Anatomic bases of ankle arthroscopy: study of superficial and deep peroneal nerves around anterolateral and anterocentral approach

We studied the anatomy of the anterolateral and anterocentral portal sites for ankle arthroscopy with reference to the superficial peroneal nerve (SPN ) in 29 cadavers (51 ankles) and the deep peroneal nerve (DPN) in 11 cadave rs (21 ankles). In relation to the level of division into the medial and in termediate cutaneous nerves and their terminal branches, we classified the structure of the SPN surrounding the ankle into five types. We also identif ied the point where the SPN and the DPN cross the level of the talocrural j oint. 32% of specimens had different SPN division types on the two sides an d there was an average of 2 nerves at the level of the talocrural joint. Br anches of the SPN were found lateral to the edge of the peroneus tertius te ndon in 11.8% of specimens, and at its lateral edge in 27.5%. The DPN and s ome branches of the SPN were positioned around the lateral edge of the exte nsor hallucis longus tendon. We consider that the anterolateral portal shou ld be made at least 2 mm lateral to the peroneus tertius tendon to avoid in jury to the SPN, since the diameter of the scope is 2.7 mm. The anterocentr al portal is unsuitable for arthroscopy due to a high risk of injury to the DPN and branches of the SPN.