Mr Srinivas Samsani

MS Orth PGI, FRCS, FRCS, FRCS Tr & Orth.
MSc Trauma, Dip Orth London.
Hip and Knee Fellow, Melbourne Australia.

Consultant Orthopaedic Surgeon
Specialisation: Knee and Hip Surgery

Ankle Arthroscopy

Ankle arthroscopy, otherwise commonly known as keyhole surgery of ankle, is an effective treatment method used to treat several common foot and ankle conditions.

What is an ankle arthroscopy (keyhole surgery of ankle)?

In ankle arthroscopy a small flexible telescope (arthroscope) is introduced in to the ankle joint through a small incision (keyhole) in the front of ankle to visualise inside of the ankle. A camera is attached to the telescope and the picture is visualised on the monitor (TV). One or more small incisions (keyholes) are also made in front of the ankle to introduce special instruments to carry out various treatments inside the ankle.

What are the advantages of ankle arthroscopy?

Traditional ankle surgery involves large incisions and is associated with increased risk of bleeding, infection, stiffness and postoperative pain. Also the recovery after traditional ankle surgery can be longer.

In contrast, small incisions are used in ankle arthroscopy and therefore the risk of bleeding, infection and stiffness is much less. Ankle arthroscopy causes less damage to the skin and surrounding tissues. Therefore patients experience less discomfort after surgery and make a rapid recovery.

Majority of ankle arthroscopies are performed as day case procedures.

What conditions are treated with ankle arthroscopy?

Ankle arthroscopy is used in the management of a wide range of ankle conditions. The following are some of the ankle conditions where ankle arthroscopy is frequently used:

  • Diagnosis of ankle symptoms: ankle arthroscopy may be performed to establish the cause of the pain, stiffness, instability or swelling in the ankle. Other tests such as X-rays, CT scan or MRI scan may also be required before ankle arthroscopy.
  • Cartilage problems
  • Removal of loose bodies
  • Management of early osteoarthritis-removal of bony spurs called osteophytes.
  • Removal of inflamed soft tissue
  • Washing of joint in cases of infection
  • Fusion of ankle joint.

What happens before ankle arthroscopy?

Once you have decided to proceed with the operation it is important to make sure that you are fit to undergo the operation. As a part of pre-operative assessment, you may have some or all of the following tests depending on your medical condition:

  • Blood tests
  • Urine tests
  • X-ray of ankle (sometimes x-ray of the opposite ankle may also be performed for comparison)
  • X-ray of chest
  • ECG

You may also require a medical examination by a medical doctor to make sure you are fit for surgery and identify any medical problems that could interfere with your surgery.

Inform Mr Samsani or his team all the medication you take regularly. You may be informed to stop taking certain medication before surgery.

A Physiotherapist will see you and advise you about exercises that will keep the ankle in the best possible condition before surgery and help to recover quickly after the operation.

What happens during ankle arthroscopy?

You are likely to be admitted on the day of operation. Sometimes you may be admitted one night before the operation. You will be given instructions not to eat or drink for 6 hours before surgery.

Majority of ankle arthroscopies are performed as day case operations. Operation can take one to two hours to perform.

A member of the anaesthetic team will see you before the operation and discuss the anaesthetic options. Ankle arthroscopy is performed under general or regional anaesthesia. Mr Samsani will also see you before the operation. Your ankle will be identified and marked prior to anaesthetic being administered.

Once you are under anaesthetic, a tight band (tourniquet) is placed around the upper leg to allow a blood less operation and the ankle is prepared in a sterile fashion.

Once your ankle is prepared your foot is placed in a boot to hold it in a position and to stretch the ankle joint. A small telescope is introduced through a small incision (keyhole) in the front of ankle. The telescope is attached to a camera and the images are viewed on the monitor (TV). One or more small incisions (keyholes) are made in the front of ankle to introduce special instruments such as probe, shavers etc. A sterile fluid is introduced in to the joint through the telescope throughout the procedure to stretch the joint and also to make it easier to visualise different areas of ankle joint.

Once the surgeon has seen relevant areas of the ankle joint, he may then proceed and carry out the therapeutic procedures depending on the patient’s symptoms. These procedures include:

  • Trimming of cartilage fragments
  • Making small holes (micro-fracture) in the bone when the cartilage is damaged. This facilitates the cartilage to grow back
  • Removal of inflamed soft tissue in the ankle joint.
  • Removing loose bodies from the ankle joint.
  • Washing out the ankle joint in case of infection.

Once the operation is completed the telescope and instruments are removed and small incisions are closed with stitches or sticky plasters. A loose bandage is applied around your ankle and tourniquet is removed.

What happens after the operation?

Once the operation is finished you will be moved to the recovery room close to the operation theatre. Here you will be closely observed to make sure that you have recovered well from anaesthesia. You will notice that:

  • Your ankle is wrapped in wool and crepe bandage.
  • Your leg is elevated to prevent swelling of the foot
  • Your leg may feel numb due to anaesthetic medication and the feeling will return in 12 to 24 hours. You have to protect your leg from very cold or hot objects or sharps until the sensation feels normal.

In majority of cases ankle arthroscopy is a day case procedure and you will be discharged from hospital in 4 to 6 hours after the operation. If you have multiple medical conditions you may have to spend one night in the hospital before discharge from the hospital.

You may have some discomfort in the leg for few days and pain killers will be prescribed to control the discomfort.

A Physiotherapist will see you and demonstrate a number of exercises for you to do at home. These exercises are important to restore the ankle and foot movements and strengthen muscles of leg.

You will need crutches or other walking aides for a while after the operation. Mr Samasani will also advise about how and when you can safely start weight bearing on your leg.

Continue to keep your leg elevated for a few days at home when you are lying or sitting to reduce the risk of swelling developing in the leg.

You can remove the outer bandage after 2 days leaving the portals-small incisions covered with Opsite dressing. Keep the incision sites dry for about two weeks.
Possible risks of ankle arthroscopy?

Complications following ankle arthroscopy are rare. Possible complications that can occur with ankle arthroscopy are:

  • Infection
  • Bleeding
  • Damage to the nerves and blood vessels
  • Blood clots
  • Stiffness
  • Failure to improve symptoms
  • Regional pain syndrome

Warning Signs: Please contact Mr Samsani or his team immediately if you experience any of the following:

  • Chills
  • Fever
  • Redness or warmth around ankle or foot
  • Persistent or increasing pain in the calf
  • Marked swelling of foot and ankle or calf

Follow up after ankle arthroscopy?

You will be reviewed by Mr Samsani about 2 weeks after the operation to check the wounds and also to make sure that you are recovering well. Further follow ups are determined by Mr Samsani depending on the diagnosis and the type of treatment given during ankle arthroscopy.

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