Complications of Ankle Arthroscopy Utilizing a Contemporary Noninvasive Distraction Technique

Background: 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. Methods: 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. Results: 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). Conclusions: 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.