SLR - October 2023 - Hill
Title: Complications following ankle arthroscopy: a systematic reviewReference: Arshad Z, Aslam A, Al Shdefat S, Khan R, Jamil O, Bhatia M. Complications following ankle arthroscopy. Bone Joint J. 2023;105-B(3):239-246. doi:10.1302/0301-620X.105B3.BJJ-2022-0796.R1
Level of Evidence: Level 3
Scientific Literature Review
Reviewed By: Russell J. Hill, DPM
Residency Program: Temple University Hospital, Philadelphia, PA
Podiatric Relevance: Advancements in arthroscopic instrumentation and techniques have greatly increased the indications for ankle arthroscopy for the podiatric physician and surgeon. Ankle arthroscopy can be used to treat a broad range of disorders including osteochondral defects, ankle arthritis, ankle instability and soft-tissue impingement lesions. While arthroscopy can be technically challenging with initial use, benefits of arthroscopy compared to open ankle surgery include reduced postoperative recovery time, increased postoperative function and decreased complication rates. While decreased complications rates are a benefit, there is still an overall complication rate in the literature ranging from 0% - 20%. Elucidating a more accurate complication rate along with range of complications can be beneficial for the surgeon and patient in determining if the benefits of ankle arthroscopy outweigh its potential risks.
Methods: A systematic review was performed with a computer-based search in PubMed, Embase, Emcare and ISI Web of Science. Search terms included “ankle”, “talocrural”, “tibiotalar”, “arthroscop”, and “endoscop”. All searches were performed with English language only filter. Observational studies, cohort studies and randomized controlled trials involving patients >18 years undergoing ankle arthroscopy were included. Studies with fewer than ten patients were excluded. The primary outcome was to determine the prevalence and type of complications occurring during and after ankle arthroscopy. Studies reporting no major or severe complications were excluded. Studies with a purpose of reporting only on a specific complication were also excluded. Major complications included deep vein thrombosis (DVT), pulmonary embolism (PE), and deep infection. All other complications were considered minor complications.
Results: A total of 150 studies were included, with 7942 cases of ankle arthroscopy across 7777 patients. The overall complication rate was 325/7942 (4.09%), with the most common complication being neurological injury. Neurological injury accounted for 180/325 (55.4%) of all complications. Injury to the superficial peroneal nerve occurred in 59/180 (32.7%). Permanent nerve damage was seen in 36/180 (20%) of cases. Anterior ankle arthroscopy had a lower complication rate compared to posterior ankle arthroscopy (4.35% compared to 6.6%). The rate of neurologic injury was 2.6% in cases with distraction and 2.2% in cases without distraction. The overall major complication rate was 16/7942 (0.2%), with DVT occurring in five cases.
Conclusions: This systematic review demonstrates that ankle arthroscopy is a safe procedure with overall low complication rates. Most complications are minor, with the most common being temporary nerve injury. The overall major complication rate was 0.2%, specifically for occurrence of DVT. These results are of great value to the foot and ankle surgeon in clinical and procedural decision making and informing patient expectations.