Comparison of a dorsolateral approach and a dorsomedial approach to access the medial malleolus of the distal tibia in horses.
Authors: Guerra Margherita, Schnabel Lauren V, Jacobs Carrie C
Journal: Veterinary surgery : VS
Summary
# Editorial Summary Surgical access to osteochondral lesions on the medial malleolus of the distal tibia can be challenging arthroscopically, particularly when instrument–arthroscope interference limits visibility and operative freedom. This cadaver study compared the conventional dorsomedial approach with a novel dorsolateral approach to the tarsocrural joint in six equine pelvic limbs, assessing identification quality and surgical accessibility to the medial malleolus using standardised grading criteria. Both techniques achieved excellent identification of the medial malleolus, but the dorsolateral approach demonstrated superior visualisation of the axial (weight-bearing) aspect of the lesion and, critically, eliminated the instrument–arthroscope crowding that occurred in all limbs using the dorsomedial technique. These findings suggest that the dorsolateral approach warrants consideration as an alternative or complementary technique for arthroscopic debridement of medial malleolar osteochondral disease, potentially offering improved ergonomics and lesion visualisation in cases where standard positioning proves restrictive. Further clinical evaluation in live horses would help establish whether this approach translates to improved surgical outcomes or reduced operative time in cases of medial malleolar pathology.
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Practical Takeaways
- •The dorsolateral arthroscopic approach represents a viable alternative technique for accessing and treating medial malleolus OCD lesions with superior visualization of key anatomical regions
- •This approach may reduce technical complications during arthroscopic procedures by eliminating instrument-scope interference present in the traditional dorsomedial approach
- •Surgeons performing tarsocrural joint arthroscopy should consider adding this technique to their repertoire, particularly for cases where medial malleolus pathology requires debridement
Key Findings
- •Dorsolateral arthroscopic approach provided excellent identification and surgical access to the medial malleolus in all 6 cadaver limbs
- •Dorsolateral approach eliminated instrument-arthroscope interference that occurred with the standard dorsomedial approach
- •Dorsolateral approach offered improved visualization of the axial aspect of the medial malleolus compared to dorsomedial approach