Ankle Arthroscopy
Ankle arthroscopy is a closed surgical technique used for anterior and posterior impingement syndromes, cartilage (osteochondral) lesions and resistant intra-articular problems. Because it is a small joint, it requires fine instruments and a delicate technique.
The Structure of the Ankle
The ankle is a joint formed by the shin bone, the fibula and the talus, and it carries the entire body weight. Despite its hinge-like movement, load distribution during walking is complex. The outer and inner collateral ligaments and the joint capsule provide stability. Sprains can affect these ligaments and, over the longer term, set the stage for problems within the joint.
In Which Conditions Is It Considered?
- Anterior impingement syndrome — bone prominence or soft tissue becoming pinched as the ankle bends upwards (footballer’s ankle)
- Posterior impingement syndrome — pain at the back of the ankle when rising onto the toes (may be seen in dancers and volleyball players)
- Osteochondral lesions — assessment and treatment of damage to the cartilage of the talus
- Removal of loose bodies within the joint
- Removal of chronic synovitis and adhesions
- Assessment of instability developing after recurrent sprains
- Supporting assessment in posterior problems of the Achilles tendon
- Inspection of the joint surface after a fracture
Pain That Persists After a Sprain
The great majority of ankle sprains heal with appropriate care. In a group of patients, however, pain, swelling or a sense of giving way continues even months later. In that situation there may be a missed cartilage lesion within the joint, soft tissue causing impingement, or ligament insufficiency. Arthroscopy can both clarify the diagnosis and allow treatment in these cases.
Related article: What to Do in the Early Days After an Ankle Sprain
Diagnosis and Assessment
- History: the number of sprains, the site of the pain (front/back/inner/outer), the timing of swelling, any sense of giving way.
- Physical examination: points of tenderness, ligament stability tests, impingement tests, range of movement.
- X-ray: bone prominences, joint space and alignment.
- MRI / CT: cartilage lesion, bone oedema and soft tissue assessment.
Conservative Treatment First
The first approach in ankle problems is generally not surgical: activity modification, balance and proprioception work, strengthening of the peroneal muscles, appropriate footwear and, where needed, use of a brace are applied first. Surgery is considered when there has been an insufficient response to this programme, or where a structural lesion has been identified.
How Is the Procedure Performed?
In ankle arthroscopy, two small portals on the front of the ankle are generally used; for problems at the back, posterior portals may be preferred. Because the joint space is narrow, fine cameras and small instruments are used. Depending on the problem identified, correction of bone prominence causing impingement, treatment of a cartilage lesion or removal of loose bodies is carried out.
Preparing for the Procedure
- Prepare an up-to-date list of every medication you take, including herbal supplements.
- If you take blood thinners, be sure to say so; your physician decides when they are stopped.
- Bring any previous MRI, X-ray and operation reports with you.
- Follow the fasting instructions; this is critical for the safety of anaesthesia.
- Arrange your transport home and someone to accompany you in advance.
For detailed preparation headings, see the Preparing for Orthopaedic Surgery page.
The Postoperative Period
Permission to bear weight varies with the procedure performed: weight-bearing may be allowed early where only debridement has been carried out, while the protection period is kept longer where cartilage treatment has been applied. Elevating the leg and moving the toes are recommended early to reduce swelling. Balance and strengthening work forms the basis of rehabilitation.
Risks and What You Should Know
Although arthroscopy is a closed technique, it is still a surgical procedure and every surgical procedure carries risks. The headings below are for general information; your individual risk assessment is made by your physician after examination and investigations.
- Infection — a risk present in every operation, despite the small portals.
- Bleeding or swelling within the joint
- Involvement of nerve and vessel structures (rare)
- Risk of clot formation (deep vein thrombosis), particularly in lower limb procedures
- General risks related to anaesthesia
- Failure to achieve the expected improvement, or persistence of symptoms
- Temporary numbness from involvement of superficial sensory nerves
- Temporary stiffness and swelling of the ankle
- Healing after cartilage treatment not reaching the expected level
The decision to operate is made by weighing together the duration and severity of symptoms, examination findings, imaging results, age, occupation, activity level and any accompanying conditions. Outcomes vary from person to person.
When Should You Seek Assessment?
- If pain and swelling persist weeks after a sprain
- If there is a recurrent sense of giving way in the ankle
- If there is sharp pain on rising onto the toes or bending the ankle forwards
- If the ankle catches, locks or makes a noise
- If pain limits you when walking or playing sport
Frequently Asked Questions
My pain has not settled months after a sprain — is this normal?
Long-lasting pain is not an expected finding and should be assessed. There may be a cartilage lesion within the joint, tissue causing impingement or ligament insufficiency. These possibilities are investigated by examination and imaging.
Is ankle arthroscopy a minor procedure?
Although the portals are small, it is a surgical procedure with its own risks. Because the joint is narrow, it is technically demanding. Describing it as a “minor operation” can be misleading.
When can I walk after the operation?
Permission to bear weight depends on the procedure performed. Walking is generally earlier where only debridement has been carried out, while the protection period is longer where cartilage treatment has been applied. Your physician determines the exact timeframe.
Do I need to use a brace?
A brace can be helpful, particularly with recurrent sprains and during return to sport. However, balance and muscle strengthening work take the place of a brace; on its own it is not sufficient.
What is an osteochondral lesion?
It is damage to the cartilage of the joint surface of the talus together with the bone beneath it. It commonly appears after a sprain. Depending on its size, position and the severity of symptoms, either follow-up or surgical treatment is considered.
Academic Work
Assoc. Prof. Bertan Cengiz, MD has scientific work published in national and international peer-reviewed journals in the field of foot and ankle surgery and related areas of arthroscopic surgery. The publication list and verifiable academic sources are available on the Publications page.
Related Pages
The information on this page is for general guidance and does not replace an in-person medical examination. Diagnosis and treatment require a physician’s clinical assessment. Outcomes of any surgical or medical intervention may vary from person to person; no guarantee of a specific result or timeframe is given on this page.