Artroscopia anterior de tobillo. Complicaciones tempranas con técnica sin distracción. [Anterior ankle arthroscopy. Early complications without joint distraction]

Juan Manuel Yañez Arauz, Fernando Emanuel Rosales Anderica, Diego Lauritto, Martín Miguel Balmaceda, Martín Amaya, Santiago Yañez Arauz

Resumen


Introducción: La artroscopia se ha convertido en una importante herramienta para tratar diversas afecciones del tobillo. El uso de portales anteriores y posteriores, asociados o no a distracción mecánica, permite una completa exploración de esta articulación. Como toda técnica quirúrgica, no está exenta de complicaciones.

Objetivos: Evaluar las complicaciones tempranas de la artroscopia anterior de tobillo, sin distracción articular, y compararlas con las descritas en la bibliografía internacional.

Materiales y Métodos: Estudio retrospectivo que evaluó a 198 pacientes sometidos a artroscopia anterior de tobillo por diversas patologías. Todos fueron operados por un único cirujano, en dos instituciones de salud, durante un período de 6 años, con un seguimiento posquirúrgico mínimo de 12 meses. Los pacientes fueron evaluados mediante el puntaje de la AOFAS y se consignaron las complicaciones intra y posoperatorias tempranas.

Resultados: Se evaluó a 34 mujeres y 164 hombres (edad promedio 37.5 años).
Hubo 23 complicaciones (11,61%): celulitis local (6 casos), parestesias transitorias del nervio peroneo superficial (4 casos), parestesia permanente del nervio peroneo superficial (1 caso), dolor residual en los portales (4 casos), artritis séptica (2 casos) y un caso de otras complicaciones.

Conclusiones: Un conocimiento preciso de la anatomía, una asepsia y una técnica quirúrgica correctas, y los cuidados de manejo intraquirúrgico del instrumental permiten evitar la mayoría de las complicaciones. La artroscopia anterior de tobillo sin distracción por medio de los clásicos portales antero-lateral y antero-medial es una técnica segura,
con un bajo índice de complicaciones y una muy baja morbilidad para el paciente.

 

Abstract


Introduction: Arthroscopy has become an important tool to treat various conditions of the ankle. The use of anterior and posterior portals, with or without mechanical distraction, allows for a complete exploration of this joint. Like all surgical techniques, it is not without complications.

Objectives: To evaluate the early complications of anterior ankle arthroscopy with or without joint distraction, and to compare them with those described in the international literature.

Materials and Methods: A retrospective study that evaluated 198 patients undergoing anterior ankle arthroscopy for various pathologies. All were operated on by a single surgeon, in two health centers, during a period of 6 years, with a postoperative follow-up of at least 12 months. Patients were evaluated by AOFAS score and early and postoperative complications were recorded.

Results: 34 women and 164 men were evaluated (average age 37.5 years). There were 23 complications (11.61%): local cellulitis (6 cases), transient paresthesia of the superficial peroneal nerve (4 cases), permanent paresthesia of the superficial peroneal nerve (1 case), residual pain in the portals (4 cases), septic arthritis (2 cases) and one case of other complications.

Conclusions: Most complications can be avoided by a precise knowledge of the anatomy and the aseptic techniques, as well as an adequate surgical approach and intra-operative management of the instrumentation. Anterior ankle arthroscopy without joint distraction through standard antero-lateral and antero-medial portals is a safe technique, having a low rate of complications and a very low morbidity for the patient.


Palabras clave


Artroscopia anterior; tobillo; complicaciones. Anterior arthroscopy; ankle; complications.

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DOI: http://dx.doi.org/10.15417/issn.1852-7434.2019.84.3.885

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Registro de la Propiedad Intelectual Nº 22171081 (en línea).

ISSN 1852-7434 (en línea).

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