Sarah Lewis, PharmD
What is ankle arthroscopy?
Ankle arthroscopy is minimally invasive surgery that diagnoses or treats many ankle problems. Common problems include infections, injuries, arthritis, inflammatory conditions, and unexplained ankle symptoms. Ankle arthroscopy uses an arthroscope with a tiny camera to view the inside of the ankle joint. Special instruments allow your doctor to treat joint problems through small incisions. Ankle arthroscopy can relieve symptom and restore range of motion.
Ankle arthroscopy is a common surgery, but it involves some risk and potential complications. You may have less invasive treatment options. Consider getting a second opinion about all of your treatment choices before having ankle arthroscopy.
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Other surgical procedures that may be performed
Your doctor may also perform a biopsy. A biopsy involves removing a cell or tissue sample and testing it for cancer and other diseases.
You may need open surgery (ankle arthrotomy) for an ankle condition that your doctor cannot treat with arthroscopy. Open surgery involves making a longer incision that allows your doctor to directly view and treat the ankle.
Why is ankle arthroscopy performed?
Your doctor may recommend ankle arthroscopy to diagnose ankle symptoms when a cause is not clear. Ankle arthroscopy can also treat ankle conditions when symptoms have not responded to other treatments. Ankle arthroscopy is not the first choice to treat ankle conditions. Ask your doctor about all of your treatment options and consider getting a second opinion.
Your doctor may recommend ankle arthroscopy to diagnose or treat:
Ankle joint infections, also called septic arthritis
Ankle joint injuries, including fractures, torn ligaments, torn cartilage, and overuse injuries
Inflammatory forms of arthritis, including rheumatoid arthritis
Loose bodies, including bone fragments and cartilage pieces
Osteoarthritis, or degenerative joint disease, which is the breakdown of cartilage and bones
Synovitis, or inflammation of the lining of the joint
Unexplained ankle symptoms, including pain, swelling, locking, catching and grinding
Who performs ankle arthroscopy?
Orthopedic surgeons and foot and ankle surgeons perform ankle arthroscopy. Orthopedic surgeons are specially trained to treat problems of the bones and joints. They perform surgery and prescribe other treatments. Foot and ankle surgeons are orthopedic surgeons or podiatrists who further specialize in surgery of the foot, ankle, and lower leg.
How is ankle arthroscopy performed?
Your ankle arthroscopy will be performed in a hospital or outpatient surgery setting. It is a minimally invasive surgery that involves making at least two small incisions in the ankle. Your surgeon will insert an arthroscope and special instruments through the incisions. A tiny camera on the arthroscope allows your surgeon to view the inside of your ankle on a video screen. Your surgeon will examine and repair joint damage as needed.
Types of anesthesia
Your surgeon will perform your ankle arthroscopy using either general anesthesia or regional anesthesia.
General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the surgery and do not feel any pain.
Regional anesthesia is also known as a nerve block. It involves injecting an anesthetic around certain nerves to numb a large area of the body. You will likely have sedation with regional anesthesia to keep you relaxed and comfortable.
What to expect the day of your ankle arthroscopy
The day of your surgery, you can expect to:
Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.
Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. The surgical team will give you blankets for modesty and warmth.
Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will have.
A surgical team member will start an IV.
The anesthesiologist or nurse anesthetist will start your anesthesia.
A tube may be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgery as they happen.
The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the surgery and during your recovery until you are alert, breathing effectively, and your vital signs are stable.
What are the risks and potential complications of ankle arthroscopy?
As with all surgeries, ankle arthroscopy involves risks and complications. Complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery.
General risks of surgery
The general risks of surgery include:
Anesthesia reaction, such as an allergic reaction and problems with breathing
Bleeding, which can lead to shock
Blood clot, in particular a deep vein thrombosis that develops in the leg or pelvis. A blood clot can travel to your lungs, heart or brain and cause a pulmonary embolism, heart attack, or stroke.
Infection and septicemia, which is the spread of a local infection to the blood
Potential complications of ankle arthroscopy
Complications of ankle arthroscopy are not common but include:
Blood vessel damage
Instrument breakage during surgery
Severe swelling of the ankle
Reducing your risk of complications
You can reduce the risk of certain complications by following your treatment plan and:
Following activity, dietary and lifestyle restrictions and recommendations before surgery and during recovery. This may include physical therapy and ankle exercises.
