Ankle Arthroscopy

Excerpt

Ankle arthroscopy has become a widely adopted minimally invasive surgical technique for diagnosing and treating intra-articular pathology of the ankle joint. The procedure relies on small portals and an arthroscope to directly visualize the joint, offering both diagnostic accuracy and therapeutic versatility while reducing soft tissue trauma compared with open approaches. This technique addresses a broad spectrum of ankle disorders that cause persistent pain, swelling, or mechanical dysfunction, particularly in patients who fail conservative management.

The etiology of ankle joint pathology includes traumatic, degenerative, and inflammatory processes. Acute ankle sprains and fractures frequently result in residual intra-articular damage, eg, osteochondral lesions of the talus, chondral degeneration, or posttraumatic impingement. Athletes and individuals in high-demand activities often sustain repetitive microtrauma, leading to synovitis, capsular thickening, or soft tissue impingement that compromises joint function. Degenerative changes, including osteoarthritis, may progress after instability or trauma, causing chronic pain and stiffness. Inflammatory arthritides, eg, rheumatoid arthritis, can also affect the ankle, producing synovial proliferation and progressive joint destruction. These diverse mechanisms underscore the complexity of ankle pathology and the need for precise diagnostic and therapeutic strategies.

Arthroscopy provides a powerful tool for both diagnosis and management. When imaging proves inconclusive, diagnostic arthroscopy enables direct visualization of subtle cartilage damage, loose bodies, or synovial disease that may not be apparent on magnetic resonance imaging (MRI) or computed tomography (CT). Therapeutically, arthroscopy enables targeted debridement, synovectomy, removal of loose bodies, and treatment of osteochondral lesions. Surgeons frequently employ this approach for anterior ankle impingement, especially in athletes, and for posttraumatic arthrofibrosis or joint infection requiring lavage. Arthroscopy also functions as an adjunct to open procedures (eg, fracture fixation or ankle arthrodesis), enhancing visualization and preparation of articular surfaces.

Techniques involve the use of anterior or posterior portals to access the joint. Anterior arthroscopy remains the most common approach, with portals placed medial and lateral to the tibialis anterior tendon. Posterior portals are selected for pathology involving the posterior compartment, often performed with the patient in the prone position. Continuous irrigation promotes joint distension and clear visualization, while specialized instruments enable debridement, cartilage repair, and other interventions. Ongoing advancements in arthroscopic tools and surgical methods have broadened the indications for ankle arthroscopy while strengthening its safety profile.

Clinical outcomes following ankle arthroscopy generally remain favorable, with reported improvements in pain relief, functional capacity, and return to activity across a wide range of pathologies. Patients undergoing arthroscopic debridement for anterior impingement frequently achieve significant symptom reduction and restoration of athletic performance. Arthroscopic management of osteochondral lesions has also demonstrated positive results in pain control and functional recovery, especially when paired with structured postoperative rehabilitation. Although outcomes vary with the underlying pathology and disease severity, ankle arthroscopy consistently offers reduced morbidity, quicker recovery, and higher patient satisfaction compared with open surgery.

Overall, ankle arthroscopy represents a significant advancement in the management of ankle pathology, combining diagnostic precision with therapeutic benefits through minimally invasive techniques. As evidence continues to validate its efficacy and as podiatric surgical expertise and technology evolve, its role in orthopedic practice continues to expand.