Table 3.

Pearls and Pitfalls of the In-Office Needle Arthroscopy Technique

Pearls	Pitfalls
Create portals sites with stab incisions only though skin and follow with blunt dissection	Improper placement of posterolateral portal may place the sural nerve at increased risk of injury
Direct the instruments toward the lateral border of third metatarsal while placing the initial portal	Iatrogenic injury to medial neurovascular bundle during instrument insertion may occur if inserting instruments too medially
Diligent initial debridement of fatty tissue with direct visualization of instrument and triangulation (place instrument and camera at 90° to facilitate localization and visualization)	Without establishing adequate visualization, debridement may lead to iatrogenic injury
Debridement of hypertrophied intermalleolar ligament if the case of posterior ankle impingement warrants it	In cases of posterior ankle impingement, failure to debride intermalleolar ligament may result in residual pain and mechanical symptoms
Identification of the flexor hallucis longus tendon using passive flexion/extension of the hallux	Incorrectly identifying the flexor digitorum longus or posterior tibial tendons as the flexor hallucis longus tendon
Maintaining awareness of the full working length of shaver while working near the flexor hallucis longus tendon	Damaging the flexor hallucis longus tendon due to length of shaver while working on other structures
Calcaneal distraction and ankle dorsiflexion to facilitate entry into the posterior tibiotalar joint	Damaging articular cartilage from aggressive attempts to pass instruments into joint space
Inserting a probe into the subtalar joint to assess range of motion in nonosseous coalition followed by resection	Attempting to resect large coalitions or osseous coalitions which are not amenable to arthroscopic treatment