Indications
- Anterior bony or soft tissue impingement
- Osteochondral lesions of the talus
- Loose bodies and synovitis
- Arthroscopic ankle arthrodesis
- Assessment and treatment of syndesmosis injury and lateral gutter impingement
- Os trigonum excision through posterior portals
Position
- Supine, non-invasive distraction, thigh tourniquet
- Posterior arthroscopy is done prone with posterolateral and posteromedial portals beside the Achilles tendon
Operative Steps
- Mark the superficial peroneal nerve, visible with plantarflexion and inversion
- Anteromedial portal just medial to tibialis anterior at the joint line
- Anterolateral portal lateral to peroneus tertius under vision
- Avoid an anterocentral portal over the dorsalis pedis and deep peroneal nerve
- Debride impinging osteophytes and synovitis
- Debride and microfracture small contained osteochondral lesions
- Use a 2.7 mm or 4 mm arthroscope
- Inspect systematically, including the gutters and the anterior and posterior tibiotalar joint
- Nick skin only and spread bluntly to protect nerves
Postoperative Care
- Early motion
- Protected weight bearing after microfracture
- Elevation and ice for swelling
- Return to sport depends on the procedure, about 6 weeks after impingement surgery
Complications
- Superficial peroneal nerve injury, the most common complication
- Portal sinus and infection
- Cartilage damage
- Sural and saphenous nerve injury
- Deep peroneal nerve and dorsalis pedis injury with anterocentral portals
- DVT is uncommon
Related Pages
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.