Ankle Arthroscopy:


Ankle arthroscopy is a surgical technique where a small fiber-optic camera, known as an arthroscope, is inserted into the ankle joint through small incisions. This allows the surgeon to visualize, diagnose, and treat various ankle conditions with minimal invasion, leading to less pain, quicker recovery times, and reduced risk of complications compared to open surgery.


Techniques:


  • Patient Positioning:

    • Supine Position: Most common for anterior ankle arthroscopy. The knee is flexed, and the ankle might be suspended for distraction or held by an assistant.

    • Prone Position: Used for posterior arthroscopy to access the back of the ankle joint.

  • Portals:

    • Anteromedial Portal: Typically used for viewing, made just medial to the anterior tibial tendon.

    • Anterolateral Portal: For instrument insertion, located just lateral to the peroneal tendons.

    • Posteromedial and Posterolateral Portals: Used for posterior arthroscopy, with careful attention to neurovascular structures.

  • Distraction:

    • Noninvasive Distraction: Using straps or an assistant to pull the ankle, increasing joint space.

    • Invasive Distraction: Less common, involves skeletal traction pins but carries higher risks of complications.

  • Instruments:

    • Arthroscopes of various sizes, shavers, burrs, probes, and graspers specific to ankle surgery are used for debridement, osteophyte removal, or repair.

  • Fluid Management: Sterile fluid is used to inflate the joint, improving visibility and working space. This fluid must be managed to maintain pressure without causing extravasation.

  • Techniques for Specific Conditions:

    • Debridement: For synovitis, loose bodies, or damaged cartilage.

    • Osteophyte Excision: For impingement syndromes.

    • Osteochondral Lesion Management: Including microfracture or cartilage repair techniques.

    • Ligament Repair: Arthroscopic techniques for chronic ankle instability.


Indications:


  • Ankle Impingement: Both anterior (athlete's ankle) and posterior types, where bony spurs or soft tissue get pinched during movement.

  • Osteochondral Lesions: Damage to the cartilage and underlying bone, often from trauma or repetitive stress.

  • Chronic Ankle Instability: After ligament injuries fail to heal properly, causing recurrent sprains.

  • Synovitis: Inflammation of the joint lining, often from arthritis or infection.

  • Loose Bodies: Fragments of bone or cartilage that can cause pain or locking.

  • Arthritis: For debridement in early osteoarthritis or to prepare joints for fusion.

  • Fractures: To assist in reduction and fixation, especially when combined with open techniques for complex fractures.

  • Infection: Arthroscopy can be useful for joint lavage in septic arthritis.

  • Unexplained Pain: When other diagnostic tools like MRI or CT scans fail to identify the cause.

  • Post-Traumatic Conditions: Like scar tissue or adhesions which might limit motion or cause pain.


The success of ankle arthroscopy often depends on the surgeon's experience, the specific pathology, and the patient's overall health. Complications are relatively low but can include nerve or vessel injury, infection, or incomplete resolution of symptoms.