Ankle arthroscopy is sometimes called an "ankle scope" or "keyhole surgery". The procedure involves making two small incisions (less than 1cm long) on the front of the ankle to create portals. A small telescopic camera (‘scope’) is inserted into one of the portals and this provides a view inside the ankle joint. The other portal is used for passing in small surgical instruments.
In addition to being able to directly assess the cause of ankle pain, there are many procedures that can be performed using arthroscopic technique including:
Repair or removal of fragments of loose cartilage and microfracture
Removal of bony ankle spurs causing impingement (catching)
Removal of loose bodies
Debridement of scar tissue
Assessment of ligament instability between tibia and fibular bone – ‘high’ ankle sprain
Microfracture is a procedure performed when there is articular cartilage loss following an injury and the underlying bone is exposed. In the procedure, small perforations are made in the exposed bone to induce new cartilage formation to cover the bone. Postoperatively this requires a period of touch weight bearing (using crutches ) to protect the area for 4-6 weeks .
Arthroscopy is a quick and effective procedure. The majority of surgeries go very smoothly without any major complications.
There may be a degree of ongoing pain if there is a large area of articular cartilage loss
Commonly, patients experience swelling around the ankle, which can take several weeks to settle.
Occasionally patients experience some transient numbness around the portals (incisions)
Serious complications such as infection and blood clots are very rare.
Simple arthroscopy takes about 30-50 minutes to perform. The joint is visually examined, and pictures/video inside the joint are taken. If there are extensive bony spurs and scar tissue it can take longer.
Generally, arthroscopy is performed as Day Stay Surgery and you may go home the same day as your procedure.
It is often performed with ankle stabilisation surgery. This will double the length of the operation.
You will need someone to drive you home, and a responsible adult to be with you overnight as you may still be sleepy and require oral pain medications.
DO NOT EAT OR DRINK from midnight, unless otherwise instructed.
Dr Schluter will meet with you, answer any further questions, check the consent form and mark the operative leg. You will also meet the anaesthetist (specialist doctor) who will be providing the anaesthetic. In most cases the procedure is done under a general anaesthetic. An IV line (drip) will be inserted and you may be given some premedication.
After the operation you will go to the recovery room where nursing staff will monitor you until you are awake. You are likely to have a cast over your ankle made of Plaster of Paris (known as a backslab) and wrapped in a crepe bandage. This is to keep the ankle immobilised but you will also required crutches to prevent you putting weight through the operated foot. I also recommend hiring a knee scooter if you are non weight bearing for longer than 2 weeks kneescooters.co.nz 0800395395
As you wake up you may experience discomfort or a tight/full feeling in the ankle, which should be easily managed with pain medication. Once you are alert, you will be encouraged to get up and mobilise slowly. Once you can mobilise safely you will be ready for discharged home.
Dr Schluter will review you at a follow up appointment 1- 2 weeks after your surgery. He will review your wounds and remove any sutures that are not dissolvable. You will be able to discuss the findings of the arthroscopy and talk through any photos/video taken during the procedure.
At this appointment, Dr Schluter will also discuss your ongoing rehabilitation programme.
For the first 5 – 7 days it is very important to elevate the leg when you are resting. Rest is important to allow the swelling and inflammation to settle.
As arthroscopy of the ankle is often performed in addition to other procedures, this may also contribute to the swelling and discomfort. Because your foot is immobilised in the backslab it should not be too painful. You cannot get the cast wet so when showering will need to cover the backslab with a plastic bag.
You will have the dressings changed, wound checked and fitted into a moonboot at the first clinic appointment. Whether you can then weight bear from then will depend on the surgical procedure but you can shower out of the moonboot so long as the wound(s) has a waterproof dressing over it.
Leave the moonboot on at all times (including in bed at night) until instructed to take it off.
You cannot drive with a moonboot on the right leg. You can drive with a moonboot on the left leg if you have an automatic after 3-4 weeks post surgery, but it is not recommended for long trips. Avoid flying for the first 6 weeks if possible because of swelling and risks of blood clots.
It is quite normal to have swelling, bruising, clicking and discomfort in your ankle for 6 - 8 weeks after the operation. These ongoing symptoms are generally related to the underlying condition of the ankle, the extent of the surgery and the amount of activity you have been doing.
If you are concerned about any of these symptoms please discuss them with Dr Schluter at the clinic visit.
Please do not hesitate to contact Dr Schluter’s rooms or your GP if you develop any of the following:
Heavy bleeding from the incision or the incision opening up
Sudden severe pain or tenderness at the wound site or in the joint.
Swelling in the calf or thigh, especially if associated with pain or heat
Redness around the incision that continues to spreads.
Temperature higher than 38.5 °C (fever) or chills.
Any concerns you may have regarding your recent surgery