Ankle arthroscopy procedural complexity is correlated with early postoperative complication risk.

PURPOSE: The risk of neuropraxic injury or other complications has not been described regarding complex/multiple arthroscopic interventions. This study aimed to examine the frequency of complications after ankle arthroscopy (AA) and identify whether a correlation exists between early postoperative complications and the number of concurrent procedures, possibly indicating procedural complexity. Additionally, we evaluated whether comorbidities, diagnoses, patient positioning, distractor use, tourniquet use/location, case duration, and number/types of portals confounded our data.

METHODS

Retrospective chart review of all AAs performed at a single institution over 10 years was performed utilizing CPT codes inclusive of arthroscopic ankle procedures. Operative records and chart reviews were undertaken to document complications.

RESULTS

177 AAs were identified, 46 isolated AA (diagnostic arthroscopy and debridement only), and 131 multi-procedure AAs. 20/177 complications were identified (11.3%). 13 were nerve-related complications. All nerve-related complications resolved with observation except one patient, which required open neuroma excision. AA performed with additional procedures demonstrated an increased risk of complication (p = 0.039). 18/20 complications (90%) occurred in AA with additional procedures. In the AA with additional procedures group, tourniquet use correlated to complication risk (p = 0.03). In the isolated AA group, use of both anterior and posterior portals correlated to complications (p = 0.01). Gender, diabetes, smoking, and distractor use were not significantly correlated with complication risk in either group.

CONCLUSION

AA early postoperative complication risk increases with procedural complexity, with the most common complication being nerve-related injury, which may be related to technique, portal placement, and case length based on the literature. However, this study only found a correlation with the number of concurrent procedures. Operative time, tourniquet use, and distractor use were not correlated to early postoperative complication risk in this study.

CLINICAL RELEVANCE: The objective of this study was to identify if a correlation exists between early postoperative complications and the number of concurrent AA procedures, as well as evaluate risk factors for AA complications, to minimize complications in the future.

LEVEL OF EVIDENCE: Level III: Retrospective Cohort Study.