Article

The risk of damage to cutaneous sensory nerves located near portals
has been evaluated for both conventional arthroscopy and extra-articular
posterior ankle endoscopy.
The objective of the anatomic study reported here was
to assess the risk of injury to the sural nerve or lateral calcaneal nerve while
using the distal lateral portal for the Achilles tendinoscopy procedure described
by Vega et al. in 2008. METHODS: We dissected the sural nerve and
its branch, the lateral calcaneal nerve, of 13 human cadaver ankles in the prone
position. We defined P as the point where the Achilles peritendon was opened
during the distal lateral approach used for the study technique. P was adjacent
to the lateral edge of the Achilles tendon, 2 cm proximal to the postero-superior
edge of the calcaneal tuberosity. T was defined as the attachment site of the
most lateral fibres of the Achilles tendon to the postero-superior edge of the
calcaneal tuberosity. We evaluated the origin of the lateral calcaneal nerve
relative to T and we measured the shortest distances separating P from the sural
nerve and lateral calcaneal nerve. RESULTS: A lateral calcaneal nerve was
identified in 10 (77%) ankles and originated a mean of 39.1mm (range,
25.0-65.0mm) proximal to T. P was at a mean distance from the sural nerve of
12.3mm (range, 5.0-18.0mm) and from the lateral calcaneal nerve of 6.8mm (range,
4.0-9.0mm). The median difference between these two distances was statistically
significant (P=0.002).
DISCUSSION: While using the distal lateral portal for
Achilles tendinoscopy, the lateral calcaneal nerve is at greater risk for injury
than is the sural nerve.
LEVEL OF EVIDENCE: Level IV. Anatomic Study.
CI - Copyright (c) 2015 Elsevier Masson SAS. All rights reserved.

Langue : FRANCAIS