Minimally Invasive Surgery: Ankle Arthroscopy
In minimally invasive surgery, our doctors use a variety of techniques to operate with less damage to the body than with open surgery. In general, minimally invasive surgery is associated with less pain, a shorter hospital stay and fewer complications.
While endoscopy describes any surgery done through one or more small incisions, ankle arthroscopy is a minimally invasive surgical technique focused on the joints. This treatment utilizes the technology of fiberoptics, magnifying lenses, and digital video monitors to allow us to directly visualize the inside of your ankle through small incisions. Several incisions are made about your ankle to allow for the insertion of an arthroscope, or small fiberoptic video camera, and/or special arthroscopic instruments. Sterile fluid is also circulated through your ankle to distend the joint, creating more space for the arthroscope and instruments. This allows us better visibility within your ankle, space to maneuver instruments, and clearance of debris.
Ankle arthroscopy can sometimes be used as an alternative to open ankle surgery, which is a surgical approach utilizing larger incisions to access the inside of the ankle. It can be used to diagnose and treat different disorders of the ankle joint.
The list of problems that this technology can be used for is constantly evolving.
Common conditions include:
- Osteochondral defect of the talus (also referred to as osteochondritis dessicans, OCDs, osteochondral fractures). This includes acute ankle sprains and repetitive ankle injuries caused by chronic instability. Patients will often present with complaints of persistent and progressive ankle pain and swelling.
- Anterior Ankle Impingement (also referred to as “athlete’s ankle” or “footballer’s ankle”) and Anterolateral Ankle Impingement. These occur when either bone and soft tissue of the anterior (the “front”) ankle joint becomes inflamed due to repetitive stress or irritation. This will cause pain in the ankle joint, swelling, and can limit the motion of the ankle, especially dorsiflexion (loss of the ability to bend your “toes towards your nose”). Walking uphill is often painful. This is common in soccer players and any athlete with recurrent ankle sprains.
- Posterior Ankle Impingement. This occurs when the bone and soft tissue of the hindfoot (the “back” of the ankle) becomes inflamed due to repetitive stress. This will cause pain in the ankle joint, swelling, and often times limited motion of the ankle, especially plantarflexion (loss of the ability to “press on the gas”). This overuse syndrome occurs most commonly in ballet dancers, but can also be seen in other athletes.
- Synovitis. Synovitis is inflammation of the soft tissue lining of the ankle joint (synovium) that will often manifest as pain, swelling, and loss of motion. This can occur due to an acute trauma, inflammatory arthritis (i.e. rheumatoid arthritis), overuse, and degenerative joint disease (osteoarthritis).
- Loose Bodies. Articular cartilage and/or scar tissue following trauma to the ankle can become free-floating in the joint and form what is referred to as a “loose body”. These can also occur within the setting of a condition called synovial chondromatosis, where the lining of the joint becomes redundant for unexplained reasons. These loose bodies can cause problems such as clicking, catching, and frank locking that often lead to pain, swelling, and loss of Motion.
- Arthrofibrosis. Sometimes, previous trauma, prior ankle surgery, infections of the ankle joint, and inflammatory arthritides, such as rheumatoid arthritis, predispose patients to the development of scar tissue, or arthrofibrosis.
- Infection. Septic arthritis, or infection of the joint space, cannot be treated effectively with antibiotics alone. It often necessitates an urgent surgery to wash out the joint. The decision of whether or not an infection is amenable to arthroscopic surgery is determined by many factors.
- Ankle Fractures. Ankle arthroscopy can also be used along with conventional techniques of fracture repair to ensure that normal anatomic alignment of cartilage within the ankle is restored.
- Unexplained Ankle Symptoms. Occasionally patients develop symptoms, such as pain, swelling, locking, catching, grinding, or popping, that cannot be explained with diagnostic techniques such as X-rays, CT scans, MRIs, or bone scans.
- Tibiotalar Arthritis. Ankle fractures, infection, osteonecrosis, and arthritis may eventually lead to chronic pain and stiffness that can not be controlled with nonoperative measures.
Ankle arthroscopy is generally performed as an outpatient surgery under general anesthesia with or without a regional pain block or epidural anesthetic with sedation.
- After adequate anesthesia is established, a tourniquet is applied to your leg, and the leg is prepped and draped in a sterile fashion.
- Mechanical distraction devices are sometimes used to help us temporarily enlarge the potential space of your ankle.
- After your foot and ankle are appropriately positioned, we will make at least two approximately 0.5mm incisions in your ankle. These incisions become the entry sites into your ankle, or portals, for our arthroscopic camera and instruments. The incisions are made in the front or back of your ankle, or a combination of these.
- Sterile fluid is then allowed to flow through your ankle to further open the joint.
- The camera and instruments can then be exchanged between portals to perform the surgery.
- At the conclusion of the procedure, small sutures are placed in the skin to close the portals.
- Then we will apply a sterile compressive dressing, and sometimes a splint or boot
- You will then be brought to the recovery area and are usually discharged home the same day with specific weight-bearing and dressing care instructions.
Your recovery depends on the type of problem and nature of the arthroscopic procedure we used to treat your problem. You can expect pain and swelling following surgery that necessitates elevation of the leg and oral pain medication for at least several days. The type of procedure performed will determine whether or not your ability to bear weight on your affected leg will be restricted after surgery. This can range from progressive immediate weight-bearing with crutches, to a period of strict non-weight-bearing for one to two months. If ankle arthroscopy is used as an adjunct to conventional fracture fixation, this period of non-weight-bearing may be longer depending on your body’s ability to heal the fracture. Your dressing will be left in place until our follow-up meeting, and we will remove the sutures one to two weeks after surgery. Active range of motion is generally allowed immediately. After the swelling and soft tissue reaction subsides, we may implement a progressive strengthening routine. Based on our evaluation, we will determine when each of these activities is allowed and whether or not a formal physical therapy referral is necessary.