Informing your doctor if you are nursing or there is any possibility of pregnancy
Notifying your doctor immediately of any concerns, such as severe swelling, bleeding, fever, increase in pain, or wound redness, swelling or drainage
Taking your medications exactly as directed
Telling all members of your care team if you have any allergies
How do I prepare for my ankle arthroscopy?
You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome. You can prepare for ankle arthroscopy by:
Answering all questions about your medical history, allergies, and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Arranging for a ride home after surgery. It is also a good idea to have someone stay with you for the first 24 hours.
Getting preoperative testing as directed. Testing will vary depending on your age, health, and specific procedure. Preoperative testing may include X-rays, EKG (electrocardiogram), blood tests, and other tests as needed.
Losing excess weight before surgery through a healthy diet and exercise plan
Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.
Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and can help the healing process.
Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners. Your doctor will give you instructions for taking your specific medications and supplements.
Questions to ask your doctor
Facing surgery can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before surgery and between appointments.
It is also a good idea to bring a list of questions to your appointments. Questions can include:
Why do I need ankle arthroscopy? Are there any other options for diagnosing or treating my condition?
If you find a problem or another condition during surgery, will you treat it right away or will I need more surgery later?
How long will the surgery take? When can I go home?
What restrictions will I have after the surgery? When can I return to work and other activities?
Will I need physical therapy? Where do I go for it?
What kind of assistance will I need at home?
What medications will I need before and after the surgery? How should I take my medications?
How will you treat my pain?
When should I follow up with you?
How should I contact you? Ask for numbers to call during and after regular hours.
What can I expect after my ankle arthroscopy?
Knowing what to expect can help make your road to recovery after ankle arthroscopy as smooth as possible.
How long will it take to recover?
You will stay in the recovery room after surgery until you are alert, breathing effectively, and your vital signs are stable. You may have a sore throat if a tube was placed in your windpipe during surgery. This is usually temporary, but tell your care team if you are uncomfortable.
You will go home the same day of your surgery. You may have physical therapy to help you recover. This will improve ankle strength, function, and range of motion. Many people can return to moderate daily activities, such as work or school, within a few days. You surgeon will tell you when it is safe to return to all your normal activities, sports, and exercise programs.
Recovery time varies depending on the procedure, type of anesthesia, your general health, your age, and other factors. Full recovery can take a few weeks depending on your ankle condition.
Will I feel pain?
Pain control is important for healing and a smooth recovery. There will be discomfort after surgery. Your doctor will treat your pain so you are comfortable and can get the rest you need. Call your doctor if your pain gets worse or changes because it may be a sign of a complication.
When should I call my doctor?
It is important to keep your follow-up and physical therapy appointments after ankle arthroscopy. Contact your doctor for questions or concerns between appointments. Call your doctor right away or seek immediate medical care if you have:
Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing
Change in alertness, such as passing out, unresponsiveness, or confusion
Chest pain, chest tightness, chest pressure, or palpitations
Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery and not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.
Inability to urinate or have a bowel movement
Leg pain, redness or swelling, especially in the calf, which may indicate a blood clot
Pain that is not controlled by your pain medication
Unexpected drainage, pus, redness or swelling of your incision
How might ankle arthroscopy affect my everyday life?
In most cases, ankle arthroscopy improves joint function and reduces symptoms so you can lead the most active life possible.
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- Ankle Arthroscopy. American Orthopaedic Foot and Ankle Society. http://www.aofas.org/footcaremd/conditions/ailments-of-the-ankle/Pages/ankle-arthroscopy.aspx.
- Ankle Arthroscopy. Arthroscopy Association of North America. http://www.aana.org/EducationLibrary/Articles/AnkleArthroscopy/tabid/122/Default.aspx.
- Arthroscopy. American Academy of Orthopaedic Surgeons. http://orthoinfo.aaos.org/topic.cfm?topic=A00109.
- DeHeer P, Groh C. Pertinent insights on ankle arthroscopy. Podiatry Today. 2013;26(1):48-54. http://www.podiatrytoday.com/pertinent-insights-ankle-arthroscopy.
- Skinner HB, McMahon PJ. Current Diagnosis & Treatment on Orthopedics, 5th ed. New York: McGraw-Hill, 2014.