Distance Between the Anterior Distal Tibial Edge and the Anterior Tibial Artery in Distraction and Nondistraction During Anterior Ankle Arthroscopy: A Cadaveric Study.

BACKGROUND: Anterior ankle arthroscopy is widely applied for various osteoarthropathies. However, distraction of the ankle may put the anterior tibial artery (ATA) at risk of injury during the procedure. The purpose of this study was to assess the difference in the distance between the anterior distal tibial edge and the ATA in distraction and nondistraction of the ankle with joint space expansion by saline injection into the joint.

METHODS: Eight whole fresh-frozen cadaveric feet (mean age 78.9 years) were used. Barium sulfate suspension was injected into the popliteal artery of each specimen, and the distance from 3 aspects of the anterior distal tibial edge to the ATA was measured to evaluate the possibility of damage to the ATA based on computed tomography (CT) scans, in ankle distraction and nondistraction, using a traction device developed for reproducible ankle positioning inside the CT scanner.

RESULTS: The distance between the ATA and the most proximal, middle, and distal parts of the anterior distal tibial edge was 0.5 mm, 3.9 mm, and 7.4 mm, respectively, without saline injection, and 3.7 mm, 7.2 mm, and 11.6 mm, respectively, with saline injection, in nondistraction. The distance was 2.2 mm, 5.9 mm, and 9.8 mm, respectively, with 5-kg distraction, and 1.7 mm, 5.1 mm, and 8.8 mm, respectively, with 10-kg distraction, both with saline injection, respectively.

CONCLUSION: The distance between the anterior distal tibial edge and the ATA with joint space expansion by saline injection into the joint increased, and that distance in distraction of the ankle decreased during anterior arthroscopic surgery.

CLINICAL RELEVANCE: The anatomic relationship of the ATA to its surrounding structures may be at more risk without saline injection or with distraction during anterior ankle arthroscopy.