Postoperative Sensory Nerve Complications Following Ankle Arthroscopy: Incidence, Risk Factors, and Clinical Course in 545 Consecutive Procedures

BACKGROUND: Neurologic complications are among the most frequent adverse events after ankle arthroscopy, yet their clinical course and prognostic factors remain incompletely defined. This study aimed to determine the incidence, risk factors, and natural history of postoperative neurologic complications following ankle arthroscopy. METHODS: A retrospective cohort study was conducted including 545 consecutive arthroscopic procedures of the ankle and hindfoot performed at a single referral center (October 2023-May 2025). Postoperative neurologic complications involving the superficial peroneal nerve or sural nerve were identified at routine follow-up. Patients presenting neurologic symptoms completed a structured electronic questionnaire assessing symptom onset, pain intensity, temporal evolution, neuropathic pain characteristics (DN4 and S-LANSS), and functional outcome using the Simple Ankle Value. Multivariable logistic regression analyses were performed to identify factors associated with neurologic injury and spontaneous symptom resolution. RESULTS: Neurologic complications occurred in 46 procedures (8.4%). The superficial peroneal nerve was most frequently involved (65.2%), followed by the sural nerve (23.9%). Symptoms developed within 48 hours postoperatively in 64.4% of cases. At a mean follow-up of 13 months, complete symptom resolution was observed in 44.4% of patients, while 84.4% reported progressive improvement. Smoking and surgical approach were independently associated with neurologic complications. Higher residual pain intensity and neuropathic pain features (S-LANSS ≥12) were associated with a lower likelihood of spontaneous recovery. CONCLUSION: Postoperative sensory nerve complications after ankle arthroscopy occurred in 8.4% of procedures and predominantly involved the superficial peroneal nerve. Although most patients reported progressive improvement, complete symptom resolution occurred in fewer than half at a mean follow-up of 13 months, which is a longer course than traditionally assumed. Smoking and non-anterior surgical approaches were independently associated with complications, and neuropathic pain features predicted lower rates of spontaneous recovery. These findings support individualized preoperative counseling and early recognition of neuropathic symptoms. LEVEL OF EVIDENCE: Level IV, retrospective cohort study.