Ankle arthroscopy
Ankle arthroscopy means looking inside the ankle joint and examining it with long telescopic cameras called arthroscopes. It is performed under general or regional anaesthesia in an operating theatre under sterile conditions. With regional anaesthesia, both legs are numbed with an injection in the lower back and the operation is done without putting the patient to sleep. Two incisions about 1 cm long are made at the front of the ankle, and the surgical procedures are carried out with a camera and instruments inserted into the joint through these two entry holes.
The advantages of ankle arthroscopy can be summarised as follows: because it is done through small holes, recovery is shorter than with open methods. Because the joint is not cut open, the risk of infection is lower. The patient feels less pain after surgery. It also speeds up the return to sport, especially for athletes.
Which conditions can be treated with ankle arthroscopy?
Pain, swelling and restricted movement in the ankle that often appear after a sprain and persist despite long treatment are usually caused by cartilage injuries and soft tissue impingement, the most common problems. These cartilage and soft-tissue problems are treated successfully with ankle arthroscopy. Synovitis – excessive growth of the joint lining filling the ankle and causing swelling, seen in rheumatic diseases, haemophilia and similar conditions with bleeding into the joint – can also be treated arthroscopically. Removal of rare tumours inside the joint is also performed successfully with arthroscopy.
What are the complications of arthroscopy?
Although it is a closed method, arthroscopy has a low rate of complications: infection in the joint, thromboembolism (clots in the leg veins travelling to other organs and blocking vessels) and damage to cartilage during surgery. The surgeon and anaesthetist take the necessary precautions, and getting the patient moving early after surgery minimises possible complications.
Ankle sprain
An ankle sprain is a very common injury; everyone sprains their ankle at least a few times in life. A simple sprain usually heals without leaving any lasting trace, and the person returns to normal life and sport. In a sprain the ankle almost always turns inwards, injuring the ligaments on the outer side. Swelling quickly appears on the outer side of the ankle, and within a few days bruising spreads towards the heel and sole. In a mild sprain the pain eases within a few days and the patient can walk on the foot. In more serious sprains, returning to normal walking can sometimes take weeks.
Treatment
There are four things to do first after an ankle sprain: do not put weight on the foot; start applying ice to the outer ankle immediately; as soon as possible wrap it with an elastic bandage from the foot upwards; and quickly raise and rest the foot. After this treatment, patients with a mild sprain can return to sport within a few days to a few weeks.
After a serious sprain, rehabilitation starts after the initial treatment to restore ankle movement and strength. The patient is followed with exercises until movement returns to its previous level. As the pain decreases, the patient uses the ankle more in daily activities. The strengthening programme continues, and complaints have usually eased considerably after a month to a month and a half. Swelling on the outer side of the ankle may persist for a long time, even months; what matters is that the pain has gone. If pain still continues a few months after the sprain, or swelling appears from time to time, a specialist should be consulted without waiting longer. Long-lasting pain after a sprain is usually due to a cartilage fracture or to overgrowth and impingement of the lining of the ankle joint.
If a cartilage fracture is suspected, the doctor can evaluate the joint with X-ray and MRI. Often the cartilage fracture does not show on X-ray, so MRI is valuable in such cases.
In patients found to have a cartilage fracture, non-surgical or surgical treatment is used depending on its location and size. If the fracture does not heal with non-surgical methods, it should be treated surgically. In surgery, the necessary procedure for the cartilage fracture is performed arthroscopically and the patient does not put weight on the foot while it heals. After such surgery, return to sport is possible after about four to five months.
Cartilage lesions of the ankle
Ankle cartilage lesions, medically called OLT (osteochondral lesions of the talus), can result from an injury (sprain, fall, sports injury) or appear without any injury. Patients feel pain around the ankle, usually at the front, when walking. Sports activities are limited by pain, and swelling around the ankle may be seen with the pain after activity.
If ankle pain persists for more than two months after a sprain, it is worth seeing a specialist. Together with the physical examination, the necessary X-rays are requested and, if needed, the joint cartilage is examined in more detail with MRI.
Treatment
When an osteochondral lesion of the talus (a cartilage lesion of the bone forming the ankle joint) is found, it is graded with MRI to see whether it has healing potential and whether the cartilage covering the joint surface is intact, and a treatment plan is drawn up.
If the lesion can heal, is not very large and the covering cartilage is intact, non-surgical treatment is tried first. This includes exercises to strengthen the ankle, water-based rehabilitation, exercises to strengthen proprioception (position sense) and a temporary period of no weight-bearing.
If the lesion is large with no healing potential, surgery is chosen and the patient is informed. Arthroscopic (camera, without opening the joint) and open methods are used. If the lesion is not very large it is cleaned arthroscopically and procedures that help the cartilage regenerate (such as drilling and shaving) are performed. If the lesion is large, cylinders of cartilage taken from the knee are placed in the damaged cartilage of the ankle (mosaicplasty).
After surgery, depending on the size of the lesion, patients walk without putting weight on the foot for 6 to 12 weeks; meanwhile rehabilitation begins and the ankle is strengthened.
After successful surgery and rehabilitation, patients can return to sports.
The information on this page is for general information only and does not replace an examination and diagnosis.