What is an Ankle Arthroscopy?
Arthroscopy is a form of ‘key-hole’ surgery. It involves one or more small cuts in the skin, where a small camera (called an arthroscope) can be inserted to look inside your ankle joint and perform operations, like washing.
The arthroscope is only three to four millimetres wide and is inserted into the ankle through small incisions in the skin. Often your surgeon will make 2 to 3 incisions to perform the operation.
Your surgeon will be able to access your joint and may perform a number of treatments to your ankle joint, including:
- treating cartilage lesions
- removing loose bodies
- removing bone spurs called osteophytes
- cleaning the joint by washing or cutting away infected or damaged tissues.
The operation is often performed under a general anaesthetic as a day case.
Who is this operation for?
The operation may be performed to:
- Diagnose the cause of symptoms
- If your doctor is unsure of the cause of your pain, swelling or stiffness an arthroscopy may be used
- Usually other tests, such as X-rays, CT scans or MRI will be used before an arthroscopy is performed.
- Help management of osteoarthritis or damage to the bone
- Trim damaged cartilage or remove fragments from the joint
- Remove inflamed soft tissue
- Special operations that are performed through arthroscopy:
- Arthrodesis, or fusion, of the ankle.
- Correction of ankle instability
There are a number of reasons why arthroscopy may not be suitable for you. Factors that make arthroscopy less likely to be successful include:
- A small or scarred joint space
- A past history of severe pain after operations
- Poor blood supply to the foot or ankle – often smokers and diabetics are more likely to have compromised blood supply, however this can be discussed with your surgeon (see Angiography).
Pain at the back of the ankle when pointing the toes can come from a small extra bone called an os trigonum. Keyhole surgery for this gives similar results to open surgery, with fewer minor problems.
What are the complications?
Are there any risks with an ankle arthroscopy?
Ankle arthroscopy is a small operation and most people have no problems. As with any surgery, there are some risks. These include:
- Numbness or tingling on the top of the foot, from irritation of a small skin nerve near the cuts. This usually settles but can sometimes last
- Infection of the small cuts or, rarely, inside the joint
- Fluid leaking from the cuts for a few days
- Bleeding or bruising
- Blood clots in the leg (DVT), which are rare
- Ongoing pain or stiffness, as the operation cannot fix every problem in the joint
- Needing another operation in the future
For more information on the general risks of surgery, see Complications of Surgery.
Before the operation
Preadmission Clinic | Preparing for Surgery
Before your operation, you will be seen at the Preadmission clinic to make sure you are fit for the operation and all the necessary tests are performed in preparation for the operation.
During the visit, you will be seen by a
- doctor
- nurse
- anaesthetist (if necessary)
If you have chronic lung or heart disease, diabetes or other risk factors for complications during surgery, you may require a detailed anaesthetic assessment.
Tests
Tests that may be ordered for you include:
- blood tests
- X-ray of ankle and/or foot. Sometimes, your surgeon may request X-rays of your other ankle to have a comparison.
- X-ray of your Chest
- Urine Test
- ECG
Preparing Your Skin
Your skin should not have any infections or irritations before surgery. If either is present, contact your orthopaedic surgeon for a program to improve your skin before surgery.
Tip
Carry a list of your medications with you including the name, dosage and how often you take it.
Medications
Your treating team will advise you which medications you should stop or can continue taking before surgery. Please make sure you inform your doctors if you are taking any blood thinning medications, like warfarin or aspirin.
If you have rheumatoid arthritis, you may need to speak with your rheumatologist about which drugs are safe for surgery.
What happens during the operation?
An ankle arthroscopy is usually done as day surgery. You will have a general anaesthetic, or a spinal anaesthetic so that you are numb from the waist down.
Your surgeon makes two or three small cuts, each about the size of a fingernail, usually at the front of the ankle. Sometimes cuts at the back of the ankle are needed. The ankle may be gently stretched open with a strap so the camera can reach the joint.
