Anterior Approach to Ankle Joint

  • The anterior approach to Ankle Joint provides excellent exposure of the ankle joint for arthrodesis.

  • The anterior approach to Ankle Joint uses include the following:
    1. Open reduction and internal fixation of pilon fractures.
    2. Ankle arthrodesis.
    3. Total ankle arthroplasty.
    4.  Drainage of infections in the ankle joint.
    5. Removal of loose bodies.

  • Place the patient supine.

  • Landmarks:
    • Medial malleolus.
    • Lateral malleolus.
  • Incision:
    • Make a 15 cm incision over anterior ankle:
      • Begin 10 cm proximal to joint.
      • Cross joint midway between malleoli.
      • Stay superficial to avoid injury to superficial peroneal nerve branches.
    • Alternatively, make a 15-cm longitudinal incision with its center overlying the anterior aspect of the medial malleolus.

  • There is no true internervous plane for the anterior approach to Ankle Joint.
  • Intermuscular plane lies between:
    • Extensor hallucis longus.
    • Extensor digitorum longus.
      • Both are innervated by deep peroneal nerve.

  • Incise deep fascia of leg in line with skin incision.
  • Incise extensor retinaculum.
  • Find plane between extensor digitorum longus and extensor hallucis longus a few cm above joint.
  • Identify neurovascular bundle.
    • Mobilizing tibialis anterior artery and deep peroneal nerve.
  • Retract extensor hallucis longus and neurovascular bundle medially.
  • Retract extensor digitorum longus laterally.
  • Remaining joint capsule tissue cleared to expose anterior ankle joint.

  • Incise capsule of ankle joint in line with incision.
  • Expose full width of ankle joint by subperiosteal and subcapsular dissection of the tibia and talus.

  • The anterior approach to Ankle Joint can be extended proximally to expose the structures in the anterior compartment.
  • To expose the proximal tibia, use the plane between the tibia and the tibialis anterior muscle.
  • Distal extension to the dorsum of the foot is possible, but rarely is required.

  • The structures at risk during the anterior approach to Ankle Joint include:
    1. Superficial peroneal nerve cutaneous branches:
      • at greatest danger during skin incision.
    2. Neurovascular bundle (deep peroneal nerve and anterior tibial artery):
      • above joint runs between extensor digitorum longus and extensor hallucis longus.
      • crosses behind extensor hallucis longus at level of the joint.

  • Surgical Exposures in Orthopaedics book - 4th Edition
  • Campbel's Operative Orthopaedics book 12th