Ankle Arthroscopy

Autor: RAFAŁ CZEPUŁKOWSKI
Consultation MICHAŁ OSOWSKI
Ankle arthroscopy is a minimally invasive surgical procedure used to treat various conditions of the upper ankle joint or lower ankle joint (talocalcaneal joint). During the procedure, the surgeon, after making small skin incisions of approximately 5 mm, uses a thin fiber-optic camera that transmits images from inside the joint to a video screen and small arthroscopic tools. This allows the surgeon to remove the source of pain in the joint and improve its function.
Ankle Arthroscopy

Applications of Ankle Arthroscopy

Ankle arthroscopy is most commonly used as a diagnostic and therapeutic method for the ankle joint after injuries. It is performed to repair damage to cartilage, ligaments, and bones, as well as to remove loose bodies in the joint, osteophytes (bone spurs), and scar tissue adhesions that limit joint mobility. Broadly, ankle arthroscopy is divided into anterior compartment arthroscopy, with access to the joint from the toes' side, and posterior compartment arthroscopy, with access from the heel and Achilles tendon side. The list of ankle joint conditions that can be treated with this minimally invasive method continues to evolve and includes:

Anterior and Posterior Impingement in the Ankle Joint

This condition causes pain and restricted motion during extreme dorsiflexion and plantarflexion of the ankle joint. It most commonly develops after an injury or repeated micro-injuries to the joint, leading to the formation of osteophytes (bone spurs) at the joint edges. These cause pain and restrict motion. Ankle arthroscopy can remove the tissues and osteophytes causing impingement in extreme positions of the joint.

Fractures Around the Ankle Joint

Ankle arthroscopy is also used for fractures of the fibula, tibia, and talus. The surgeon examines the ankle joint under camera control to evaluate the fracture gap, displacement, joint stability, and any additional soft tissue damage caused by the injury. Arthroscopic techniques can be used to fix fracture fragments from the joint side with small screws and dedicated implants or to remove small bone fragments (loose bodies) unsuitable for fixation.

Ankle Instability

Ankle arthroscopy is employed in treating chronic instability caused by frequent ankle sprains. After multiple sprains, patients often experience ankle joint instability—while walking, the joint "gives way," and subsequent sprains occur even during minor incidents. This is due to complete ligament damage or insufficiency, most commonly of the anterior talofibular ligament (ATFL). If left untreated, instability can lead to osteophyte formation at the joint edges due to improper joint glide, which further restricts ankle mobility. Arthroscopy allows for ligament repair to restore joint stability and the removal of osteophytes limiting mobility.

Restricted Mobility - Fibrosis and Adhesions in the Ankle Joint

Following significant ankle injuries or prolonged immobilization in a cast, arthrofibrosis may occur, characterized by joint capsule fibrosis and hypertrophy of the synovial membrane. Ankle arthroscopy is used to release and remove adhesions, increasing or restoring joint mobility.

Loose Bodies in the Joint

As a result of trauma or chronic ankle instability, small bone fragments may detach and block the ankle joint during movement, causing a sensation of catching and pain. This is an indication for ankle arthroscopy to remove the loose bodies.

Osteochondral Lesions in the Ankle Joint

Osteochondral lesions (OCL) refer to separated fragments of bone and cartilage, typically a few millimeters to centimeters in size. They usually result from twisting injuries or fractures and can provoke pain and restricted ankle motion.

For small osteochondral lesions, during arthroscopy, the surgeon removes the detached fragment and drills the bone (microfracturing) to stimulate the formation of scar tissue resembling cartilage at the site of the lesion.

For larger lesions, a collagen membrane may be used to replace cartilage function, and bone grafts can be applied to fill the defect left by the osteochondral fragment.

Ligament Injuries

Ankle arthroscopy enables the repair of ligaments connecting the talus to the tibia and fibula, as well as ligaments forming the connection between the tibia and fibula. Using dedicated implants and sutures, the ligaments are repaired or reinforced to restore their function.

Degenerative Changes in the Ankle Joint

Following fractures and sprains in the ankle, when cartilage injury occurs, degenerative changes may develop in the ankle or talocalcaneal joint. Patients experience pain while walking and restricted joint mobility. In such cases, to eliminate pain and restore activity, a fusion procedure—arthrodesis—is often performed. This allows for pain-free function. Through ankle arthroscopy, residual cartilage can be removed minimally invasively, and the joint can be fused using screws. After this procedure, patients can return to physical activity.

Surgical Procedure

After the patient is brought to the operating room, the leg is prepared for surgery, and a tourniquet is applied. Following appropriate anesthesia (spinal anesthesia with additional peripheral nerve blocks) administered by the anesthesiologist, the procedure begins. The surgeon makes at least two small incisions in front or behind the ankle, through which the arthroscope and instruments are introduced. Sterile fluid is introduced into the joint to improve visualization during the procedure. After the surgery, stitches are placed to close the portal incisions through which the tools and camera were inserted. A sterile dressing is applied over the stitches. Ankle arthroscopy lasts between 30 minutes and 2 hours, depending on the injury and the specific surgical repair.

Recovery

Post-surgery, pain and swelling are expected. However, because arthroscopic surgery is minimally invasive, these symptoms are significantly less severe than with open surgery involving large skin and tissue incisions. For a few days after surgery, the operated limb should be elevated while at rest. Oral pain medications may be required for several days. Depending on the treated condition, the patient uses crutches or a brace for 2 to 8 weeks post-surgery. Skin stitches are removed after 2 weeks. Rehabilitation begins under the supervision of a qualified physiotherapist, and physical activity should be limited. After completing treatment, a full return to sports is typically possible.

Related Articles:
Learn about other possible foot and ankle injuries.

Bibliography:

Autor
RAFAŁ CZEPUŁKOWSKI
RAFAŁ CZEPUŁKOWSKI

Specjalista do spraw content marketingu, dziennikarz sportowy i medyczny. Redaktor naczelny magazynu „Poradnik Zdrowie i Sport”, członek Dziennikarskiego Klubu Promocji Zdrowia, współtwórca wielu artykułów medycznych z zakresu ortopedii i urazowości w sporcie.

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Konsultacja merytoryczna
MICHAŁ OSOWSKI
MICHAŁ OSOWSKI

Lekarz w klinice Rehasport, specjalizuje się w ortopedii i traumatologii narządu ruchu z ukierunkowaniem na chirurgię urazową oraz medycynę sportową. Zajmuje się leczeniem schorzeń oraz urazów kończyny dolnej, zwłaszcza stopy i stawu skokowego.

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