Fluid is used to fill the joint so your surgeon can see clearly. Small instruments are passed through the other cuts to clean the joint, remove loose pieces or bone spurs, or treat damaged cartilage. At the end, the cuts are closed with stitches or tape and a padded bandage is put on.
What happens after the operation?
Most people go home on the same day. Your ankle will be in a padded bandage and will feel sore and swollen for the first few days.
To help the swelling go down:
- Keep your foot raised above the level of your heart as much as you can
- Use an ice pack wrapped in a cloth for short periods
- Take your pain medicine as prescribed
You may need crutches for a short time. Most people can put weight through the foot as pain allows. If cartilage has been repaired, your surgeon may ask you to keep weight off the ankle for several weeks.
Recovery and Rehabilitation
What happens after discharge?
You will usually be seen in clinic about 10 to 14 days after surgery to check the cuts and remove any stitches. A physiotherapist will give you exercises to get your ankle moving, then to build strength and balance.
When can I return to work?
If you have an office job you can often return within a week or two, once you can keep your foot raised. If your work is physical or keeps you on your feet, it will take longer. Your surgeon will guide you, as it depends on what was done in the operation.
When is it safe to drive?
You can drive once you are off strong pain medicine, can walk without crutches and can press the brake hard in an emergency stop. This is often sooner if your left ankle was operated on and you drive an automatic car. Check with your insurance company before you start driving again.
What should I do if I have a problem?
If you experience severe pain, excessive swelling, discharge, excessive numbness or pins and needles please report it to your GP. If you cannot contact your GP you should visit the Emergency Department as quickly as possible.
F.A.Q.s | Frequently Asked Questions
How long will I be on crutches?
Most people use crutches for a few days to a week, mainly for comfort. Your surgeon will tell you how much weight you can put through the ankle, as this depends on what was done inside the joint.
When can I drive?
Once you can walk without crutches, are off strong pain medicine, and can do an emergency stop without hesitating. For a left ankle in an automatic car this is often sooner.
When can I go back to work?
Desk work is often possible in one to two weeks. Work on your feet takes longer, often four to six weeks.
When can I play sport again?
Usually somewhere between six weeks and three months. It depends on what was found and repaired. Build back up rather than going straight into a game.
Why is my ankle still swollen weeks later?
Swelling after ankle surgery is normal and can come and go for several months. Keeping the foot up and using ice helps. Swelling that is getting worse, with heat and redness, should be checked.
Will the arthroscopy cure my ankle?
It depends on the problem. Removing loose bits, trimming torn tissue or clearing bone spurs often works well. Arthroscopy cannot undo arthritis that has already worn the joint surface.
What are the little cuts on my ankle?
The camera and instruments go in through two or three small cuts, usually at the front of the ankle. They are closed with stitches and leave small scars.
When should I call the doctor?
Call if the pain is severe and your medicine is not helping, if the wounds are red, hot or leaking, if you get a fever, or if your calf becomes painful and swollen.
References
Briggs, T., et al., ‘Operative Orthopaedics: The Stanmore Guide’, Hodder Arnold Ltd., UK, 2010.
Chou, L. B., et al., ‘Osteoarthritis of the Ankle: The Role of Arthroplasty’, Journal of the American Academy of Orthopaedic Surgeons, Vol. 16, No. 5, May 2008, pp. 249–259.
Easley, M. E., ‘Perspectives on Modern Orthopaedics: Total Ankle Arthroplasty’, Journal of the American Academy for Orthopaedic Surgery, Vol. 10, No. 3, May/June, pp 157–167.
Zwiers R, Miedema T, Wiegerinck JI, Blankevoort L, van Dijk CN. Open Versus Endoscopic Surgical Treatment of Posterior Ankle Impingement. A Meta-analysis. Am J Sports Med. 2022, 50(2), 563-575. PMID 34048272.