ORTHOPEDICS + SPORTS MEDICINE
Ankle Arthroscopy
A small-incision look inside the ankle to diagnose and treat impingement, loose fragments, and cartilage damage.
The ankle contains very little unused space. Cartilage damage, inflamed tissue, scar tissue, or a small bone fragment can interfere with movement inside this compact joint and cause pain that is difficult to address from the outside. Ankle arthroscopy gives the surgeon a magnified view of these structures through small openings around the joint.
Dr. Christopher Dillingham may use ankle arthroscopy when examination and imaging identify a problem that can be treated without a larger open incision. The procedure can serve different purposes depending on the condition, from removing tissue that blocks motion to treating a damaged area of cartilage. The expected recovery is therefore based on what is done inside the ankle rather than the size of the incisions alone.
Bones and Cartilage of the Ankle
The main ankle joint is formed by three bones: the tibia, fibula, and talus. The lower ends of the tibia and fibula create a stable space around the talus, allowing the foot to move upward and downward.
Articular cartilage covers the surfaces where these bones meet. A thin synovial lining produces fluid that helps the joint move with less friction. Ligaments on both sides of the ankle provide stability, while tendons and muscles control foot and ankle movement.
When cartilage becomes damaged or tissue becomes trapped between the joint surfaces, the ankle may feel painful, stiff, swollen, or blocked. Because several structures are positioned close together, a precise diagnosis is necessary before surgery is considered.
Conditions Treated With Ankle Arthroscopy
Ankle arthroscopy may be used to address:
- Loose fragments of bone or cartilage
- Ankle impingement
- Inflamed synovial tissue
- Scar tissue limiting motion
- Osteochondral lesions of the talus
- Selected cartilage injuries
- Certain forms of ankle instability
- Problems associated with an ankle fracture
- Joint infection
Anterior ankle impingement occurs when bone spurs or soft tissue become pinched at the front of the joint, often when the foot moves upward. Athletes may notice pain during running, squatting, or other movements that require ankle flexion.
An osteochondral lesion involves cartilage and the bone beneath it, commonly on the surface of the talus. These injuries may occur during an ankle sprain and can cause persistent deep pain, swelling, or catching after the ligament injury appears to have healed.
Determining the Source of Ankle Pain
Ankle pain is not automatically a reason for arthroscopy. Tendon disorders, nerve problems, fractures, arthritis, and ligament injuries may require other forms of treatment.
The evaluation includes the location of pain, previous injuries, ankle motion, stability, swelling, and walking mechanics. X-rays can show bone spurs, fractures, alignment, and arthritis. MRI or CT imaging may be used to evaluate cartilage, bone, ligaments, tendons, and other soft tissues.
Nonsurgical treatment may include activity changes, bracing, medication, injections, and physical therapy. Arthroscopy is considered when these measures do not provide adequate improvement and a treatable problem has been identified within the joint.
How Ankle Arthroscopy Is Performed
Ankle arthroscopy may be completed under general or regional anesthesia. The leg is positioned so the surgeon can safely reach the affected area of the joint.
Small openings called portals are created around the ankle. A narrow camera is inserted through one portal and projects images onto a monitor. Sterile fluid expands the joint and keeps the surgical view clear.
Miniature instruments enter through another portal. Depending on the condition, the surgeon may:
- Remove loose bone or cartilage
- Trim a bone spur
- Remove inflamed synovial tissue
- Clear scar tissue
- Smooth unstable cartilage
- Treat the bone beneath a cartilage injury
- Evaluate joint alignment after fracture repair
For certain osteochondral lesions, the damaged area may be cleaned and the underlying bone stimulated to encourage a healing response. Larger or more complex cartilage injuries may require a different restorative procedure.
Once the necessary work is complete, the instruments are removed and the portals are closed. A dressing, splint, or walking boot may be applied before the patient leaves the surgical facility.
Weight Bearing After Surgery
Some patients can place weight on the foot relatively soon after a limited debridement. Others must protect the ankle for several weeks because cartilage, bone, or ligaments were treated.
Crutches or another walking aid may be needed during this period. Patients should follow the prescribed restrictions even if the ankle feels comfortable, as deeper tissues heal more slowly than the portal incisions.
Early instructions may include:
- Elevating the foot to control swelling
- Keeping the incisions clean and dry
- Wearing a boot or splint as directed
- Using crutches correctly
- Taking medication as prescribed
- Moving the toes to support circulation
Swelling may increase as activity resumes. The amount and duration vary with the work performed and the condition of the ankle before surgery.
Physical Therapy and Restoring Ankle Function
Physical therapy may begin with controlled range-of-motion exercises once movement is permitted. Rehabilitation then progresses toward restoring strength, balance, and a normal walking pattern.
Therapy may address:
- Ankle flexibility
- Calf and lower-leg strength
- Foot stability
- Balance and proprioception
- Walking without a limp
- Return to running or sports
Patients recovering from cartilage treatment or ligament repair generally progress more slowly than those who had loose tissue removed. Returning to activity too quickly can irritate healing structures even when swelling and pain have decreased.
The final stages of rehabilitation should reflect the patient’s goals. An athlete may need jumping, landing, and directional drills, while another patient may focus on walking endurance and negotiating uneven surfaces.
When to See an Ankle Specialist
An evaluation is appropriate when ankle pain or swelling continues after an injury has had time to heal. Catching, locking, repeated giving way, or loss of motion may indicate a problem inside the joint.
Patients should also seek care when symptoms repeatedly return during exercise or prevent normal walking. Identifying the source early may allow treatment before a cartilage injury or mechanical problem becomes more extensive.
Summary
Ankle arthroscopy allows the surgeon to see joint surfaces and spaces that cannot be directly examined through imaging alone. It is most valuable when the source of symptoms is specific and can be treated through the arthroscopic portals.
Dr. Christopher Dillingham uses the examination, imaging, and patient’s functional needs to determine whether this focused approach is suitable and how the ankle should be protected afterward.