Ankle arthroscopy is performed to address problems that occur within the ankle joint itself. This may include:
- Injuries to the cartilage (such as an osteochondral defect or lesion of the talus)
- A loose body (usually a fragment of bone or cartilage) in in the ankle joint
- A bony or soft tissue impingement that occurs in the front of the ankle
- Extensive inflammation of the synovium surrounding the joint lining of the ankle can also be removed using an arthroscope
In addition ankle arthroscopy can sometimes be used to aid in performing other procedures (ex. ankle fusion)
Ankle arthroscopy involves making a small nick in the skin (about 5mm) and placing a small tube about the size of a pen into the ankle joint. This tube has fiberoptics in it and is attached to a camera (See Figure #1). An image of the inside of the ankle joint is then projected onto a video monitor for the surgeon to see (See Figure #2). Another skin incision (portal) is made on the other side of the ankle to allow instruments to be passed into the joint. These instruments are controlled by the surgeon and can be used to grab, cut, and shave tissue within the ankle joint (See Figure #3).
One of the most common pathologies is an injury to the cartilage covering the talus also known as an osteochrondral lesion of the talus. This occurs when there is damage to the cartilage and the smooth surface of the cartilage is lost (See Figure #4). This can be addressed with a curette to remove the frayed and loose cartilage (See figure #5). This leaves the underlying bone, which is often then treated with micro fracturing (See Figure #6). This involves making a few microscopic holes in the bone to encourage blood to extravasate from the bone and increase the chance of fibrocartilage healing.
Additionally, if bone spurs are identified at the front of the ankle, or significant soft tissue impingement is identified shavers and burrs can be used to address and remove the problem (See Figure #7).
The recovery time from ankle arthroscopy varies depending upon the nature of the procedure. If a procedure is performed that does not require a period of healing following the surgery, then patients can be mobilized reasonably quickly. These procedures would include simple shavings of the synovium, or removing basic osteophytes [bone spurs] in the front of the ankle. If an osteochondral injury is addressed, and particularly of micro fracturing occurs, then it is often necessary to keep the patient relatively immobilized for 46 weeks in order to allow healing. In addition, if there is a procedure to another part of the foot or ankle, such as in a lateral ligament stabilization, then the patient will need to be kept relatively immobilized during the first 6 weeks.
Potential General Complications
- Infection: The infection rate in ankle arthroscopy is very low because the joint is flushed with a large amount of saline which tends to dilute out any bacteria.
- Wound Healing Problems
- Asymmetric Gait (leading to pain elsewhere)
- Deep Vein Thrombosis (Blood Clot)
- Pulmonary Embolism (PE)
- Failure to Resolve ALL Symptoms
- Ankle arthroscopy is performed to provide more detailed information on what is actually happening within the ankle joint. Procedures can then be done to improve a patients situation (remove loose bodies, clean up areas of cartilage damage, etc.). However, this surgery can not return the ankle to “normal” when significant damage has already been done to the ankle joint.
Potential Specific Complications
Superficial Peroneal Neuritis: The potential to irritate the nerves that travel near the portals. This particularly includes the superficial peroneal nerve, which provides sensory innervation to the dorsal aspect of the [top part of the foot] (See Figure #8). If this occurs, local massage and desensitization will need to be performed in order to resolve these symptoms. This occurs in approximately 5% of patients undergoing arthroscopy where a lateral [front and outside] portal is used. In a very small percent of the patients, this nerve irritation will progress to a complex regional pain syndrome, which can be a very serious complication.
Edited on July 2nd, 2014