Arthroscopy of the Ankle

Introduction

Ankle arthroscopy is a surgical technique in which an arthrocope is inserted into the ankle joint. An arthroscope is a small fibre-optic viewing instrument which has a tiny lens, light source and is connected to a video camera. The camera displays images on a television screen. By using this instrument, the surgeon is able to visualise the joint to make a diagnosis or to perform a surgical procedure.

The arthroscope is inserted through a small incision in front of the ankle. Through this portal, fluids are connected to expand the joint and to allow adequate vision and enable repair. Small instruments can then be introduced through 1 – 2 other incisions in the joint. The procedure takes 45 to 60 minutes.

Indications for ankle arthroscopy

Removal of scar tissue and inflammation

Following an ankle sprain, some people develop scar tissue and inflammation within the joint. This leads to continued pain and discomfort.

Removal of loose bone or cartilage

Sometimes after an ankle sprain or spontaneously, a piece of bone +/or cartilage can be detached within the joint. This causes pain.

Removal of bony spurs causing impingement

Peri-operative patient education

The patient may present with pain, swelling, locking and feeling of instability after an injury or spontaneously. After physical examination, Dr Lane may recommend further investigations such as X-rays, CT or MRI scans which can further identify the problem in the joint.

If ankle arthroscopy is recommended, Dr Lane will give comprehensive explanation of the procedure, expected recovery and surgical risks. You will also receive educational leaflets supplied by the Australian Orthopaedic Association for further information.

Pre-operative Instructions

Non-steroidal anti-inflammatory drugs such as Feldene, Naprosyn and Celebrex should be stopped 5 days before surgery. These drugs increase the risk of bleeding. Aspirin or other blood thinning drug use prior to surgery should be discussed with Dr Lane. The shoulder to be operated on should be free of cuts, scratches or sores as this can increase the risk of post-operative infections. If there is damage to the skin, surgery will be postponed until healed.

Ankle arthroscopy is performed as a day procedure. The reception staff will give clear instructions about your admission location and time. Do not eat or drink 6 hours before your surgery.

Bring to Hospital:

  • List of medications.
  • Relevant X-rays or MRI scans.
  • Medicare, DVA or Private Health Care Cards.

Once your details have been taken in the admissions area:

  • The duty nurse will take your clinical details and baseline observations.
  • Theatre gown is given to wear.
  • The shoulder to be operated on will be inspected by the nursing staff, washed with anti-septic solutions and covered with sterile drape.
  • TED stocking will be given to wear to reduce the risk of deep venous leg thrombosis following surgery.

You will be taken to the theatre complex by the nursing staff and then into the anaesthetic bay where you will meet Dr Lane and your anaesthetist.

Ankle arthroscopies are performed under a general anaesthetic. The anaesthetist may also give you a regional nerve block when you are asleep to help with post-operative pain.

Procedure

When you are asleep in theatre, a tourniquet is applied to the leg to give a bloodless field for surgery. The foot and leg is then prepped with an anti-septic solution (up to tourniquet) and then the patient is covered with sterile drapes with a window for the operative site.

Following ankle arthroscopy, the joint is injected with morphine (unless patient allergy), and a long acting local anaesthetic to aid post-pain relief. The incisions are usually closed with steri-stripes but occasionally sutured if incision bigger, covered with sterile primapore, dressings and crepe bandage applied.

Once surgery is complete, the patient is taken to recovery. When adequately awake, observations stable, comfortable and able to eat and drink, the patient is discharged home. A script will be given for pain relief.

Post-operative Instructions

For the first 1 -2 days you will be required to use crutches after which you can weight bear as tolerated. Sometimes if more extensive surgery is carried out, you will be instructed to remain on crutches for 7 -10 days.

For the first few days it is important to keep the foot elevated which will reduce the amount of swelling and discomfort. It is important to keep the dressings dry. The outer dressings can be removed after 3 days, leaving primapore in place until seen at the first post-operative visit in 10-14 days following surgery. At this review, your wounds will be checked and sutures removed. Dr Lane will discuss your surgery with you and provide photographs of the procedure.

It usually takes 2-3 weeks for the majority of swelling to settle and usually 6-8 weeks for ankle function to improve to a better level than before surgery. Each patient’s recovery will be different, so Dr Lane will advise the best time for the patient to return to work and sport.

Risks

General risks associated with Anaesthetic (rare)

  • Death (rare).
  • Myocardial infarction (heart attack).
  • Stroke.
  • Deep venous thrombosis.

Local risks (uncommon)

  • Bleeding.
  • Infection –  wound +/- joint.
  • Nerve damage.
  • Ankle stiffness.

Patients with diabetes, obesity, pre-existing multiple medical conditions and smokers will have an increased risk of adverse complications.