Ankle Arthroscopy | Minimally Invasive Surgical Procedure

Ankle Arthroscopy

Ankle arthroscopy is a minimally invasive surgical procedure that orthopaedic surgeons use to treat problems in the ankle joint. Ankle arthroscopy uses a thin fiber-optic camera (arthroscope) that can magnify and transmit images of the ankle to a video screen. Ankle arthroscopies can reduce ankle pain and improve overall function.

Conditions

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

  • Ankle arthritis: Ankle fusion is a treatment option 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.
  • Ankle fractures: Ankle arthroscopy may be used along with open techniques of fracture repair. This can help to ensure normal alignment of bone and cartilage. It also may be used during ankle fracture repair to look for cartilage injuries inside the ankle.
  • Ankle instability: Ligaments of the ankle can become stretched out, which can lead to a feeling that the ankle gives way. These ligaments can be tightened with surgery. Arthroscopic techniques may be an option for treating moderate instability.
  • Anterior ankle impingement (also referred to as athlete’s ankle or footballer’s ankle): Ankle impingement occurs when bone or soft tissue at the front of the ankle joint becomes inflamed. Symptoms include ankle pain and swelling. This can limit the ability to bend the ankle up. Walking uphill is often painful. Osteophytes (bone spurs) can be seen on X-ray. Arthroscopy can be used to shave away inflamed tissues and bone spurs.
  • Arthrofibrosis: Scar tissue can form within the ankle. This can lead to a painful and stiff joint, known as arthrofibrosis. Ankle arthroscopy can be used to identify the scar tissue and remove it.
  • Infection: Infection in the joint space cannot be treated with antibiotics alone. It often requires an urgent surgery to wash out the joint. This can be done with arthroscopy.
  • Loose bodies: Cartilage, bone, and scar tissue can become free floating in the joint and form what is referred to as loose bodies. Loose bodies can be painful and can cause problems such as clicking and catching. Locking of the ankle joint may occur. Ankle arthroscopy can be used to find and remove the loose bodies.
  • Osteochondral defect (OCD): These are areas of damaged cartilage and bone in the ankle joint. OCDs usually are caused by injuries to the ankle such as fractures and sprains. Common symptoms include ankle pain and swelling. Patients may complain of catching or clicking in the ankle. The diagnosis is made with a combination of a physical exam and imaging studies. Imaging may include X-rays, MRI, or CT scan. The treatment is based on the size, location, and stability of the OCD. The patient’s symptoms and activities also are considered. Surgery often consists of scraping away the damaged cartilage and drilling small holes in the bone to promote healing. Bone grafting and cartilage transplant procedures also can be performed.
  • Posterior ankle impingement: This occurs when the soft tissue at the back of the ankle becomes inflamed. Pointing the foot down can be painful. This overuse syndrome occurs commonly in dancers. It can be associated with an extra bone called an os trigonum. The problem tissue can be removed with arthroscopy.
  • 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 also can cause synovitis. Ankle arthroscopy can be used to surgically remove inflamed tissue that does not respond to nonsurgical treatment.
  • Unexplained ankle 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.

Elective arthroscopy is not appropriate for some patients. Patients with severe ankle arthritis may not benefit from arthroscopic surgery. Patients with active infections or other medical problems may not be appropriate surgical candidates.

Ankle Injury
Usually due to an underlying injury, ankle pain refers to any kind of sudden or worsening discomfort affecting any part of the ankle.

Arthritis of the Foot and Ankle
The pain and stiffness you feel in your feet and ankles as you age could be arthritis. If left untreated, this nagging pain can get worse over time, eventually making it difficult to walk even short distances.

Bent Toe Disorders (Hammer, Mallet and Claw)
A bent toe disorder is an oddly bent toe joint. Hammer, claw and mallet toes are often painful and commonly occur in one or more of the four smaller toes.

Big Toe Arthritis (Hallux Rigidus)
Hallux rigidus is arthritis of the joint at the base of the big toe.

Bone Union Problem
A bone is “healed” when it is strong enough to allow for normal activities. A bone union problem is a bone that does not heal properly or is taking longer than expected.

Broken Ankle (Ankle Fracture)
A fracture is a partial or complete break in a bone.

Bunion
A bunion is a visible, bony bump that forms at the joint of the toe. It occurs when some of the bones in the front part of the foot move out of place.

Great Big Toe Joint Disorder
Hallux rigidus is a disorder of the joint located at the base of the great big toe. It causes pain and stiffness in the joint.

Haglund’s Deformity
Haglund’s deformity is a bony enlargement on the back of the heel that, when it rubs against shoes, may irritate the soft tissues near the Achilles tendon.

Impingement
Ankle Impingement is a condition where pain is experienced due to compression of the bony or soft tissue structures during a specific range of motion.

Injuries to the Achilles Tendon
An overly stressed Achilles tendon can be subject to mild or serious injuries. If the injury is mild or moderate, it may be limited to burning or stiffness.

Instability
Instability is the inability of a joint to support weight or maintain balance, a feat which requires coordination between functional ligaments and tendons.

Ligament Sprain
An ankle sprain is an injury to a ligament, a band of tissue that functions like a rubber band to connect bones and bind joints together.

Morton’s Neuroma
Morton’s neuroma is a painful condition that affects the ball of the foot, most commonly the area between the third and fourth toes.

Osteochondral Lesions
Osteochondral lesions of the talus (OLT), sometimes called osteochondritis dessicans or osteochondral fractures, are injuries to the talus (the bottom bone of the ankle joint) that involve both the bone itself as well as cartilage that overlays it.

Sesamoid Injury
A sesamoid acts as a pulley to help a tendon flex and curl. A sesamoid injury affects the bone’s ability to provide leverage while walking and jumping.

Surgery

Your foot and ankle orthopaedic surgeon will mark the operative leg prior to surgery. You will be transported to the operating room and given anesthesia. A tourniquet is commonly applied to the leg. The leg is thoroughly cleaned. The surgeon will sometimes use a device to stretch the ankle joint and make it easier to see inside.

At least two small incisions are made in the front and/or back of the ankle. These portals become the entry sites into the ankle for the arthroscopic camera and instruments. Sterile fluid flows into the joint to expand it and allow for better visualization. The camera and instruments can be exchanged between portals to perform the surgery. Both motorized shavers and hand operated instruments are used. After the surgery is complete, sutures are placed to close the portals. A sterile dressing is placed over the sutures. A splint or boot is often used.

You can expect some pain and swelling following surgery. The leg may need to be kept elevated. You may need to take oral pain medication for several days. You may be able to walk on the leg immediately, or you may need to wait several months before putting weight on the leg. This will depend on the type of surgery performed and the recommendations of your surgeon. If needed, sutures are removed one to two weeks after surgery. Your surgeon will determine when activities such as range-of-motion and ankle exercises are allowed. Physical therapy may also be used.

All surgeries come with possible complications, including the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots.

Potential complications specific to ankle arthroscopy include injury to nerves and blood vessels 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.

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