Procedure
Arthroscopy of the ankle joint is performed either under general or regional anaesthesia. In consultation with the surgeon and the anaesthetist, the appropriate anaesthetic procedure is selected for each patient. The procedure is performed in the operating theatre under sterile conditions.
It is possible to inspect only the upper ankle joint or only the lower ankle joint, a combination is also possible. The upper ankle joint is subjected to arthroscopy about twice as often as the lower one. The arthroscopy of the ankle joint is started after a tourniquet is applied.
The tourniquet is necessary to prevent blood from leaking from small vessels in the operating area, as this blood would considerably restrict visibility. Since the ankle joint has very narrow spatial relationships, a distraction (pulling apart) of the lower leg and foot is necessary. This distraction can be done manually or with weights.
Two small incisions are made at the front of the ankle joint to insert the instruments. A blunt guide rod is inserted into one of the two access points, through which the camera is inserted into the joint. The second access route serves as a working channel for instruments.
Due to the keyhole technique used, muscles and tendons are not injured but pushed aside by the instruments, which significantly reduces the complication rate compared to open surgery. It may be necessary to create additional access channels for instruments, which are either also located at the front of the ankle joint or are attached to the lateral back. The camera transmits images from the ankle joint, so the surgeon can see where he is at any time and which structures he is working on with the instruments.
During arthroscopy of the ankle joint, the surgeon identifies the pathological structures and, if necessary, treats them by inserting suitable instruments through the working channel. For example, the examiner identifies cartilage damage in the entire ankle joint and analyses it in relation to congenital malpositions or previous injuries. If the surgeon discovers excessive growth of mucous membrane changes or bone spurs, he can remove them. Torn or loosened ligament structures can be fixed or sutured. Arthroscopy of the ankle joint takes 30-60 minutes, depending on the therapeutic procedure, and in many cases can be performed on an outpatient basis.
Risks
Arthroscopy can be performed under local anesthesia and is relatively low-risk. Of course, due to its invasiveness, arthroscopy should nevertheless only be used in patients where this procedure is absolutely necessary.
Aftercare
After arthroscopy, full weight-bearing is possible in principle, but the patient should still take it easy and avoid heavy loads in the two weeks following the procedure. Pain can be relieved by taking painkillers. The doctor may prescribe partial weight-bearing of the ankle joint, physiotherapy or thrombosis prophylaxis. The prognosis depends on the underlying disease and cannot be generally predicted.
