Arthroscopy of the Ankle for Arthritis and Related Issues
Ankle sprains, ankle fractures, flat feet and many other foot problems can lead to damage within the ankle joint. Much of this damage can be fixed with a surgical procedure called an ankle arthroscopy or ankle "scope". In short, the surgeon introduces a small camera 2.7 mm or 4.0 mm wide into the front of the ankle through a very small incision and through a second equally sized incision places instrumentation to clean up the ankle joint and repair damaged structures.
Osteochondral Defects (OCD)
OCD's show up commonly after ankle fractures or bad ankle sprains. The surfaces of the ankle joint bang into each other causing cartilage and/or underlying bone to die or degenerate leaving a "pot hole". Pain from this problem often feels like sharp shooting pain that hits you at certain moments while walking, especially on uneven terrain. If pressure is applied just right to the defective area, pain can be excruciating.
Treatment normally starts with a simple steroid injection into the ankle joint for two reasons. One reason is the anti-inflammitory effective of the injection that for some patients can bring long lasting relief, the other reason is for diagnostic purposes. Often with the injuries that lead up to the OCD, there can be surrounding tissues outside the ankle that become injured. The local anesthetic injections into the joint helps rule out sources of pain outside the ankle. If most of the pain is relieved from an ankle injection of local/steroid than chances are that the space within the ankle is where surgical attention should be focused.
Stable shoes, ankle braces and custom foot orthotics all can be very helpful in limiting the pain associated with an OCD, however, surgery is often required.
If all else fails, an ankle arthroscopic procedure can be used to accomplish several things. Joint synovitis almost always accompanies OCD's. Synovitis resembles tentacles of scar tissue that hang within the joint and become painful when pressure or stress is applied to them. Some describe their appearance as "crab meat" and is removed with a mechanical devise called a shaver.
If an OCD is found, which is normally confirmed by MRI prior to surgery, then several options are available depending on the size of the lesion. Generally, if the hole is less than 1.5 cm, drilling the surface bone to create bleeding can help the body repair the damage with a new layer of fibro-cartilage. If the defect is larger, then the problem can be fixed with cartilage grafts either taken from the patient or a donor such as with Zimmer's Denovo product.
Recovery times depend on the extent of the repair carried out. If a simple clean out is performed, the patient may walk in a CAM boot immediately. If OCD drilling and cartilage filling is done, then the patient is required to be non weightbearing for 3-6 weeks followed be a rehab protocol.
Dr Groberg and Dr Preece are accomplished arthroscopists and have performed these procedures many times in training and in practice in the Salt Lake area with very good outcomes.
When damage within the joint becomes too extensive for these joint salvage measures, the discussion turns to ankle joint replacement or ankle fusion depending on the situation.
Please contact our clinic with any questions you may have or to schedule an exam to hear what options may be available for you.
Dan Preece, DPM
Dan Preece, DPM & Darren Groberg, DPM