Many ankle injuries can result in damage to ligaments, swelling in the joint or even damage to cartilage. Over time, this can lead to significant ankle pain. Thankfully, we can treat several of these problems with arthroscopic surgery. Arthroscopic surgery in a form of minimally invasive surgery done by placing a camera in the joint through a small incision in the ankle. Through a second incision, other instrument can be used to help to treat joint pathology.
I have talked in a previous blog about arthroscopic repair of ankle ligaments after ankle sprains, but there are several other applications where “scoping” the ankle can help to relieve pain. Like all surgeries, ankle scopes are not the correct procedure for every patient or condition, but in the right hands they are a valuable tool to help limit surgical exposure and decrease healing times. Here are a few conditions we can treat arthroscopically.
-Arthritis: Arthritis in the ankle occurs most commonly after a bad ankle sprain or fracture. Damage to the cartilage over time can lead to spurring in the ankle. Ankle arthroscopy can be used to “clean” the joint by removing bone spurs and cleaning out the cartilage and surrounding tissues. Post-operative recovery is generally 2 weeks in a walking boot and many patients return to full activity within 2-4 weeks. For severe arthritis, ankle joint fusion can be performed arthroscopically. We try to avoid ankle fusions whenever possible in my clinic by attempting an ankle arthroscopy with debridement first.
-Cartilage Defects: I will write another blog about this topic by itself at some point. Cartilage defects, known as “OCDs” are caused by direct trauma to the cartilage during and injury. In a severe sprain or ankle fracture, the ankle bones can collide with each other causing damage to the cartilage and underlying bone. Ankle arthroscopy can be used to clean out the damage cartilage and the defect is drilled to the underlying bone allowing for new cartilage formation. Newer techniques include adding ground cartilage matrix to the area and sealing it in pace with a biologic glue. These procedures can be done entirely through the scope. The patient is often non-weight bearing for 4 weeks after the procedure, then in a walking boot for 2-4 weeks.
-Synovitis: Inflammation in the synovial sack can cause pain in the ankle. The synovium is the lining on the inside of the joint capsule that produces joint fluid. When it becomes inflamed, small tendrils like octopus arms creep into the joint. These can cause impingement and pain when walking or exercising. Often patient complain of pain in the ankle when going up and down the stairs. Debridement of the synovium using arthroscopy is an effective way to reduce the pain associated with this problem. Recover is 2 weeks in a walking boot. Patients usually return to activity in 2-4 weeks post-surgery.
-Ankle ligament repair: See our blog on ankle sprains for more information on arthroscopic lateral ankle ligament repair. Ankle Sprains
-Fractures: Certain fractures can be partially repaired via ankle arthroscopy. Micro fracture procedure to increase blood flow into the ankle bone or fibula can be performed via a scope along with reduction of certain ankle fractures.
Ankle arthroscopy is an important tool in the treatment of ankle conditions. Along with regenerative technologies, fewer total ankle replacements and fusions have been needed. If you are having chronic ankle pain, it is best to see your Podiatrist for an evaluation.
Chris Suykerbuyk, DPM, FACFAS