Ankle Arthroscopy

Overview

Ankle arthroscopy is a minimally invasive surgical procedure that uses a small camera and specialized instruments to diagnose and treat various conditions inside the ankle joint. Through small incisions, surgeons can address soft tissue impingement, loose bodies, osteochondral lesions, and other ankle pathology. The procedure offers advantages including smaller incisions and potentially faster recovery compared to open ankle surgery.

Indications

This procedure may be considered when:

• •Anterior or posterior ankle impingement (bony or soft tissue)
• •Osteochondral lesions of the talus or tibial plafond
• •Loose bodies within the ankle joint
• •Ankle synovitis or inflammatory conditions
• •Mild ankle arthritis for debridement
• •Evaluation of ankle instability
• •Ankle fracture management (assessment, reduction, fixation assistance)
• •Ankle fusion preparation or assistance
• •Removal of scar tissue or adhesions

How It Works

The procedure typically involves several coordinated steps:

• •The procedure is performed under general, regional, or local anesthesia with sedation
• •The patient is positioned supine with the ankle accessible
• •Noninvasive distraction may be applied to improve visualization
• •Small portals are created around the ankle joint (typically anterolateral and anteromedial)
• •A camera (arthroscope) is inserted to visualize the joint interior
• •The joint surfaces, ligaments, and soft tissues are systematically examined
• •Therapeutic procedures are performed: debridement, microfracture, loose body removal, bone spur excision
• •Posterior ankle arthroscopy may be performed for posterior pathology using prone positioning
• •Portals are closed with sutures or adhesive strips

Risks

As with any surgical procedure, potential risks include:

• •Nerve injury (particularly superficial peroneal, sural, or saphenous nerves)
• •Infection of the surgical site or joint
• •Persistent pain or swelling
• •Stiffness or limited range of motion
• •Damage to articular cartilage from instruments
• •Blood clots
• •Complex regional pain syndrome (rare)
• •Incomplete resolution of symptoms
• •Need for additional surgery

Recovery Expectations

Recovery follows a gradual progression:

• •Many procedures are performed as outpatient surgery
• •Weight bearing status depends on the specific procedure performed
• •Crutches may be needed for days to several weeks
• •Early range of motion exercises often begin within days
• •Swelling management with elevation and ice is important
• •Physical therapy may be recommended for strengthening and mobility
• •Return to normal activities varies from 2 weeks to 3 months based on procedure
• •Return to sports may require 6 weeks to 6 months depending on the condition treated

Alternatives

Depending on individual circumstances, alternatives may include:

• •Physical therapy and conservative management
• •NSAIDs and other medications for pain relief
• •Corticosteroid or other injections into the ankle joint
• •Activity modification and bracing
• •Open ankle surgery for conditions not amenable to arthroscopy
• •Ankle fusion or replacement for advanced arthritis

Sources

• Mayo Clinic – Arthroscopy
• Cleveland Clinic – Ankle Arthroscopy
• American Orthopaedic Foot & Ankle Society – Ankle Arthroscopy