Ankle Arthroscopy FAQs

What is an ankle arthroscopy?

An ankle arthroscopy is a minimally invasive surgical procedure used to diagnose and treat various conditions affecting the ankle joint. During the procedure, a small camera called an arthroscope is inserted into the ankle through small incisions. This allows the surgeon to visualize the inside of the joint and identify any issues, such as cartilage damage, ligament tears, or inflammation.

The surgeon can also perform certain treatments during the arthroscopy, such as removing loose pieces of cartilage, repairing ligaments, or smoothing out damaged surfaces. Overall, it’s a less invasive alternative to traditional open surgery, often resulting in quicker recovery times and less postoperative pain.

How does ankle arthroscopy work? What does ankle arthroscopy entail?

A surgeon makes an incision in the skin and dissects into the ankle joint. This is used as a portal for a minimally invasive camera, called an arthroscope. We try to avoid all nerves, vessels, and tendon in this step.  The joint in inflated with irrigation fluid. We have a look around the joint, looking for damage to cartilage, bone, ligaments, and soft tissue structures. We make a second incision to make a portal for shavers/working tools. 

 

At this stage we address any issues we may find. Loose bodies of cartilage or bone are removed. Unstable flaps of cartilage can be unstable, causing pain / inflammation. These are typically trimmed to a stable edge. If there are large areas of cartilage missing, we will typically try to promote this to heal with cartilage repairing procedures. This includes procedures such as microfracture, autologous cartilage implantation, juvenile cartilage allograft, etc. 

 

What are the benefits of ankle arthroscopy?

Ankle arthroscopy offers several benefits, including:

  1. Minimally Invasive: Arthroscopy involves small incisions, reducing the overall trauma to the tissues compared to traditional open surgery. This often leads to less pain, quicker recovery times, and a lower risk of infection.
  2. Diagnostic Precision: The arthroscope allows for a detailed and magnified view inside the ankle joint, enabling the surgeon to accurately diagnose conditions like cartilage damage, ligament injuries, or inflammation.
  3. Targeted Treatment: In addition to diagnosis, ankle arthroscopy allows for targeted treatment during the same procedure. Surgeons can address issues such as removing loose cartilage, repairing ligaments, or smoothing out damaged surfaces.
  4. Faster Recovery: Due to the minimally invasive nature of the procedure, patients often experience a faster recovery compared to traditional open surgery. This can lead to quicker return to normal activities and reduced postoperative pain.
  5. Reduced Scarring: The smaller incisions result in minimal scarring, which can be aesthetically more appealing and may contribute to a better cosmetic outcome.
  6. Outpatient Procedure: Many ankle arthroscopies are performed on an outpatient basis, meaning patients can typically go home the same day as the surgery, avoiding the need for a hospital stay.

While ankle arthroscopy has these advantages, it’s important to note that not all ankle conditions require arthroscopic intervention. The decision to use arthroscopy depends on the specific diagnosis and the best course of action for each individual patient. Ask your surgeon if you are a candidate for arthroscopic surgery. 

What are the indications for ankle arthroscopy?

Ankle arthroscopy may be indicated for various conditions, including:

  1. Unexplained Ankle Pain: When a patient experiences persistent ankle pain without an obvious cause, arthroscopy can help diagnose and identify issues within the joint.
  2. Cartilage Damage: Arthroscopy is valuable for assessing and treating cartilage injuries or defects within the ankle joint.
  3. Ligament Injuries: It can be used to diagnose and repair damaged ligaments, such as sprains or tears.
  4. Synovitis: Inflammation of the synovial lining of the joint can be addressed through arthroscopy.
  5. Loose Bodies: If there are loose bone or cartilage fragments within the joint, arthroscopy allows for their removal.
  6. Impingement Syndrome: Arthroscopy can be used to address impingement issues, where abnormal contact between bones causes pain and limited motion.
  7. Osteochondral Lesions: Arthroscopy is helpful in managing lesions involving both the bone and the overlying cartilage.
  8. Tendon Disorders: Certain conditions affecting the tendons around the ankle may be diagnosed and treated using arthroscopy.
  9. Ankle Instability: In cases of chronic ankle instability, arthroscopy can help assess and address contributing factors.

It’s important to note that the decision to perform ankle arthroscopy depends on the specific symptoms, clinical findings, and imaging results for each patient. Your orthopedic surgeon will carefully evaluate your condition to determine if arthroscopy is the most appropriate course of action.

What diagnosis do you use for an ankle arthroscopy?

See indications for arthroscopy above. 

What to expect after ankle arthroscopy?

There will be pain and swelling at the surgical site. This settles greatly after the first few days. The ankle may be casted for approximately 2-6 weeks. During this time, you are not putting any weight on the affected foot/ankle.  At 2 weeks post op sutures are removed and the ankle is typically placed into a rigid boot. At 4-6 weeks we start physical therapy. We also start gradually increased weight bearing around 6 weeks. The boot is discontinued around approximately 8 weeks. Most patients feel limited pain at the 6-week mark. That is when physical therapy comes into play. Full recovering can take 3 months or more. We will provide and information booklet with more details regard what to expect before, during, and after surgery.

How bad does ankle arthroscopy hurt?

After ankle arthroscopy, pain and swelling at the surgical site is expected. Typically, the pain is worst in the first few days. During this time, you may require opioid medication. However, most patient are able to cope with anti-inflammatories and Acetaminophen after the first few days. It tends to be less painful that other major orthopedic surgeries. 

Is ankle arthroscopy common?

Ankle arthroscopy is much less common than knee or shoulder arthroscopy. However, is remains of the main way to address ankle joint issues such as damage to cartilage, ligaments, or bone. These types of injures are very common.  

Is ankle arthroscopy safe?

