Arthroscopy is an orthopedic surgical technique where small incisions are made to insert a 2.9mm diameter camera into the joint while fluid runs into the joint allowing visualization of pathology as well as treatment of various conditions.
Ankle arthroscopy is useful for multiple ankle conditions including: removal of loose cartilage or bone pieces, removal of bone spurs, inspection and drilling/treatment of osteochondritis desiccans lesions as well as cleaning out an infected ankle joint. It can be a very effective treatment in these conditions but is not useful in advanced osteoarthritis of the ankle.
Surgical intervention usually involves a general anaesthetic or a spinal anesthetic. A tourniquet is applied to the thigh and is usually inflated to limit bleeding and improve visualization in the ankle joint. Two small incisions are made, occasionally more, and these facilitate the probing of the anatomic structures in the ankle as well as treatment.
Bone spurs are spikes of bone that typically form on the front of the tibia at the ankle and are often associated with early to advanced osteoarthritis of the ankle. They can impede the ability to dorsiflex the ankle, resulting in pain on the front of the ankle with activities such as squatting and climbing stairs. Removal of these bone spurs with small bone chisels known as osteotomes can for some patients dramatically improve their symptoms. For patients with advanced arthritis that involves actual loss of joint cartilage, this technique is often not an ideal solution.
'Loose bodies' are typically pieces of bone or cartilage that have spontaneously formed or else have broken off from part of the ankle joint. They can cause mechanical symptoms such as joint locking or pain. Ankle arthroscopy is typically a very effective method of treatment in these cases. Some patients, however, may have underlying conditions which may cause them to reform loose bodies and may require additional arthroscopies in the future.
Osteochondritis Dessicans is a condition that can affect children and adolescents where there is softening of the bone underneath the joint cartilage on the talus bone. Many patients will get pain with this condition and in some patients, pieces can actually break off, float in the joint and cause locking. If surgical treatment is required, the treatment algorithm depends on whether the cartilage joint surface is intact or not. If it is, we leave the cartilage undisturbed and then use a technique called 'retrograde drilling' which involves feeding in a small wire into the soft bone under x-ray guidance, drilling over the wire in an effort to stimulate healing. If there is a defect in the cartilage, classic technique involves stimulating bleeding in the underlying bone in an effort to stimulate scar-cartilage formation. Either way, the patient must be non-weightbearing in a splint or cast for 6 weeks on the affected side.
Septic Arthritis of the Ankle is relatively rare. It can affect completely healthy patients or patients with various medical conditions such as diabetes. Treatment involves irrigating sterile saline fluid through the ankle to remove the burden of infection as an effort to save the cartilage cells. This is followed my multiple weeks of antibiotic treatment.