Fig 4.

(A) As shown in a left ankle, a 22-gauge needle is used to assist in portal placement 1.0 to 1.5 cm anterior to the tip of the fibula while transillumination is used to protect the superficial peroneal nerve. (B) The tip of the lateral malleolus (blue arrow) and the remnant of the anterior talofibular ligament (yellow arrow) are identified. The talus is also visible (asterisk). (C, D) The surgical blade is used to cut the skin, and blunt dissection by a mosquito clamp is used to penetrate the joint, lowering the risk of iatrogenic injuries.