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By Ned Amendola

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4-17). As the arthroscope is slowly withdrawn, the more superficial portion of the ligament and the anterolateral margin of the posterior subtalar joint are examined (Fig. 4-18). As the arthroscope is manipulated into the lateral gutter, rotating it for viewing and keeping the joint line visible as the corner is rounded, the lateral talocalcaneal ligament is the first ligament capsular condensation observed (Fig. 4-19). Proceeding slightly more posteriorly, the operator can see the location of the calcaneofibular ligament.

The contraindications to distraction are found in Box 3-3. 1,22,23 The need for distraction can be minimized or eliminated by using smaller arthroscopic instruments or by a more accurate preoperative diagnosis. Distraction may make some portions of ankle arthroscopy more difficult. 1 Because most therapeutic ankle arthroscopy procedures occur within the anterior 22 AANA ADVANCED ARTHROSCOPY: THE FOOT AND ANKLE Box 3-2 Potential Complications of Invasive and Noninvasive Distraction in Ankle Arthroscopy INVASIVE DISTRACTION ● ● ● ● ● ● ● ● ● ● ● Vascular complications Deep peroneal artery injury Lesser saphenous vein injury Neurologic complications Deep peroneal nerve injury Sural nerve injury Tendinous complications Peroneal tendon injury Ligament stretching or disruption Infection (soft tissue or bone) Pin breakage Fractures Acute pull-out Delayed second degree to stress riser Pain at the insertion site Subtalar joint injury Hypertrophic scar Sharp injury to surgeon or patient A NONINVASIVE DISTRACTION ● ● Neuropraxia Skin abrasion Data from references 3, 6, 14, 17, 18, and 19.

As the viewing angle is turned toward the joint, the articular surface of the posterior process of the talus, or the os trigonum if present, can be seen. Turning the viewing angle toward the capsule laterally reveals the posterior talocalcaneal ligament. If the arthroscope cannot be advanced into the posterolateral recess from the anterolateral portal, the arthroscope is switched to the posterior portal to achieve visualization of the structures previously described. In a relatively lax ankle, the arthroscope can be advanced across the joint, and the interosseous ligament can be examined from this posterior view.

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AANA Advanced Arthroscopy. The Foot and Ankle by Ned Amendola

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