risk. Accessory lateral portal placement is relatively safe but should be meticulously executed to avoid damage to nearby anatomical structures.

KEYWORDS:

Anterior talofibular ligament repair; Arthroscopy; Broström Gould; Lateral ankle instability; Neurovascular injury

PMID:
31133369
DOI:
10.1016/j.fas.2019.04.008

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