Ankle arthroscopy is a relatively safe procedure. Small incision and a minimally invasive approach allows for a low risk of infection or complications. 

Can you walk after an ankle arthroscopy?

It depends on the type of surgery you have. After simple debridement patients can often walk immediately after surgery. However, if there is any cartilage, bone work, or fusions done, then there is a period of non-weight bearing.

How long until you can walk after ankle arthroscopy?

It depends on the type of surgery you have. After simple debridement patients can often walk immediately after surgery. However, if there is any cartilage, bone work, or fusions done, then there is a period of non-weight bearing. This is usually around 6 weeks, after which point, we start weight bearing and rehab. 

How soon after ankle arthroscopy debridement can I walk?

For a simple ankle debridement, you can start walking right away. You may be limited by pain for a few days, but we anticipate slow and gradual return to walking. This will typically take 2-4 weeks before you are able to walk without a limp. 

How soon can you start physical therapy after ankle arthroscopy?

This depends on the type of procedure you require. For simple debridement, we can start physical therapy after the incision are healed (2 weeks). For more extensive procedures, physical therapy starts when the cast / immobilization is removed (6 weeks). 

How long does ankle arthroscopy surgery take?

1-3h depending on how much work needs to be done.

How long does it take to recover from ankle arthroscopy?

It depends on the type of surgery you have. After simple debridement patients can often walk immediately after surgery. People feel much better approximately 4-6 weeks after surgery. However, if there is any cartilage, bone work, or fusions done, then there is a period of non-weight bearing, casting, and rehab involved. In this case, it will likely be 6 weeks until you are able to walk. We anticipate slow return to function / pain free walking approximately 3 months post op. 

How long on crutches after ankle arthroscopy?

You will need crutches for the period of time you are casted or non-weight bearing. The crutches can be safely weaned when casting and non-weight bearing status has been lifted. 

How long after ankle arthroscopy can I drive?

This depends on the type of surgery required. If you have a period of casting or non-weight bearing, then typically patients will start driving shortly after the cast is removed. This is typically around the 6-week mark. If no casting is required, driving can be resumed when pain is no longer prohibitive. You should always start to integrate driving in a slow and controlled manner. Start in an empty parking lot. Practice braking. And graduate yourself to a empty road, slightly busy road, to full traffic. Safety is the highest priority in this matter. You should not be driving if you are wearing a brace or cast. You should not be driving while on opiate medication. 

 

What kind of anesthesia is used for ankle arthroscopy?

This depends on your level of comfort, and what is required to get the surgery completed safely. Most patients can have a local nerve block and spinal for ankle surgery. However, some patients / anesthesiologist prefers a general anesthetic. This is a good topic of discussion for you and your anesthesiologist prior to your surgery.

How much does an ankle arthroscopy cost?

Vast majority of the time your insurance covers the cost of an ankle arthroscopy. Your out-of-pocket expenses are variable, depending on the parameters of your individual health insurance plan. Our billing staff can help you answer this question on a case-by-case basis

Is ankle nerve damage visible on MRI and arthroscopy?

Typically, nerve damage is not visible on an arthroscopy. Area of nerve damaged may or may not be visible on MRI. These tests are not ideal of identifying nerve damage.

Is arthroscopy necessary for ankle fracture?

Many ankle fractures involve the ankle joint. It is one of the most common joints involved in direct trauma. Traditionally, ankle fractures are treated with immobilization / casting or surgical intervention. This depends on patient factors, stability of the injury, fracture pattern, and prognosis of the injury. If surgery is indicated, this typically involves fixing the fracture with plates and screws. 

 

However, there are some recent studies that suggest performing an arthroscopy at the time of fracture fixation can help with pain and recovery. Here the arthroscopy is done to remove hematoma and fracture fragments in the joint. It allows us to irrigate the joint and removed components which may later cause pain/inflammation. Additionally, cartilage impaction injuries are common with ankle fractures. These often go under diagnosed. Arthroscopy allows us to identify these injuries acutely and intervene if necessary. Some studies report an improvement in patient outcomes when utilizing arthroscopy in addition to ankle fracture fixation. There is one national database studies which suggests that doing ankle arthroscopy at the time of ankle fixation surgery greatly decreases the risk of needing an ankle arthroscopy in the future. Have a looked at these studies. 

 

https://journals.lww.com/jaaos/abstract/2011/04000/the_role_of_arthroscopy_in_the_management_of.7.aspx

 

https://www.sciencedirect.com/science/article/abs/pii/S0749806315003825

 

https://journals.sagepub.com/doi/full/10.1177/2473011420904046

 

https://journals.sagepub.com/doi/full/10.1177/1938640015599034

 

These questions have been personally answered by:

A seasoned orthopedic surgeon and foot and ankle specialist, Dr. Mohammad Athar welcomes patients at the offices of Complete Orthopedics in Queens / Long Island. Fellowship trained in both hip and knee reconstruction, Dr. Athar has extensive expertise in both total hip replacements and total knee replacements for arthritis of the hip and knee, respectively. As an orthopedic surgeon, he also performs surgery to treat meniscal tears, cartilage injuries, and fractures. He is certified for robotics assisted hip and knee replacements, and well versed in cutting-edge cartilage replacement techniques. In addition, Dr. Athar is a fellowship-trained foot and ankle specialist, which has allowed him to accrue a vast experience in foot and ankle surgery, including ankle replacement, new cartilage replacement techniques, and minimally invasive foot surgery. In this role, he performs surgery to treat ankle arthritis, foot deformity, bunions, diabetic foot complications, toe deformity, and fractures of the lower extremities. Dr. Athar is adept at non-surgical treatment of musculoskeletal conditions in the upper and lower extremities such as braces, medication, orthotics, or injections to treat the above-mentioned conditions.