Fig 3.

Creation of medial portal in a left ankle. (A) In dorsiflexion, at the level of the joint line (red line), a soft spot can be felt just medial to the tibialis anterior tendon (blue lines). Notice that in plantar flexion position the tendon is considerably more medial (dashed lines). The medial portal is created medial to the intersection of the tibialis anterior tendon and the joint line. (B) A surgical blade is used to cut the skin. (C, D) A mosquito clamp is used to bluntly dissect the soft tissue until reaching inside the joint. The ankle is kept in dorsiflexion at all times to open the anterior “working area,” diminish tension of the surrounding structures, and protect the joint cartilage.