Ankle Arthroscopy

Why look into the ankle with a telescope?

The ankle is a small joint where the bones are covered with a smooth shiny cartilage.  The ankle is supported by ankle ligament and tendons. After an ankle fracture or a sprain there can be scar tissue formed in the ankle joint. The joint surfaces may have become scuffed during the original injury. These problems may cause symptoms such as pain and swelling in the ankle.
The inside of the ankle can be assessed by performing an ankle arthroscopy. This means looking inside the ankle with a telescope. This is usually performed under a general anaesthetic. The telescope is inserted by making small cuts in the skin rather than making a large incision. These small cuts heal very quickly and will allow you to get back to normal sooner than using a large cut.

What does an ankle arthroscopy involve?

An ankle arthroscopy can be performed under general anaesthetic. It is usually performed as a day case meaning you can go home on the same day of surgery. During the arthroscopy the joint surfaces are inspected. Any soft tissue scarring can be removed by using special machines. This can often make the ankle more comfortable.
If the articular cartilage is scuffed then this roughened surface can rub when the ankle is moved and this can cause pain. This damaged cartilage can be smoothed with special machine. Sometimes the cartilage damage extends to the surface of the bone. In this situation holes are drilled into the bone. This stimulates the growth of a new type of cartilage. This technique of drilling holes in bone is called micro fracture.
After the operation you will have some stitches. The ankle is wrapped in a big woolly bandage.

Ankle arthroscopy : post-operative course

After the operation you will be issued with crutches for comfort. You will be able to put as much weight on the foot as you can tolerate. Most patients build up their weight bearing over a two week period.
Stitches are removed after 2 weeks. From two weeks is likely that you will be fully weight bearing comfortably. Your ankle will be swollen and stiff for up to three months following the ankle arthroscopy.
If you have a micro fracture technique than you will be partial weight bearing meaning you must not put all your weight on the ankle.

Risks of the arthroscopy of the ankle joint:

Infection

This is an uncommon complication. Most infections are superficial and may be treated with a short course of antibiotics. If the infection is deep then an admission to hospital and further surgery may be required. This is an uncommon occurrence.

Nerve Injury

A small nerve about 1mm in diameter lies just beneath the skin. This may be damaged during the approach to ankle. This may lead to permanent damage to the nerve with permanent numbness on the top of the foot.

Pain and Swelling

It is not surprising that it may take several weeks or months for your foot and ankle to settle down after this extensive surgery. Many patients experience pain and swelling especially in the first few weeks. Rest and high elevation are required to keep these at a minimum.

Deep vein thrombosis and pulmonary embolus

After any lower limb surgery there is a risk of a clot on the leg (deep vein thrombosis - DVT) and clot on the lung (pulmonary embolus - PE) After this procedure you will be mobile and so the risk of these complication is small and prophylaxis is not required. If you have had a previous DVT or PE you may be at increased risk.
A risk assessment will be performed pre-operatively. The majority of people undergoing this surgery are at a low risk and do not require any prophylactic medication to reduce the risk of these clots. If your risk is moderate or high prophylactic treatment may be necessary.

Worsening of symptoms

There is a small chance that the symptoms after ankle arthroscopy may worsen. If this happens then an injection of local anaesthetic and steroid may reduce any inflammation and improve the comfort in the ankle. If the symptoms continue then a further assessment and treatment may be necessary.