Summary

Arthroscopic posterior tibial nerve neurolysis : a cadaveric study

Abstract

Arthroscopic Posterior Tibial Nerve Neurolysis
A. GHABCHA, N. BAUDRIER, A. HARDY, T. BAUER

Introduction

The indications for an ankle arthroscopy is expanding, neuropathy of the tibial nerve could be one of them, the purpose of our study is to discuss the safety and feasibility of the arthroscopic neurolysis of the posterior tibial nerve proximal to the tarsal tunnel.

Materials And Methods

Fourteen lower limbs of seven fresh frozen cadavers were dissected. Posterior tibial nerve neurolysis was done arthroscopically starting 5cm proximal to the medial malleolus until 2cm distal to the medial malleolus (proximal border of the tarsal tunnel) using standards posteromedial and posterolateral arthroscopic portals, then open dissection was done at the same level of the neurolysis to identify any iatrogenic nerve injury, vascular injury or tendon injury.
The main judgment criteria were the achievement of the neurolysis of the posterior tibial nerve, the secondary criteria were the presence of any nerve lesion, vascular lesion, flexor hallucis longus lesion.

Results

The Neurolysis of the Posterior Tibial Nerve was successful in 14 ankles, no nerve lesion was noted, we had 1 arterial lesions in 14 ankles (7%), no flexor hallucis longus lesion was observed.

Conclusion

The neurolysis of the posterior tibial nerve proximal to the Tarsal Tunnel can be done Arthroscopically, the risk of the vascular lesion remains high, the procedure should be done by experienced surgeon familiar with ankle anatomy and arthroscopy to minimize this rate.

Key Words: Arthroscopic Neurolysis, Posterior Tibial Nerve, Ankle