Paving New Pathways in Ankle Arthroscopy: Utilization of a Lateral Portal for Patients Undergoing Multiple Procedures

Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: Ankle arthroscopy (AA) is commonly utilized to diagnose and treat intra-articular pathologies of the ankle joint. Arthroscopy can be performed in either the anterior or posterior ankle. In anterior AA, anteromedial (AM) and anterolateral (AL) portals are commonly established to visualize the joint. However, AL portal use is associated with neuropraxic injuries to the superficial peroneal nerve (SPN) as it runs in close proximity to the AL portal site. When AA is combined with additional procedures, such as a Brostrom-Gould ligament repair or open reduction internal fixation (ORIF), the creation of a lateral incision is required. We present a novel approach to performing AA with adjunct procedures and avoiding the use of an AL portal; the AM and lateral incision are used for instrumentation instead. Methods: Following IRB approval, a retrospective review of patients who underwent ankle arthroscopy by a single surgeon at a single institution between January 2020 to October 2024 was conducted. Patients were then assigned to one of three groups: patients who underwent AA only (AA), AA plus Brostrom-Gould repair or ORIF (AA+), or AA plus adjunct procedures using the lateral portal instrumentation method (LP). One hundred fifty-seven patients were initially identified; two were excluded per criteria. Data collected included demographic information, intraoperative details, postoperative complications, and reoperations. Descriptive statistics were used to describe demographics and operative data, and two-tailed Student t-tests were employed to identify statistical differences between group metrics. Results: 155 patients were included, 35 underwent LP, 57 underwent AA+, and 63 underwent AA. There were no significant demographic differences between groups. Mean follow-up was 11.2 months. Increased complication rates were seen in LP (12/35, 34.29%) and AA+ groups (20/57, 35.09%) compared to the AA group (12/63, 19.05%), however, none were statistically significant. SPN neuropathy occurred in two patients in the LP group and one patient in the AA group, all three resolved at follow-up. SPN neuropathy occurred in one patient in the AA+ group, but did not resolve at follow-up. The LP group demonstrated the highest rate of reoperation (11/35, 31.4%), followed by the AA+ group (8/57, 14.1%) and the AA group (2/63, 3.17%); however, none were statistically significant. Conclusion: This is a pilot study demonstrating preliminary data for a far-lateral arthroscopic approach. Our initial data suggests two conclusions: one, that SPN injury risk is not increased with a lateral approach; and two, that the lateral approach does not result in higher complication or reoperation rates than a traditional AA plus adjunct procedures approach. However, as expected, multiple procedures still increase risks versus simple diagnostic AA, which is reflected in the results. Future studies should include a larger sample size with multiple surgeons across multiple sites to validate these results.