PAULO ROCKETT, M.D.

Porto Alegre Brazil

AnkleArthroscopy

Ankle sprains are among the most

common injuries in sports and at work.

Between 20 and40% of patients

treated withconservative

therapy may haveresidual problems.

Ankle Arthroscopy

Articular injurySoft tissue impingementBony impingementSome types of fractures (mild displacement)

indications

SynovitisLoose bodies and

osteophytesChondromalaciaOsteochondral lesions

of the talus

Ankle Arthroscopy

Ankle Arthroscopyindications

May also be used for:

Ankle stabilizationArthrodesis

Ankle ArthroscopyAuthor’s techniquePatients are placed in supine positionLeg is secured in midportion with the leg-holder

Noninvasive joint distraction

Establish portals -dull disection

Cannula system

Ankle ArthroscopyportalsAnterior

AnterolateralAnteromedial

Anterocentral

Ankle ArthroscopyportalsAnterior

Ankle ArthroscopyportalsPosterior

PosterolateralTrans-Achilles tendonPosteromedial

Ankle ArthroscopyportalsPosterior

Ankle ArthroscopyportalsTransmalleolar

MedialLateral

Ankle Arthroscopycomplications

Damage to neurovascular structures and tendonsChondral injuriesSynovial fistula

Anterior bony impingement (arthritic conditions, loose bodies and fractures)Anterolateral soft tissue impingement (synovitis or scar tissue)Osteochondritis dissecans

Ankle Arthroscopy

Pain on forced dorsiflexionX-Rays confirm exostoses

Ankle Arthroscopyanterior bony impingement

PrePos

Tibia

Talar neck

Osteoarthritis of the ankleOsteophytes of anterior lip of the tibiaOsteophytes at the talar neckChondral lesion of the talar dome (tram track)Loose bodies

Ankle Arthroscopyanterior bony impingement

Excision of exostoses (tibial and talar neck)Distraction is essential in avoiding injury to the talar articular surfacePartial synovectomyAbrasion or drilling of chondral lesion (tram track)

Ankle Arthroscopyanterior bony impingementtreatment

History of sprain and pseudo-instabilityPain and tenderness anterolateral jointPain with eversion and dorsiflexionPositive response to local injectionMRI has minimal benefit

Ankle Arthroscopyanterolateral soft tissue impingement

Injuries to lateral capsuleTorn anterior ligaments (tibiofibular, talofibular)Synovitis or scar tissue that becomes trappedbetween bony structuresMay erode lateral talar dome ridge

Ankle Arthroscopyanterolateral soft tissue impingement

Partial synovectomyDo not resectcapsuleDo not resectremained ligamentChondrectomy –talar dome ridge

Ankle Arthroscopyanterolateral soft tissue impingementtreatment

Ankle Arthroscopyosteochondritis dissecans

PainCatchingGrindingIntermitentswelling

Ankle Arthroscopy

Stage I, II or III (Berndt and Hartyclassification) with persistent symptoms afteran adequate nonoperative therapy ( up to 3 months) would benefit with arthroscopy.Stage IV should be treated surgically.

osteochondritis dissecans

Ankle Arthroscopyosteochondritis dissecans

Removal of loose bodiesCurettage or drillingFixation (>2cm)

Ankle Arthroscopy

Symptoms of chronic ankle pain that had failed to respond to conservative treatment for

at least 6 months.

method37 patients

Ankle Arthroscopy

Sex! 11 women! 26 men

Age: !minimum 13 y.o.!maximum 81 y.o.

method37 patients

Follow-up: ! minimum 2 years! maximum 10 years! average 6 years

Ankle Arthroscopymethod 37 patients

6Osteochondritis dissecans (OCD)

Bleeding

Ankle Arthroscopymethod 37 patients

3Post ankle fracture

Ankle Arthroscopymethod 37 patients

3Post ankle fracture

Chondromalacia IV grade

Ankle Arthroscopymethod 37 patients

3Post ankle fracture

Debridement and abrasion

Ankle Arthroscopymethod 37 patients

2Osteoarthritis and chondromalacia

Ankle Arthroscopymethod 37 patients

7Anterior bony impingement

Ankle Arthroscopymethod 37 patients

7Anterior bony impingement

Osteophyte

Ankle Arthroscopymethod 37 patients

4Loose bodies

Ankle Arthroscopymethod 37 patients

4Loose bodies

Ankle Arthroscopymethod 37 patients

4Loose bodies

Flexion Extension

Ankle Arthroscopymethod 37 patients

14Anterolateral soft tissue impingement

Ankle Arthroscopymethod 37 patients

14Anterolateral soft tissue impingement

Ankle Arthroscopymethod 37 patients

1Artrhroscopic subtalar arthrodesis

Indicated for instability(neuropathic conditions)

Ankle Arthroscopymethod 37 patients

1Artrhroscopic subtalar arthrodesis

Ankle Arthroscopymethod 37 patients

1Artrhroscopic subtalar arthrodesis

Pre

Post

Ankle Arthroscopyresults 37 patients

3%

3%

46%

48%

1Poor

1Fair

17Good

18Excellent

Improvement in: pain, swelling, stiffness, activity and instability

Ankle Arthroscopy

36 patients benefited in some way fromthe procedure1 patient with degenerative joint diseasehad the worst result

results 37 patients

Improvement in: pain, swelling, stiffness, activity and instability