Arthroscopy of the Ankle
Keyhole surgery of a joint is called arthroscopy. Most people are familiar with this being carried out on knee joints but not everyone is aware that foot and ankle orthopaedic surgeons routinely do the same for joints in the foot, particularly the ankle. Such keyhole surgery offers advantages over conventional open surgery including more rapid recovery and improved visualisation for the surgeon since everything is magnified and brightly lit on the television screen. The ankle joint can develop bony spurs, frayed and loose cartilage or inflamed, scarred joint lining tissue (synovium) which catches within the ankle in certain positions. Such problems can be assessed and usually treated arthroscopically.
The surgery is normally carried out under general anaesthetic supplemented by local anaesthetic to ensure good post-operative pain relief. Most procedures are carried out as a daycase. Each incision is about 1cm long on the front of the ankle, one to each side. A strap device is fitted over the foot giving a constant pull so as to open the joint and allow enough room to work inside. The joint is filled with fluid during the operation and drained off at the end. The length of time taken depends on the work required. Sometimes it is straightforward removal of some soft tissue catching in the corner of the ankle (taking only half an hour or so) whereas sometimes lots of work is necessary to remove various bony spurs and damaged cartilage taking well over an hour. The amount of work will also determine how long it takes to return to normal walking and activities. Although on the outside there are only two small incisions to see (usually 1 stitch required for each) there might have been substantial surgical work carried out on the inside.
No plaster cast is required. The bandage can be self-removed after 5 days and the stitches removed after 10-11 days by the day ward, district nurse or you practice nurse. Often it is safe to wean off your crutches and fully weight bear as soon as comfort permits. On other occasions it is important to allow the joint surface to heal over with a new cartilage layer by keeping to the crutches and limiting weight bearing for several weeks. Your surgeon will give you precise information.
In the case of removal of inflammed tissue in an otherwise healthy joint, walking and activities can return to normal in a week or two, sometimes even before the stitches are due for removal. Often however patience is required and although the sharper pains disappear very quickly the deeper 'toothache' type pains can take 2-6 months to fully settle, again depending on the problem and the surgery required to treat it. We will do our best to predict for you what you can expect.
Finally, the arthroscopy is sometimes carried out in conjunction with other surgery, such as repair of torn ligaments. Then, it is the latter surgery which determines the recovery period rather than the arthroscopy.