ARTHROSCOPY OF THE ANKLE
Introduction
Arthroscopy is a “keyhole” surgery. An instrument set containing a miniature video camera (arthroscope) is inserted into the joint along with other miniature tools to repair the damage. This allows a surgeon to accurately assess the problem and repair it in a single operation. Arthroscopic procedures of the ankle usually require a one-day stay in the hospital. Anaesthesia can be general or nerve block – depending on an anaesthesiologist. In order to introduce operating instruments into the joint, small skin incisions are made around the joint. After inserting the instruments, the joint is filled with sterile saline solution, under the control of a precise pump. After repair (reconstruction) of intra-articular damage, sutures are placed and a dressing is applied. In reconstruction of joint instability, the use of an ankle stabilizer is required. The next day, the patient is discharged home with the recommendations on check-ups, rehabilitation and the need to walk with elbow crutches.
Causes
The most common reasons for arthroscopy of the ankle are conflicts within the soft tissues of the anterior and posterior ankle joint compartment, cartilage and bone injuries of the ankle, free bodies, ankle fractures, arthrodesis (stiffening) of the ankle joint, ankle instability, infectious inflammation of the ankle joint and arthrofibrosis.
Symptoms
Typical symptoms of ankle injuries are pain (especially during sports activity), swelling, limited mobility of the joint, instability, clicking and local temperature increase.
Diagnosis
During the preoperative consultation, the doctor takes medical history (information on the condition, previous treatment) and performs a clinical examination, including specialized tests to determine the cause of ailments. The next step is to perform X-ray imaging, computed tomography and high-field magnetic resonance, which is currently the most common examination. All these diagnostic elements together allow for precise diagnosis.
Treatment
Arthroscopic procedures of the anterior and posterior ankle joint compartment allow for resection (excision) of massive fibrosis, hypertrophied synovium, removal of interposing chondro-osseous outgrowths on the tibia and talus, removal of free bodies, and repair of articular surface defects, in particular osteochondral necrosis (OCD) of the talus. Arthroscopic stiffening, or arthrodesis of the joint is performed in severe degenerative changes. Under arthroscopy, intra-articular fractures are connected in the area of the ankle, the cartilage surfaces are precisely reconstructed. In joint instability, especially in sport-active patients, ligament reconstructions are carried out. Arthroscopy of the ankle is also carried out in infectious cases.
Postoperative period
The patient spends the day after the surgery in the hospital. The next day, after changing the dressing, removing drains from the joint, control of sensation and blood supply to the operated limb, the patient is verticalized and taught to walk with crutches under the supervision of a physiotherapist. Next, the patient receives recommendations on further management and receipt of medical records, and leaves the hospital. Further treatment-check-ups at the attending doctor and rehabilitation consultations take place on an outpatient basis.
In the Szpital Zakonu Bonifratrów, arthroscopy of the ankle is performed by a team of specialists in orthopaedics and traumatology:
Stanisław Szymanik, MD – Head of the Diagnostic and Treatment Department
Michał Latos, MD
Michał Starmach, MD