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Complications of Ankle Arthroscopy Utilizing a Contemporary Noninvasive Distraction Technique
Brett H. Young, MD1; Ryan M. Flanigan, MD1; Benedict F. DiGiovanni, MD1
1 Department of Orthopaedics, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Box 665, Rochester, NY 14620. E-mail address for B.H. Young: brett_young@urmc.rochester.edu. E-mail address for R.M. Flanigan: ryan_flanigan@urmc.rochester.edu. E-mail address for B.F. DiGiovanni: benedict_digiovanni@urmc.rochester.edu
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Investigation performed at the Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, New York

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

Copyright © 2011 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2011 May 18;93(10):963-968. doi: 10.2106/JBJS.I.00977
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The reported complication rates of ankle arthroscopy, as well as the types of complications, refer to cases performed fifteen to twenty years ago and include a mixture of invasive and noninvasive distraction methods. As ankle arthroscopy has matured with a move away from invasive distraction and the introduction of improved instruments, it is unclear whether the previously reported complications are reflective of contemporary ankle arthroscopy. We sought to evaluate the types and rates of complications that are associated with contemporary ankle arthroscopy that utilizes noninvasive ankle distraction and a padded foot strap.


We retrospectively reviewed 294 consecutive arthroscopies. All patients underwent the same intraoperative noninvasive distraction protocol. Demographic data, diagnoses, duration of follow-up data, and procedure-related complications were identified, recorded, and analyzed.


All 294 cases were eligible for review. There were twenty complications, resulting in an overall complication rate of 6.8%. There were four non-neurologic complications, including one case of deep venous thrombosis, one case of prolonged portal drainage, and two cases of superficial infection. There were sixteen neurologic complications; six were related to the anterolateral portal, and eight patients had dysesthesias involving the dorsal part of the midfoot. When analyzed as a group, patients who were receiving Workers’ Compensation had a higher complication rate than patients who were not receiving Workers’ Compensation (21% versus 4.7%, respectively).


Contemporary ankle arthroscopy performed with use of a noninvasive distraction technique is a safe procedure. Our observed complication rate of 6.8% is lower than that reported in a previous benchmark study, although our patients who were receiving Workers’ Compensation had a significantly higher risk of having nerve symptoms. An important benefit of the use of contemporary ankle arthroscopy, in which small-joint arthroscopic instruments and noninvasive distraction techniques are used, is a marked reduction in the rate of non-neurologic complications.

Level of Evidence: 

Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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