Ankle arthroscopy: Patient information

 

Ankle arthroscopy is a ‘keyhole’ operation to look inside the ankle joint. Arthroscopy may be used to inspect the joint and allow the treatment of some conditions which affect the ankle.

 

 

Conditions which can be treated with ankle arthroscopy

 

Cartilage damage ("Osteochondral defects")

Cartilage is important for normal pain free movement of the ankle. If your ankle is injured, areas of cartilage inside the joint may be damaged. This is known as an osteochondral defect (OCD). An OCD may result in pain and swelling. In the long term, arthritis may develop. 

OCD can usually be picked up by MRI scan, but an ankle arthroscopy is a useful tool in assessing the severity of damage to the cartilage. In addition OCDs can usually be treated using ankle arthroscopy.

 

Small OCDs can often be treated by using a shaver to remove areas of torn or damaged cartilage.

 

Larger OCDs sometimes involve a large area of bone, in which case a technique known as microfracture is used to help healing. Using a sharp pick, the damaged bone is punctured to generate bleeding. This in turn results in the formation of a ‘scab’ which can fill the area of cartilage loss. Although not as resilient as normal joint cartilage, the scab helps to reduce the development of ankle arthritis in the long term. After microfracture you will be asked to use crutches for four to six weeks after the surgery to allow healing of the bone surface.

 

Ankle impingement

Often known as ‘footballers’ ankle’, repetitive minor injuries to the ankle can result in the formation of bone spurs at the edge of the joint. These can result in pain and restriction in movement. The bone spurs can usually be removed using ankle arthroscopy.

 

Loose bodies 

Minor injury may result in tiny fragments of bone floating around the ankle joint. With time these can increase in size to become loose bodies. They can cause pain, clicking and locking of the ankle. In most cases they can be removed through the ankle arthroscope.

 

Ankle instability

Sprains to the ligaments on the outside of the ankle can result in damage to the ligaments here. In some cases this is associated with cartilage damage or inflammation within the joint. An ankle arthroscopy allows these associated problems to be looked for and treated. If the ankle ligaments are found to be very lax, then the surgeon can go on to perform a ligament reconstruction through a larger incision on the side of the ankle. If this is required, then you will be in plaster for six weeks after the surgery to allow the ligaments to heal.

 

Ankle arthritis

Although ankle arthroscopy alone cannot treat ankle arthritis, it does allow accurate assessment of the severity and extent of arthritis in the joint. Bone spurs can be trimmed and loose bodies removed. In addition, washing out the joint may help symptoms in the short term.

 

 

What is involved with ankle arthroscopy?

 

Under general anaesthetic, your ankle is carefully examined to document stability and range of movement.

 

Using a strap, gentle traction is applied to the ankle. The joint is filled with water and two 1cm incisions are made at the front of the ankle. In some cases a third incision may be required at the back of the ankle. A camera is inserted through one of the incisions and the inside of the joint is examined. Instruments such as a probe, shaver or burr can be inserted through the second incision.

 

After the operation, the wounds are sewn up with stitches, adhesive dressings are applied and the ankle is wrapped up with a bandage. Most patients will be able to return home the same day.

 

What should you expect after surgery?

 

If you have had a ligament reconstruction at the same time as an ankle arthroscopy, you will be in plaster. If you have had microfracture for an osteochondral defect you will be non-weightbearing on crutches. The surgeon will warn you berforehand if this is likely to be the case. Otherwise you will be allowed to bear weight through the ankle.

 

The bandage should be left in place for 48 hours. This helps to reduce swelling and bleeding.

 

You may remove the bandage after 48 hours. The adhesive dressings should be kept in place to protect the wounds. You should keep the ankle dry, using a plastic bag or something similar when you shower.

 

We will make a clinic appointment for you at 10-12 days. The dressings and stitches will be removed. At this stage physiotherapy and exercises may be commenced to regain movement and prevent stiffness.

 

Your ankle may be swollen and tender for up to six weeks, especially if extensive bone spurs have been removed. If you have had a ligament reconstruction or microfracture, recovery may be longer. Your surgeon will discuss this with you.

 

What can go wrong?

 

Ankle arthroscopy is a common procedure, and most patients can expect a full recovery. As with all operations, sometimes complications may occur. These include:

 

Swelling, stiffness and pain

How much work has been done inside the ankle will determine how sore and swollen it is afterwards. If bone spurs have been removed, the ankle can be swollen for up to six weeks, sometimes longer. You should rest, elevate and ice the ankle. Activity should be limited until the wounds have healed (usually 10-14 days).

 

Failure to improve

In some cases, despite surgery, the condition may progress resulting in ongoing pain, swelling or stiffness.

 

Infection

Although rare, infection inside the ankle can be very serious. By keeping the wounds clean and dry until they have healed the chances of this are minimised. Signs of infection are increasing pain, redness, swelling and a high temperature. You should conact the hospital if you are worried. If infection has occurred, you may require further surgery to wash out the ankle joint.

 

Blood clots

This is a rare complication. Blood clots can travel to the lungs causing difficulty breathing and sometimes can be fatal. If you are at risk of blood clots or in plaster after surgery you will be given medication to reduce the risk.

 

Nerve damage

A small nerve which provides sensation to the top of the foot passes directly over the ankle. If it is bruised or damaged by surgery, numbness may result. This usually resolves but may take up to six months.