Ankle arthroscopy is a recently pioneered medical technique that uses a small telescope, knows as an arthroscope, which is inserted directly into the joint of the ankle itself. This telescope is connected to a camera and recording equipment relaying the picture back to the doctor. Through a separate incision, the surgeons introduces small instruments into the joint to perform micro-operations. This avoids the need to open up the ankle, as in traditional surgical methods, reducing scarring and recovery times over that of classical techniques.
The most common use for ankle arthroscopy is for the treatment of chronic pain or discomfort following an injury to the ankle and usually involves removal of excess scar tissue and inflammation (synovitis), removal of ankle spurs and loose pieces from the joint (footballers ankle), and the treatment of damage to the articular surface.
- inflammation in the ankle (synovitis)
- impingement from boney spurs or scar tissue
- cartilage injury (osteochondral defect)
Anterior arthroscopy is the most common procedure and is performed through two small incisions at the front of the ankle. Posterior arthroscopy - as you may guess - is performed through two incisions either side of the achilles at the back of ankle
Similar techniques have been used in the past to repair the torn cartilage in knees, but as the technology has advanced, both the arthroscope and the instruments that can be paired with it have become smaller. This reduction in size allows the surgeon to view and treat much smaller joints, such as those found in the ankle, subtalar joint, and big toe, and to operate with a higher degree of accuracy.
Osteochondral Defects (OCD)
In cases of severe sprains, the ligaments of the ankle may be torn, and additionally the smooth cartilage surface that covers the surfaces at the joint of bones may be damaged, known as an "osteo-chondral defect". This defect can become loose, and cause further problems within the ankle. An OCD may be suspected after examination of the ankle, but may require one or a combination of X-Ray, MRI, and CT scans to be properly diagnosed. An arthroscopy may be performed to remove a loose OCD.
Arthroscopic Ankle Fusion
It is now possible to use these keyhole methods in the treatment of severe ankle arthritis and undertake minimally invasive ankle fusion surgery.
During this operation, the joint surface is removed and the bony surfaces of the tibia and talus are encouraged to heel as if they were a fracture. Normally special screws are passed across the joint to hold it stable while this fusion takes place. Arthroscopic fusion has advantages with regards to healing of the skin and soft tissues and a reduced complication rate and improved rates of fusio. However, not every patient with advanced arthritis of the ankle is suitable for an arthroscopic fusion but I will be able to advise you if the option is appropriate.
This is to treat problems with the joint beneath the ankle joint and is performed through two incisions on the outside of the ankle. Occasionally it is through incisions at the back of the ankle. The sural nerve may be injured, leaving a patch of numbness at the side of the hindfoot. Again this may be temporary or rarely, permanent.
Metatarsophalangeal Joint Arthroscopy
This is arthroscopy of the 'big toe' joint and is performed for damage to the articular cartilage (OCD). It is performed through 2-3 incisions around the joint.
Risks of surgery
There are two small nerves (superficial peroneal and saphenous) either side of the ankle joint, near where the portal incisions are made. There is a small risk (5%) that one of these nerves is damaged. This will leave a patch of numbness over either the inside border of the foot or over the back of the foot. Usually this is temporary, but may be permanent.
Deep infection due to Arthroscopic surgery is extremely unlikely. Published results show a risk of 1 in 25,000. If this does happen, further surgery to wash out the joint will be needed, and a course of antibiotics. Minor wound infections are also rare, but can normally be treated with oral antibiotics.
Stiffness & Swelling
Arthroscopic surgery causes much less soft tissue trauma than traditional open surgery. As such, stiffness & swelling tends to settle rapidly. In general, the joint will be Ok to walk on immediately, with some discomfort for the first two weeks. By six weeks, one should be able to perform full activities.
Recovery from surgery
You can expect some pain and swelling following surgery and your leg will need to be kept elevated for three days. Normal over the counter pain relief should suffice.
Depending upon the nature of any procedures undertaken during arthroscopy, you may be able to walk on the leg immediately, or you may need to wait several months before putting your full weight on the leg.
Activity and time off work
If you work in an office or your role does not involve standing, walking or driving, you may be able to return work several days after surgery. However most patients can expect to be out of work for at least one to two weeks.
It is possible to return to high-level sports following ankle arthroscopy, but expect at least four to six weeks of recovery before getting back into activities that stress the ankle. You will be advised on what will be appropriate in terms of activities and ranges of motion.