Ankle arthroscopy (keyhole) surgery

Why might I need ankle arthroscopy surgery?

There are various problems that can be treated with ankle arthroscopy. These include:

• Prominent bone spurs at the front of the ankle. These commonly occur in sportspeople or in early arthritis of the ankle. Arthroscopy is an excellent way of viewing the joint surfaces to assess their condition.
• Osteochondral lesions
• Inflammation of the lining of the joint or other soft tissues
• Loose pieces of bone or cartilage inside the joint
• Impingement from bone spurs at the back of the ankle
• Ankle arthroscopy is commonly performed alongside ligament stabilisation surgery

What does the surgery involve?

Surgery is usually carried out under general anaesthetic and you would usually either go home the same day or stay one night. You will meet the anaesthetist before the procedure to discuss what type of anaesthetic is best in your situation.

The surgery is carried out through two incisions of about 5mm at the front of the ankle. Sometimes one or two incisions is required at the back of the ankle.

Fine precision burrs can be used to remove any spurs of bone from the front or back of the ankle to prevent them catching (known as ankle impingement) and causing pain. 

Fine shavers can be used to smooth off any areas of inflammation of the joint lining or loose pieces of cartilage on the joint surface.

Osteochondral lesions can be treated by a combination of techniques known as “debridement, curettage and microfracture”. This involves smoothing off the damaged area of the joint surface, cleaning out damaged bone and creating a series of small holes in the bone to stimulate formation of new cartilage. The new cartilage that forms is not quite the same as natural joint surface cartilage but for many people can be good enough to relieve the pain.

What happens after the surgery?

You will wake up with bandaging on your ankle. In some situations you might have a temporary cast or moonboot if other conditions have been treated at the same time. 

You can walk straight away. At first it will be shorter distances building up rapidly over the first two weeks. You will have an appointment around two weeks after surgery to check the wounds. The stitches are usually dissolvable so do not need to be removed. You might have a course of physiotherapy depending on what you have had treated. You can return to driving. As soon as you can safely use the pedals and do an emergency stop. This may be after two or three weeks if the surgery was straight forward and did not require any additional procedures – your surgeon will be able to advise.

What are the potential problems?

All surgery carries some risks.  The risks are rare but include:

• Persistent pain
• Infections
• Blood clots in the legs or lungs
• Numbness – this is usually temporary but occasionally can be permanent
• Nerve related pain problems