Ankle Arthroscopy

Ankle Arthroscopy

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Overview

Ankle joint is a complex joint that is formed by articulation of three bones, namely-tibia, fibula (long bones of the leg) and talus (bone of the foot). The joint is surrounded by an articular capsule which is rather weak and thin, but it is strengthened and supported by various ligaments, tendons and muscles. The joint acts as a shock absorber when the heel first strikes the ground.

What is ankle arthroscopy?

Ankle arthroscopy is a minimally invasive surgical procedure that is used for both diagnosing and treating various disorders of the ankle joint. It is performed using a handheld device called an arthroscope, which is inserted into the joint by making a small incision almost the size of a keyhole. For the same reason arthroscopy is also known as keyhole surgery.

Who are candidates for ankle arthroscopy?

Various diseases and injuries can damage the cartilage, ligaments, tendons and muscles (connective tissues) of the ankle joint. Arthroscopy can be initially used to determine the extent of damage and later performed to treat the ailment. Patients diagnosed with following conditions are ideal candidates for arthroscopic surgery-

  • Ankle osteoarthritis: wear and tear of the articular cartilage of the ankle joint
  • Inflammatory arthritis: such as rheumatoid arthritis
  • Ankle instability: laxity (stretching out) of ankle ligaments, having a feeling of ankle “giving way”
  • Ankle impingement: inflammation of the soft tissue structures of the ankle joint causing pain and swelling
  • Ankle fractures: especially intra articular fractures and micro fractures of the ankle joint
  • Arthrofibrosis: scar tissue formation within the ankle joint resulting in stiff joint.
  • Infection: infection in the joint space
  • Post traumatic injuries: such as severe ankle sprains
  • Synovitis: inflammation of the soft tissue lining of the ankle joint may be due to injury or overuse.
  • Osteochondritis dissecans: breakage of fragment of bone or cartilage due to lack of blood flow

What are the advantages of arthroscopic surgery?

  • Minimally invasive procedure does not disrupt joint anatomy
  • Minimal soft tissue trauma
  • Shorter hospital stay (patient is discharged home the same day)
  • Lesser post-operative joint pain and stiffness
  • Recovery usually takes less time
  • Minimal scar formation
  • Less chances of infection
  • Early arthroscopic surgery helps in preventing or delaying the need of future joint arthroplasty (joint replacement surgery) in the target population.

How to prepare for ankle arthroscopy?

  • Preoperative evaluation will be done by the orthopaedic surgeon a few weeks before the surgery is planned.
  • Your surgeon will take complete medical history and question if you have any pre-existing comorbidity such as diabetes mellitus, hypertension, thyroid disorder etc. In case of RTA or sports injury, the mechanism of injury will be closely studied.
  • Review of medications will be performed and in case a patient is taking any blood thinning medicine, it will be discontinued.
  • Your doctor will advise you to undergo X-ray, MRI (magnetic resonance imaging), or CT scan (computerised tomography) of the ankle joint to exactly identify the site of injury/damage.
  • Additional blood tests, urinalysis, chest x ray, electrocardiogram (ECG), etc. should also be performed as advised by the doctor.
  • In case the reports suggest any kind of infection, severe diabetes mellitus, high blood pressure, severe heart or lung disease or any other active metabolic disorder, then surgery is deferred until the condition is resolved.
  • If you are generally healthy and there are no underlying medical complications, arthroscopy can be performed without any delay.
  • Approximately 8 hours of fasting is required prior to surgery, preferably starting from midnight.

How is ankle arthroscopy performed?

Your doctor will give you anaesthesia depending on the condition being treated. You may be given either general anaesthesia or regional nerve block to numb your leg and foot. A small incision (size of a keyhole) is made over the front or back of the ankle to insert an arthroscope into the joint. It is attached with a camera lens and light which projects the image on a screen. This gives a clear vision of the structures inside and helps in accurately locating the site of injury or damage. The doctor then fills in sterile fluid to control any bleeding and to obtain a better view. Once the problem is identified, doctor will proceed further and make small accessory insertions called portals. Special instruments for grasping, cutting, shaving and sewing are inserted into the joint through these portals.Most surgeries usually take 1-2 hours, however the duration will depend on the injury being treated. After completion of the surgery these small incisions will be closed with the help of special tapes or stitches and covered with sterile dressing.

What happens after ankle arthroscopy?

You will be moved to the recovery room and observed for a few hours before getting discharged. Expect some pain and swelling over the ankle joint for the first few weeks after the surgery. But these symptoms will gradually wear off. Icing over the affected area along with elevation will help in reducing the swelling. Your doctor will prescribe anti-inflammatory and pain-relieving medicines to help you feel better. If you had an extensive surgery or remodelling of the ankle joint, your doctor may put your ankle in a cast or splint to prevent any unnecessary movements of the joint, early weight bearing and promote healing.Once you get back home, walking around (mostly for basic activities) should be done with the help of crutches. Avoid putting any weight on the operated joint during the first two weeks after the surgery. You need to wear the splint/cast for almost 2 weeks. After almost 2-3 weeks most of the patients will be able to resume their normal daily activities and sedentary jobs (desk work). It may take almost 6 weeks before you can put weight on the ankle.

After 6 weeks, your doctor will recommend you to begin rehabilitation with a physiotherapist. To begin with, simple ankle strengthening and stretching exercises can be performed. Gradually the frequency and intensity of the exercise can be increased depending on the rate of recovery. Return to high level sport activities can be expected around 8 months post-surgery.Driving can be resumed almost 6-8 months post-surgery. However, it is recommended that you should always consult your doctor before doing so. The expected complete recovery time is around 6 to 12 months. It is recommended that patients should wear an ankle brace for up to a year while engaging in any sports activity.

Recovery time varies individually depending on the type of procedure, anaesthesia, age, general health, associated medical conditions (diabetes, heart problems etc) and other factors. Complete recovery can take around 6 to 12 months.

What are the complications of ankle arthroscopy?

These are rare and occur in quite a few patients. Possible complications include-

  • Infection
  • Nerve damage
  • Artery damage causing excessive bleeding,
  • Blood clots,
  • Allergic reaction to anaesthesia.

It is recommended that you should immediately contact your doctor in case you have fever, worsening pain, numbness and tingling, excessive swelling or coloured discharge from the wound.

Tips to speedy recovery

  • Surgical wounds should be kept dry for at least 2 weeks.
  • Elevate your foot and apply ice packs to reduce swelling.
  • Taking iron supplements will promote tissue healing.
  • Topical pain-relieving gels/ointments should be preferred over oral pain medications.
  • Perform regular light exercises to maintain strength and mobility.
  • Physical therapy plays a vital role during rehabilitation. Follow your doctor/therapist advice.

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