Ankle-related complaints are among the most commonly encountered problems for musculoskeletal clinicians. Ankle pathology is widely variable, including, but not limited to, fractures, deformity, infection, oncologic diseases, neuromuscular conditions, and arthritis. While nonoperative management with activity modification, bracing and/or shoe modifications, and medications is usually indicated as first line of treatment, surgical intervention may become necessary. A thorough understanding of the complex anatomy and biomechanics of the ankle, and in particular, the potential neurovascular structures that may be encountered, is important to reduce complications and obtain good surgical outcomes. The purpose of this review is to discuss the most common open and arthroscopic exposures to the ankle with a focus on surgically relevant anatomy for each approach. 1. Introduction Symptoms and complaints regarding the ankle are some of the most commonly encountered problems seen by musculoskeletal care providers. Ankle injuries encompass a broad array of pathology including trauma, deformity, reconstruction, and sports medicine. For nontraumatic injuries, physicians typically provide nonoperative treatment modalities to start including activity modification, rest, immobilization, bracing, orthotics, nonsteroidal anti-inflammatory medications, intra-articular injections, and physical therapy. When patient symptoms worsen and begin to negatively affect quality of living, surgical intervention often becomes necessary for definitive management. Patients with traumatic injuries, including fractures and/or dislocations, often require immediate surgical intervention. Regardless of the specific surgical technique performed, these procedures all require adequate visualization of the ankle pathology to be performed correctly. A thorough understanding of the anatomy about the ankle joint, including the osseous, muscular, ligamentous, tendinous, and neurovascular structures, is critical to perform safe and effective ankle surgery. Open surgical exposures allow complete visualization of the tibiotalar articular surface and are the most commonly employed surgical approaches to the ankle. In recent years, less invasive ankle techniques including miniopen approaches and ankle arthroscopy have become more commonly used. The purpose of this review is to discuss the most common open and arthroscopic exposures used in the surgical treatment of ankle pathology with a focus on surgically relevant anatomy. 2. General Overview The ankle joint is comprised of three bones including the
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