Table 2.

Surgical instrumentation and operative technique

Instrumentation	30° 2.7 short (“small joint”) arthroscope
	30° 4 mm arthroscope;
	70° 2.7 short (“small joint”) arthroscope not always necessary
	2.9 mm shaver, 2 mm shaver, 3.2 mm burr
	Small probe
	Small joint knives and biters
	90° small radiofrequency wand
Patient positioning	supine, lateral decubitus, semilateral decubitus
Anesthesia	general or epidural; in rare instances (diagnostic procedures) local anesthesia
Tourniquet	around the proximal thigh, inflated to 120 mm Hg above mean arterial pressure, after exsanguination and instillation of intravenous antibiotics
Bony landmarks	tip of the lateral malleolus, fifth metatarsal tuberosity, peroneal tubercle
Ankle position	plantar flexion and eversion
Arthroscopy fluid	dilute epinephrine (1:1000) in normal saline to maintain hemostasis. Pressure of fluid: gravity feed or low flow pump system set at 50 mm Hg or less to prevent insufflation of the subcutaneous tissue
I portal (distal)	1.5-2 cm distal to the posterior edge of the apex of the fibula, just over the tendon sheath, proximal to the peroneal tubercle; blunt trocar with corresponding cannula introduced with saline irrigation;scope introduced inside the cannula
Inspection	start 6 cm proximal from the posterior tip of the lateral malleolus where the fibrous septum splits the tendon compartment into two separate tendon chambers; more distally both tendons lie in one compartment; rotate the endoscope over and in between both tendons to complete the inspection; identify vincula if possible;
	distal examination can be difficult due to the different tendon course and the small space
Dynamic testing of the tendons	tendons through ankle flexion-extension and inversion-eversion; to test stability and exclude the presence of subluxation or dislocation
II portal (proximal)	assisted by transillumination and with the help of an 18 gauge spinal needle; posterior to the fibula, 2–2.5 cm proximal to the tip of the fibula
III portal (accessory):	distal to the myotendinous junction of the peroneus longus, 5–6 cm proximal to the tip of the fibula, 5 mm posterior to the palpable edge of the fibula
IV portal (accessory):	distal to the peroneal tubercle (for the release of the inferior peroneal retinaculum)
Fibular groove deepening	3.9 small burr introduced through the distal portal, endoscope through the proximal portal; typically the deepening has to be extended 3 mm in depth and 5 mm in width
Suture	Suture portals with non-absorbable sutures to prevent synovial shunt formation