Ankle Arthroscopy

What is ankle arthroscopy?

Arthroscopy is a minimally invasive surgical procedure that foot and ankle surgeons use to treat a wide range of problems in the ankle joint. Ankle arthroscopy uses a thin fibre-optic camera (arthroscope) that can magnify and display images from within the ankle on a video screen.

What are the problems that would benefit from an ankle arthroscopy?

Arthroscopy can be used to diagnose and treat different disorders of the ankle joint. The list of diseases that can be treated with this technique is constantly evolving and includes:

Anterior ankle impingement (footballer's ankle): Ankle impingement occurs when bone spurs (osteophytes) are formed on the front margins of the ankle joint. Soft tissue inflammation at the front can cause similar symptoms. Symptoms include pain and swelling on the front side of the ankle. This can restrict the ability to bend the ankle up. Walking uphill is often painful. Arthroscopy can be used to shave away inflamed tissues and bone spurs.

Posterior ankle impingement: This occurs when the soft tissue at the back of the ankle becomes inflamed. This can be associated with an extra bone called an os trigonum. The inflamed tissue and the accessory bone can be removed with posterior ankle arthroscopy.

Ankle arthritis: Ankle fusion is a treatment option appropriate for many patients with end-stage ankle arthritis. Ankle arthroscopy offers a minimally invasive way to perform ankle fusion. Results can be equal to or better than open techniques.

Chronic ankle instability: Ligaments of the ankle can become incompetent, which can cause a tendency of the ankle to give way. These ligaments can be tightened with surgery. Arthroscopy may be used to diagnose the problem and exclude other causes of pain after ligament injury.

Stiffness: Following complex fractures or soft tissue injuries, scar tissue can form within the ankle. This can lead to a painful and stiff joint. This is known as arthrofibrosis. Ankle arthroscopy can be used to identify the scar tissue and remove it.

Infection: Deep infection within the joint space cannot be treated adequately with antibiotics alone. It requires an urgent surgery to wash out the joint. This can be done with arthroscopy.

Loose bodies: Small fragments of cartilage, bone and scar tissue can become free floating in the joint as loose bodies. Loose bodies can be painful and can cause mechanical problems such as clicking and catching and locking of the ankle. Ankle arthroscopy is the best method to remove the loose bodies.

Cartilage injuries (Osteochondral defects OCDs): OCDs are usually caused by injuries to the ankle such as fractures and sprains. These are areas of damaged cartilage and underling bone in the ankle joint. Common symptoms include deep pain and recurrent swelling. Patients may complain of catching or clicking in the ankle. The diagnosis is made with a combination of a physical examination and imaging studies such as MRI and CT scan. The treatment is based on the size and location of the lesion. Arthroscopy is used to scrap away the damaged cartilage and drill small holes in the bone to promote healing. Bone grafting and cartilage transplant procedures can also be performed.

Synovitis: The soft tissue lining of the ankle joint (synovial tissue) can become inflamed. This causes pain and swelling. It can be caused by injury and overuse. Inflammatory arthritis (rheumatoid arthritis) and osteoarthritis can also cause synovitis. Ankle arthroscopy can be used to surgically remove inflamed tissue that does not respond to nonsurgical treatment.

Diagnosis of unexplained symptoms: Occasionally patients develop symptoms that cannot be explained by other diagnostic techniques. Arthroscopy provides the opportunity to look directly into the joint. The surgeon can then identify problems that may be treated with surgery.

How the operation is done?

After the patient is given anaesthesia, a tourniquet is applied to the leg. The foot and ankle are thoroughly cleaned. The surgeon will sometimes use a device to distract the ankle joint and make it easier to see. At least two small incisions are made in the front and/or back of the ankle. These "portals" are the entry sites into the ankle for the arthroscopic camera and instruments. Sterile fluid flows into the joint to expand it and allow better visualization. After the surgery is complete, sutures are placed to close the portals. A sterile bandage is placed over the sutures.

What to expect after the procedure?

You can expect some pain and swelling. You may need to take oral pain killers for few days. The surgeon will advise whether you can weight bear or need to wait few weeks before putting weight on the leg. This will depend on the type of surgery performed. Sutures are removed around two weeks after surgery. Your surgeon will determine when activities such as range-of-motion and ankle exercises are allowed. Physiotherapy may also be indicated.

What are the potential complications?

80 to 90 percent of patients undergoing ankle arthroscopy for the most common problems achieve good or excellent results. There is a small risk of general complications such as: infection, bleeding or blood clots.Complications specific to ankle arthroscopy include injury to nerves around the ankle. Numbness or tingling at the top of the foot can occur approximately 10 percent of the time. This typically resolves over time.