What is an ankle arthroscopy?
Also known as key hole surgery or minimally invasive ankle surgery. Ankle arthroscopy involves using very small incisions to gain access into the ankle joint. Each incision is less than 1cm and usually two incisions are required. The ankle joint is relatively small and to allow good surgical access to the joint, its dimensions need temporarily to be increased. This is done using a combination of distraction across the joint together with having a stream of pressurized fluid circulating through the joint which distends it.
Not all ankle surgery can be done or is sensible to try using arthroscopy. The list of conditions below is comprehensive for those disorders in which the technique is useful. The alternative is open ankle surgery which results in larger scars and generally more post-operative pain. For certain cases though this is unavoidable.
The inside of the ankle joint can be inspected using a small camera with operations carried out on the joint using small, specially designed instruments.
The various disorders in which the technique is useful :
- Ankle arthritis
- Footballers ankle (Anterior Ankle Impingement)
- Unstable ankle
- Lateral ligament reconstruction
- Ankle pain following fracture
- Loose bodies within the ankle
- Osteochondral defects of the talus
- Diseases of the synovium
- Undiagnosed ankle pain
Why ankle arthroscopy?
The alternative to ankle arthroscopy is open ankle surgery. The very small incisions used result in minimal soft tissue disruption and trauma. This in turn results in:
-Significantly lower pain levels than an open approach
-The ankle is comfortable to weight bear through on the day of surgery
-Most cases can be performed as day cases
-Lower infection rates than open surgery
-Earlier return to work/function/sports
-Little scarring
-Minimal effect if further surgery to the ankle is required
How is an ankle arthroscopy done?
The ankle joint has small internal dimensions under normal circumstances. To produce sufficient space in which to perform the procedure and avoid damaging the joint surfaces with instruments, it is necessary to "stretch open" the joint .This is achieved under anaesthesia by using a combination of traction across the joint and distending the joint by infusing sterile fluid under pressure.
Most ankle arthroscopy is performed under general, or occasionally regional, anaesthesia. Firstly a padded bar is placed behind the thigh.
What conditions can be treated with ankle arthroscopy?
Unstable ankle - An ankle may be unstable because it is restraining tissues (bone, tendon) or more commonly the ligaments have been injured and are no longer competent or in the normal position. This is known as mechanical instability and though ankle arthroscopy will not by itself treat this condition, there are often associated problems within the ankle joint which will require an arthroscopy as well as addressing the underlying mechanical problem.
An ankle may also be subjectively unstable. This is when the normal restraints (bone, tendons and ligament) are working fine, but the ankle nevertheless feels unstable. This is usually due to a painful area within the joint such as synovitis injury, a plica, arthrofibrosis or a chondral or osteochondral injury. All of these conditions can be treated arthroscopically.
What happens after my ankle arthroscopy?
The first 24 hours
Pain relief
When the patient wakes up after surgery the ankle should feel comfortable. The patient will have had ankle and intra-articular injections of local anaesthetic whilst asleep.
Following surgery a patient will be given a combination of three painkillers to be used regularly for the first 48 hours post-operatively and then to be used only as needed.
Mobility
After the ankle arthroscopy, once you are back on the ward the physiotherapist will start mobilising you. You may put as much weight through the ankle as is comfortable. The conditions where this is not the case are with an osteo chondral defect and if your arthroscopy has been part of a lateral ligament reconstruction. You will be more comfortable using crutches for a day or two and then these can be discarded.
Your operated leg will need to be elevated when non-weight bearing for the first 24 to 48 hours.
You are encouraged to exercise your ankle within the bandage both by moving it up and down as well as moving it from side to side. This is from as soon as you are able to do this.
Length of stay
Once fully awake and mobile the patient can go home if they wish. It would be sensible for a responsible adult to pick up from hosptail and accompany overnight.
Bandaging after Ankle Arthroscopy
Following an ankle arthroscopy you will have three layers of covering. Closest to the wounds are two small adhesive coverings and these should be kept on for two weeks. Overlying this is a layer of sterile wool and overlying this is a crepe bandage. The dressings should be left intact for the first week. The wounds themselves should be kept dry for two weeks. At one week following the surgery you may remove the outer crepe bandage and the underlying wool. The adhesive dressings over the two arthroscopic portals should be left intact. If these should become loose or dislodged, replace them (without touching the wound) with a good sized adhesive plaster. These can be replaced as often as required, it is important that the wound itself is kept untouched and dry.
Driving after Ankle Arthroscopy
Generally you should be comfortable and safe to drive at one week following your ankle arthroscopy as long as you are permitted to weight bear.
Return to Sport
After ankle arthroscopy you will be back to walking at 1-2 days following your ankle arthroscopy. This will be without use of a crutch. Any sporting activity is best left for at least two weeks following the procedure. Realistically, things can be built up from two weeks post-operatively but will probably take in excess of four weeks before more vigorous sporting activity will be possible.
At two weeks
A patient will be seen in the Outpatients Clinic to have their sutures removed a two weeks post-operatively. The specific advice from here on depends somewhat upon the problem which has been treated. In most cases it will be to return to unrestricted activities from here. A patient may now drive and get their wounds wet.
Complications of ankle arthroscopy
The vast majority of patients following ankle arthroscopy suffer no complications.
Parasthesia - 4%
This is numbness, effecting the skin and occurs as a result of injury (bruising or division) of branches of, or the actual, cutaneous nerves. It occurs because the safe 'corridors' allowing access into the ankle, away from the vital structures, lie close to these nerves.
Superficial Wound Infection - 1%
You will receive pre-operative antibiotics which minimise the risk of this complication.
Deep (Joint) Infection - 0.2%
You will receive pre-operative antibiotics and the operation is carried out in a laminar flow theatre (the same degree of sterility as is used for open joint replacement) which will minimise the chances of complication.
Haemarthrosis - 1%
This complication is bleeding into the joint after the operation. Small amounts of bleeding are not uncommon and generally will go unnoticed. However, if a large amount of bleeding is present this will lead to painful swelling which may require surgical drainage. This generally requires washing the ankle out at the end of arthroscopy. The chance of this complication is probably reduced by a compressive bandage after the operation and leaving it on for a week following the operation.
Deep Vein Thrombosis - 0.5-1%
The chance of this complication is small following an ankle arthroscopy. You will nevertheless be given a prophylactic anticoagulant once you are asleep prior to the onset of your operation. If you are likely to be immobile for any length of time following the operation you will also be given a course of short injections following the operation to reduce the chance of this.
OK ni sedikit sebanyak lah....adooii cuak lah plak!
UPDATE FOR THIS TOPIC (20/01/2010) : Baru sat tadik Dr.Soong dtg jumpa aku, ckp sok aku akan menjalani Ankle Arthroscopy ni..Jam 2pm yg mungkin akan mengambil masa sejam tetapi kalau ada benda yang kena heal, it's take time lah. Then i told him that i've watched the step by step of procedur from Internet and he said, "WoW! No need to explain to u...u're really good journalist!" kahkahkah..aparaaa doktor...dah semalam dia x terangkan, so aku carik arr sdr... cuma hari ni dia ckp risk yg kebarangkalian berlaku only affection...only 1% but so far takde kes camtu lagik... "Then u'll feel the pain a bit (yeker a bit?) and i'll give u pain killler, no worries." Ok doktoc... i leave it to u...Insyaallah! Cepat arr sembuh! aku nak super duper active balik..uwaaa...hehehe...
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