An unexpected complication of anterior ankle arthroscopy: Section of the posterior tibial neurovascular bundle

Background: This paper reports for the first time in the literature a case of sectioning of the posterior tibial neurovascular pedicle after an anterior ankle arthroscopy. Case presentation: A 30-year-old patient presented one year after an anterior ankle arthroscopy with paresthesia, neuropathic pain, and a partial sensory deficit in the sole of the foot. Nerve conduction studies and electromyography revealed an axonomyelinic sensory impairment of the tibial nerve. Surgical exploration showed an almost complete section of the tibial nerve and a neuroma in continuity as well as a complete section of the posterior tibial vessels with a defect requiring nerve grafting and bypass surgery. This lesion was likely owed to an inappropriate introduction of the arthroscopic trocar in the anteromedial approach through the patient's ankle. Conclusions: This original clinical case is a reminder to exercise caution when inserting trocars and instruments during ankle arthroscopies.