Ankle Arthroscopic Surgery

Arthroscopic Surgery of Ankle Joint

Arthroscopic surgery, also known as key-hole surgery, is a minimally invasive surgical procedure used to diagnose and treat problems involving the knee joint. It involves making small incisions (portals) to insert a thin telescope and other miniaturized instruments into the joint, allowing the surgeon to visualise the inside of the joint on a video monitor and perform necessary repairs or reconstruction.

It is a minimally invasive technique since it involves using very small incisions without having to open the joint. It helps to minimise the surgical pain and allows for faster recovery times and early return to function.

Common Ankle Joint Conditions Treated with Arthroscopy (key-hole surgery)

1. Loose body removal: Loose bodies are pieces of bone or cartilage inside a joint. These are formed either due to an injury, or due to osteoarthritis or due to a condition called ‘osteochondritis dissecans’. Loose bodies typically cause ‘locking’ (jamming) of a joint along with pain. Arthroscopic surgery can easily remove these loose bodies with instant relief of symptoms.
2. Osteochondritis disseccans: This is a unique condition affecting a joint in which the bone underlying the cartilage of a joint becomes loose and detached from the joint surface. This is commonly seen in the knee, elbow and ankle joints. It is caused due to an acute injury or due to repetitive injury to the joint. It causes pain on activity with locking of the joint. Arthroscopic surgery is used to either fix the loosened fragment back in its place or remove the loose and detached fragment.
3. Ankle impingement: Impingement simply means ‘pinching’ of tissues inside a joint. It is a condition commonly seen in footballers and other athletes. It occurs due to a repetitive injury causing thickening of the synovial or capsular tissue or due to the formation of a bony prominence (called a ‘spur’). Ankle arthroscopy is a good way of clearing the impingement with a faster return to activity.
4. Ankle instability due to ankle sprain: Ankle sprains are very common in day-to-day life. They are caused by twisting or buckling of the ankle, causing injury to the ankle ligament complex. Majority of the ankle sprains heal well with conservative treatment consisting of rest, pain medication, ice application, compression bandage, and occasionally a plaster cast.
   Surgery is sometimes indicated in a patient with a complete tear of the ankle ligament complex or in a patient with recurrent sprains (instability). This requires repair and/or reconstruction of the torn ligaments. This can be treated with a combination of arthroscopic and minimally invasive open surgery.
5. Ankle arthrodesis (fusion): Arthrodesis of the ankle joint is considered when the ankle joint is diseased or damaged beyond salvage. Arthrodesis involves fusing the surfaces of the ankle joint. This is done either by arthroscopic surgery or an open surgery.
6. Synovitis: Synovitis is the inflammation of the synovial lining of the ankle, often causing swelling, pain, and stiffness. Arthroscopy allows for direct examination and removal of the inflamed tissue, providing relief from symptoms and improving joint function.

Open surgery for certain ankle conditions:

Some ankle injuries and conditions may require an open surgery, or a combination of open and arthroscopic surgery.

1. Ankle instability (repeated ankle sprains): Patients who suffer a bad ankle sprain with complete rupture of ligaments, or those with repeated ankle sprains may require open surgery to repair or reconstruct the torn ligaments.
2. Ankle fusion (arthrodesis): Patients with a painful ankle joint due to advanced arthritis may require open surgery to fuse the ankle joint to relieve and improve function.
3. Inflammation or tears of the tendo-achilles tendon: Patients with a rupture (tear) or inflammation (tendinitis) of the tendo-achilles tendon may require an open surgery to repair or reconstruct the affected tendon.