Current Concepts In Ankle Arthroscopy

Lawrence A. DiDomenico, DPM, FACFAS, and Albert A. Giagnacova DPM

Given new technological advances, key intraoperative benefits and quicker post-op recovery, ankle arthroscopy continues to emerge as a viable modality for podiatric surgeons. Accordingly, these authors review the literature and share their insights on proper indications, portal placement, whether you should use distractors and the potential of radiofrequency waves in arthroscopic procedures.

Ankle arthroscopy is still considered a somewhat new and exciting addition to the armamentarium for the foot and ankle surgeon. Typically, this is a physician and patient friendly procedure that allows direct visualization of intra-articluar structures without the need of an open arthrotomy or malleolar osteotomy in order to gain access to the ankle joint.

   The most significant advantage of ankle arthroscopy is the direct visualization of intra-articular pathology. The minimal dissection required for the placement of the ankle portal is a distinct advantage in comparison to open arthrotomy. The minimal disruption of the soft tissue envelope is paramount in the reduction of healing time. For this reason, violation of soft tissue layers is rarely an issue when considering ankle arthroscopy as opposed to more traditional techniques such as an open arthrotomy.

   Key technological advances in fiber optics, cameras, video screens, instrumentation and advanced surgical techniques have resulted in an improved ability to perform diagnostic and therapeutic arthroscopy of the ankle.

   Ankle arthroscopy is a valuable tool for the foot and ankle surgeon who is diagnosing and treating various ankle conditions. More recently, additional surgical techniques are developing with the intention of minimizing exposure and reducing the risk to the patient. Ankle arthroscopy provides the surgeon and the patient a better means for facilitating surgical outcomes. This includes an improved, quicker postoperative recovery in comparison to traditional open procedures.

A Closer Look At Indications And Contraindications

Prior to a patient undergoing an ankle arthroscopy procedure, it is a considerable advantage for the surgeon to gather additional information through diagnostic testing. It is helpful to pursue basic laboratory testing to obtain complete blood cell count and differential, uric acid levels, and inflammatory markers, such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Rheumatoid panels can be beneficial for patients who have a non-traumatic etiology.

   Standard plain radiographic films along with specialized stress views are necessary to evaluate the structural alignment of ankle. Magnetic resonance imaging (MRI) is an excellent adjunctive tool for the evaluation of soft tissue and articular lesions. One may also consider computed tomography (CT) and specialized bone scans.

   Since Takagi and colleagues first performed arthroscopic evaluation of the ankle in 1939, much has changed.1 While the theory of ankle arthroscopy has not changed significantly, ankle arthroscopy has evolved to become a fundamental tool in the treatment of several conditions associated with ankle disorders. As the technology has improved, there has been a notable increase in the indications for ankle arthroscopy.

   Some suggested diagnostic indications include chronic edema, stiffness, instability, hemarthrosis and audible locking or snapping on the joint.

   Other specific pathologies may include congenital bands, scar tissue, rheumatoid arthritis, pigmented villonodular synovitis and synovial chondromatosis.

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