Pertinent Insights On Ankle Arthroscopy

Patrick DeHeer, DPM, FACFAS, and Corey Groh, DPM

Over the last few decades, arthroscopy has become an advanced treatment method offering enhanced visualization of the joint, accuracy and low complication rates. These authors offer insights on arthroscopy portal location, helpful surgical pearls from their experience and tips on post-op care.

Arthroscopy is a valuable tool in the management of a variety of intra-articular pathologies. Ankle arthroscopy in particular allows unrivaled diagnostic visualization of the ankle joint with the opportunity to treat ankle joint pathology at the same time. It also offers the additional benefit of having relatively low morbidity and high rates of patient satisfaction when a well-trained surgeon conducts the surgery.

   Takagi first described arthroscopy in the Japanese medical literature in 1918.1 The original scope model was based upon pediatric cystoscopies of the time. Takagi later described the first ankle arthroscopy technique in the Japanese orthopedic literature in 1939.1 By 1949, smaller scopes with magnifying optics had emerged but it was not until the 1970s that arthroscopy became popular in North America. This popularity was aided by the advent of power shavers, abraders and retrograde knives. In 1980, Johnson published the first ankle arthroscopy paper in America.2 Finally, the first ankle arthroscopy courses (pioneered by Lundeen and Gurvis) were offered to podiatric surgeons in 1984.3

   Since 1984, ankle arthroscopy has become a widespread and versatile technique that many podiatric surgeons use to treat ankle pathology in their practices. Its popularity has grown because surgeons can perform the procedures quickly with increased accuracy and lower complication rates. Arthroscopy also offers shorter recovery times in comparison to other operative techniques for treating intra-articular pathology.

What You Should Know About Indications And Complications

So when is ankle arthroscopy indicated? As with any pathology that we encounter in podiatric practice, one should exhaust all conservative treatment before considering surgical intervention. Conservative care options include immobilization, nonsteroidal anti-inflammatory drugs (NSAIDs), physical therapy, tapered dosing of prednisone and intra-articular corticosteroid injections.

   Diagnostic indications for ankle arthroscopy include unexplained pain, stiffness, instability, hemarthrosis, edema, locking of the joint, lateral ligamentous laxity, aching within the joint, joint line tenderness and popping with range of motion.

   Traditional imaging modalities have their limitations. Radiographs cannot show the cartilage itself, allowing for one to miss osteochondral defects. Radiographs also tend to have a lag effect in diagnosis, especially for subtle new injuries. This can happen with stress fractures. Computed tomography (CT) can allow for assessment of the size of a lesion. Magnetic resonance imaging (MRI) can give the surgeon insight on the extent of the injury and if osteonecrosis is present. Inserting a camera into the joint can allow the surgeon to directly visualize pathologies that other imaging modalities may miss.

   After establishing a diagnosis either by arthroscopic visualization or other methods, one may use arthroscopy to effectively treat a variety of pathologies. Indications for arthroscopic treatment include: debridement of synovitis, soft tissue impingement, arthrofibrosis, loose bodies, accurate anatomical fracture reduction, osteophytes, osteochondral defects, articular cartilage injury, debridement of gouty tophi and debridement of cartilage for joint preparation in ankle arthrodesis procedures.

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