Ankle Arthroscopy

Background

Recent advances have permitted surgical procedures to be performed inside joints without opening the joints by traditional methods. A small telescope (arthroscope) with video equipment may enable a surgeon to look into the joint and introduce small instruments under direct vision.

Classically this has been used to treat knees with a torn cartilage (meniscus). With technological advances the size of the arthroscopes and the surgical instruments have become smaller and more precise allowing surgeons to view and treat conditions in smaller joints such as the ankle, subtalar joint and even the great toe.

The common arthroscopic procedures performed on the ankle are removal of excessive scar tissue and loose bodies from the joint and treatment of fractures and unstable areas of the articular surface.

The surgery is often performed as a day-case procedure under general or regional anaesthesia. If soft tissue surgery is performed then you will usually be able to fully weight-bear from the day of surgery. If bony surgery is performed then you may need crutches for 10 - 14 days.

Arthroscopic Treatment of Fractures of the Talus

A severe sprain may tear the ligaments of the ankle but it may also damage the smooth cartilage covering the joint surface of the bones. This is called an "osteo-chondral defect" (OCD) - it is part bone and part cartilage. It may become loose and is a cause of continuing ankle pain following a bad sprain. Occassionally, they can occur spontaneously (without an injury).

An OCD may be suspected after careful examination, may show up on an X-ray but may also require a CT or MRI scan before it is diagnosed. An arthroscopy may be performed to remove a loose OCD.

Arthroscopic Ankle Fusion

Patients with advanced arthritis of the ankle may require surgical fusion of the ankle. 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.

• X-ray view of screws across ankle joint following arthroscopic fusion

This is normally carried out through a small incision on the outside of the ankle. Recent technological advances have enabled the ankle to be fused arthroscopically. This has advantages with regards to healing of the skin and soft tissues, may lead to earlier fusion and patients may be able to weight-bear earlier. Not every patient with advanced arthritis of the ankle is suitable for an arthroscopic fusion but your specialist with be able to advise you.