Posterolateral Approach to Ankle Joint

  • The posterolateral approach to ankle joint is used to treat conditions of the posterior aspect of the distal tibia and ankle joint.

  • The posterolateral approach to ankle joint other uses include the following:
    1. Excision of sequestra.
    2. Removal of benign tumors.
    3. Arthrodesis of the posterior facet of the subtalar joint.
    4. Posterior capsulotomy and syndesmotomy of the ankle.
    5. Elongation of tendons.

  • Prone position.
  • Lateral position.
  • Supine position:
    • A large bump is needed under ipsilateral hip to allow for access.

  • Landmarks:
    1. Lateral malleolus.
    2. Achilles tendon.
  • Incision:
    • Make a 10-cm longitudinal incision halfway between the posterior border of the lateral malleolus and the
      lateral border of the Achilles tendon.
    • Begin the incision at the level of the tip of the fibula and extend it proximally.

  • The internervous plane for The posterolateral approach to ankle joint lies between:
    • The peroneus brevis muscle: which is supplied by the superficial peroneal nerve.
    • The flexor hallucis longus muscle: which is supplied by the tibial nerve.

  • Mobilize the skin flaps.
    • The short saphenous vein and sural nerves run just behind the lateral malleolus.
  • Incise the deep fascia of the leg in line with the skin incision, and identify the two peroneal tendons as they pass down the leg and around the back of the lateral malleolus.
    • The tendon of the peroneus brevis muscle is anterior to that of the peroneus longus muscle at the level of the ankle joint and, therefore, is closer to the lateral malleolus.
  • Incise the peroneal retinaculum to release the tendons, and retract the muscles laterally and anteriorly to expose the flexor hallucis longus muscle.

  • Make a longitudinal incision through the lateral fibers of the flexor hallucis longus muscle as they arise from the fibula.
  • Retract the flexor hallucis longus medially to reveal the periosteum over the posterior aspect of the tibia.
  • If the distal tibia must be reached, develop an epi-periosteal plane between the periosteum covering the tibia and the overlying soft tissues.
  • To enter the ankle joint, follow the posterior aspect of the tibia down to the posterior ankle joint capsule and incise it transversely.

  • To extend the posterolateral approach to ankle joint proximally, extend the skin incision superiorly and identify the plane between the lateral head of the gastrocnemius muscle and the peroneus muscles.
  • Develop this plane down to the soleus muscle; retract it medially with the gastrocnemius. Next, reflect the flexor hallucis longus muscle medially, detaching it from its origin on the fibula.
  • Continue the dissection medially across the interosseous membrane to the posterior aspect of the tibia.

  • The structures at risk during the posterolateral approach to ankle joint includes:
    1. Short saphenous vein.
    2. The sural nerve.

  • Surgical Exposures in Orthopaedics book - 4th Edition
  • Campbel's Operative Orthopaedics book 12th
Posterolateral Approach to Ankle Joint Posterolateral Approach to Ankle Joint Posterolateral Approach to Ankle Joint Posterolateral Approach to Ankle Joint Posterolateral Approach to Ankle Joint Posterolateral Approach to Ankle Joint
Images Source:
  • Surgical Exposures in Orthopaedics 4th Edition Book.

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