From the Research
The recommended anatomical approach for arthrocentesis of the ankle is the anteromedial approach. This technique involves positioning the patient supine with the ankle in slight plantar flexion, then inserting the needle between the tibialis anterior tendon and the medial malleolus, directing it toward the center of the joint space. Before the procedure, the area should be properly sterilized with chlorhexidine or povidone-iodine solution, and local anesthesia (1-2 mL of 1% lidocaine) may be administered. Use a 20-22 gauge needle attached to a 10-20 mL syringe for the aspiration. The needle should be inserted at a 45-degree angle to the skin, aiming toward the center of the joint.
Key Considerations
- The anteromedial approach is generally preferred due to easier access and fewer neurovascular structures in the area, as noted in various studies 1, 2, 3, 4.
- Alternative approaches include the anterolateral approach (between the lateral malleolus and peroneus tertius tendon) and the anterior approach (between the tibialis anterior and extensor hallucis longus tendons).
- It is essential to be aware of the anatomical variations of the tibialis anterior, extensor hallucis longus, and extensor hallucis brevis muscles, as reported in a case study 4, to minimize the risk of damage to surrounding structures.
Procedure Details
- Position the patient supine with the ankle in slight plantar flexion.
- Insert the needle between the tibialis anterior tendon and the medial malleolus.
- Direct the needle toward the center of the joint space.
- Use a 20-22 gauge needle attached to a 10-20 mL syringe for the aspiration.
- Insert the needle at a 45-degree angle to the skin, aiming toward the center of the joint.
Anatomical Considerations
- The tibialis anterior tendon is located between the medial malleolus and the tibialis anterior muscle.
- The extensor hallucis longus tendon is located between the medial malleolus and the extensor hallucis longus muscle.
- The medial malleolus is a prominent landmark for the anteromedial approach.
This approach provides reliable access to the joint space while minimizing the risk of damage to surrounding structures such as blood vessels, nerves, and tendons, which is crucial for reducing morbidity, mortality, and improving quality of life.