Ankle arthroscopy can be useful in treating a variety of intra-articular disorders, which may be caused by trauma or by degenerative, inflammatory, or neoplastic conditions. In some cases, the ankle joint disorder may be related to extra-articular anomalies, which may be regional (eg, mechanical malalignment in the lower extremity) or systemic (eg, inflammatory arthritis).
Arthroscopy is indicated for definitive diagnosis of certain soft-tissue disorders when the exact etiology of ankle symptoms remains unclear, as well as for treatment of a variety of ankle disorders, usually after conservative measures have failed.
Indications for diagnostic ankle arthroscopy include the following:
- Unexplained pain, swelling, stiffness, instability
- Mechanical symptoms such as locking and popping
Indications for therapeutic ankle arthroscopy include the following:
- Articular injury
- Soft-tissue injury
- Posttraumatic soft-tissue impingement
- Bony impingement
- Arthroscopic-assisted fracture fixation
- Loose bodies
- Intra-articular bands
- Osteochondral defects (see the image below)
- Septic arthritis
The ankle joint is a hinged synovial joint with primarily up-and-down movement (plantarflexion and dorsiflexion). However, when the ranges of motion of the ankle and subtalar joints are taken together, the complex functions as a universal joint. The contours of the articular surfaces and the neurovascular and tendinous structures in the surrounding soft tissue, is vital for planning and performing arthroscopy in this joint.
The ankle joint has small internal dimensions under normal circumstances. To produce sufficient space in which to perform the ankle arthroscopy procedure and avoid damaging the joint surfaces with instruments, it is necessary to “stretch open” the joint. This is achieved under anaesthesia by using a combination of traction across the joint and distending the joint by infusing sterile fluid under pressure.
Most ankle arthroscopy is performed under general, or occasionally regional, anaesthesia. Firstly when setting up the patient a padded bar is placed behind the thigh.
Conditions we treat
Unstable ankle after injury
This is usually due to a painful area within the joint such as a synovitis (inflammed tissue in the joint), a plica or arthrofibrosis(scar tissue in the joint) or a chondral or osteochondral injury (damage to the bone & cartilage lining of the joint). All of these conditions can be treated using an ankle arthroscopy.
Ankle pain after injury
Persistent pain after an ankle sprain is often caused by the development of intra-articular fibrous scars or even tibiotalar spurs as a consequence of repetitive trauma. This may result in a posttraumatic impingement syndrome of the ankle. Pain is typically provoked by dorsiflexion of the ankle and palpation of the tibiotalar anterior joint space.
Ankle arthroscopy with resection of hypertrophic synovium and fibrous bands (type I) or tibial spurs (type II and III injuries) after an ankle sprain proved to be a reliable therapy for a posttraumatic impingement syndrome of the ankle.
Footballers ankle manifests itself with pain at the front part of the ankle joint which remains well localised and occurs mainly during dorsiflexion of the ankle( when the foot moves towards the shin ). It is due to spurs of bone forming usually on the front of the Tibia at the ankle joint. A spur of bone at the front of the ankle is also a common finding in ankle arthritis.
Debridement or fusion are the two arthroscopic options for an osteoarthritic ankle. See ankle arthritis section for detail on this. Ankle arthroscopy can be usefully used to debride (tidy up) mild or moderately arthritic joints.
Loose bodies are pieces of bone and cartilage which either float freely between a joint or sit loosely attached at the margin of the joint. If these jar between the surfaces of the joint they may cause symptoms of instability or pain. This tends to be intermittent rather than continual. They can also produce symptoms of instability.
Diseases of the synovium
The synovial joint lining itself may become diseased as the primary complaint within the ankle joint. Conditions which cause this are diseases such as rheumatoid arthritis or synovial chondromatosis. The symptoms are those of pain or instability and arthroscopy again can assist.
Post Op Recovery
The first two weeks post-op the patient should aim simply to return to comfortable walking.
Once this is achieved they may start physio rehab and during week 3 work on gentle strengthening and balance , using a static bike for exercise. Week 4 & 5 are spent using cross-trainer and week 6 light jogging. The realistic expectation after ankle arthroscopy for removal of soft tissue pathology is for largely unrestricted activity by 6 weeks.