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Risks Associated with Posterior Ankle Hindfoot Arthroscopy Complications

Risks Associated with Posterior Ankle Hindfoot Arthroscopy Complications

Aly Fayed, MD, M.SC., UNITED STATES Nacime Salomao Barbachan Mansur, MD, PhD, UNITED STATES Karthikeyan Chinnakkannu, MD, UNITED STATES Natalie Glass, PhD, UNITED STATES Phinit Phisitkul, MD, UNITED STATES Annunziato Amendola, MD, UNITED STATES John E Femino, MD, UNITED STATES

University of Iowa hospitals and clincs, Iowa city, Iowa, UNITED STATES

2023 Congress   ePoster Presentation   2023 Congress   rating (1)


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Summary: Sensory nerve injuries were the most common complications after posterior ankle arthroscopy, and they were primarily related with the accessory posterolateral portal.


The use the posterior ankle and hindfoot arthroscopy (PAHA) is expanding over time. Many new indications have been reported in the literature. The primary objective of this study is to report the rate of PAHA complications in a large cohort of patients and try to correlate findings with demographical and surgical variables.


In this IRB-approved retrospective comparative study, patients who underwent posterior ankle and/or hindfoot arthroscopy in a single institution from December 2009 to July 2016 were studied. A total of 232 subjects were selected, and 251 surgeries accounted. Three fellowship-trained orthopedic foot and ankle surgeon performed all surgeries.. Demographic data, diagnosis, surgical variables , associated procedures, and complications. To investigate a priori factors predictive of neurological complication after PAHA, unadjusted and multivariable regression techniques were utilized. Sparse events sensitivity analysis was tested by fitting models with Firth log-likelihood approach.


Indications were posterior ankle impingement (37%), flexor hallux longus disorders (14%), subtalar arthritis (8%), and osteochondral lesions (6%). Complications were observed in 6.8% (17/251) procedures. Neural sensory lesions were noted in 10 patients (3.98%), wound complications in four ankles (1.59%). When using unadjusted analysis, subtalar fusion and the use of accessory posterolateral portal were associated with neurological complications (p=0.002). In multivariable regression model controlled for confounders, the use of accessory posterolateral portal was the significant driver for neurological complications (OR=32.19, 95%CI: 3.53-293.50).


The complication rate in this cohort who were treated with posterior ankle and/or hindfoot arthroscopy was 6.8% Most complication was due to neural sensorial injuries (5 sural, 4 MPN,1 MCS) and three required additional operative treatment. The use of an accessory posterolateral portal was significantly associated with neurologic complications. The provided information may assist surgeons in establishing diagnoses, making therapeutic decisions, and instituting surgical strategies for patients that might benefit from a posterior arthroscopic approach.

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