Ankle arthroscopy is keyhole surgery used to treat a variety of ankle problems. It is commonly used to treat and assess problems such as:
The surgery is performed as day case surgery. A general anesthetic will usually be given and a local anesthetic is placed into the incisions to numb some of the pain following surgery.
Two or three ‘keyholes’ are made for small telescopes and instruments to see into the joint and ‘clean up’ or treat lesions.
The surgery usually takes between 45 minutes to one hour.
After surgery you will go home a few hours later once you have recovered. (You will need someone else to pick you up from hospital).
RECOVERY
Crutches are required for the first few days until it is comfortable to walk on your foot unaided.
Generally, ‘Full weight-bearing’ as much as is comfortable is allowed – Occasionally you may be instructed by your surgeon to be ‘Non-weight-bearing’ (this is sometimes required following a ‘microfracture’ procedure).
Please REST and ELEVATE your foot strictly for the first 36-48 hours and then keep it mostly rested and elevated for the first week. Icing for 20 minutes twice or three times daily for the first 3-5 days can help with swelling and pain.
The outer soft bandage can be removed 48 hours after surgery and then an elastic ‘tubigrip’ applied to help control swelling. The stick-on plastic dressings should be left on until your review – if these fall off please replace with a bandaid. A small amount of bleeding on the dressings is normal.
The foot and ankle should be moved up and down and in circles to prevent stiffening and blood clots.
Physiotherapy may be started after 10 days if required. Stationary bike exercise can start 5-7 days post-op.
No driving right foot for 1 week or until walking comfortably with no crutches.
| Time Off Work | |
|---|---|
| Desk work | 4-7 days |
| Light duties | 1-2 weeks |
| Standing / heavy work | 3-5 weeks |
| Sports | 6-12 weeks |
| Full recovery | 3-4 months |
RISKS
The risks of arthroscopic ankle surgery are rare but include: Anaesthetic complications, Infection, Nerve damage, Blood clots (DVT) and Stiffness.
Ankle sprains are one of the most common sporting injuries. Usually the injury recovers with suitable rest and physiotherapy. Ankle instability occurs when the ankle repeatedly gives way during sporting or daily activities. This leads to recurrent ankle sprains, joint pain, swelling, inflammation, and further damage to the ligaments around the ankle. Some people experience intermittent ankle pain, which occur with episodes of instability, whilst others feel that their ankle aches more often. Recurrent instability episodes can cause damage to the joint surface cartilage, the formation of bony spurs (osteophytes), and arthritis.
NON-OPERATIVE MANAGEMENT
The first line of treatment for ankle sprains is rest, ice, compression, elevation with painkillers and anti-inflammatories (if tolerated). Physiotherapy is then useful to regain range of movement, strength, balance and joint position sense (proprioception). An ankle brace may be useful for people who have tried all these measures and experience ongoing problems with sporting or daily activities. Finally, a targeted PRP injection may offer relief from ankle inflammation and help settle symptoms so that physiotherapy can continue.
OPERATIVE MANAGEMENT
When all these non-operative measures fail, and recurrent ankle instability becomes an ongoing problem, surgery is indicated. The ankle ligaments are assessed clinically and an MRI scan may be necessary to identify any problems within the ankle joint itself or the tendons and ligaments around the joint. There are 2 components to the surgery. An incision is made over the outside of the ankle where the ligaments have been torn away and the ligaments are reconstructed in an anatomical fashion and reinforced with overlying tissue (modified Bröstrum-Gould repair). If indicated, the tendons behind the ankle are inspected and repaired. At the end of the operation a backslab (half plaster) is applied to immobilise the ankle and protect the reconstruction and wounds.
In addition to the ligament repair, an arthroscopy is initially performed through 2 small incisions at the front of the ankle. The joint surfaces are inspected, inflammatory and scar tissue is removed, and any bony spurs (osteophytes) are trimmed away.
POST-OPERATIVE RECOVERY
As with all reconstructive surgery your rehabilitation and postoperative physiotherapy regime forms a vital part of your recovery from surgery and return to normal activities. The first 2 weeks are dedicated to reducing the swelling with elevation of the foot and mobilising non-weight bearing with crutches to allow the wounds to heal. You will then be allowed to wear a lace-up ankle brace and gradually increase your weight bearing status and work on a range of motion. 6 weeks after surgery the brace is removed for daily activities and an intensive strengthening and balance program begins. The brace is to be worn for all sporting activities and you should be able to return to sport 3-6 months after surgery. The ankle may always be a bit stiffer than the normal side, but this is rarely a significant problem.
RISKS AND COMPLICATIONS
No surgery is completely risk free. The risks and complications will be assessed and discussed with you. There is always a small risk of infection, blood clots, nerve injury and anaesthetic problems and measures are taken to reduce these. There is approximately a 5% chance of experiencing problems with recurrent instability and this is usually due to a fresh injury or sprain. A good outcome is achieved in more than 90% of cases
| Recovery Times | |
|---|---|
| Hospital stay | 1 night |
| Rest and elevation | 7-10 days |
| Plaster = crutches (non-weight bearing) | 2 weeks |
| Lace-up brace/cam walker (full time - 2 weeks partial then 2 weeks full weight bearing) | 4 weeks |
| Lace-up brace (training) | 6 weeks |
| Ankle strapping (competition) | 12+ weeks |
| Time off Work | |
|---|---|
| Seated | 2-3 weeks |
| Standing | 6 weeks |
| Heavy Physical Work | 12 weeks |
Foot and ankle surgery is a specialised area of orthopaedic surgery. The surgery can be quite challenging and every patient is different with unique needs and goals.
You will need to follow instructions, perform appropriate exercises, and modify your activities during your healing process.
This requires patience, persistence, and a desire to get better. If you are unable to complete the post-operative instructions it will affect your results and you should consider alternative treatments.
Successful results from surgery require a contribution from you.
Whenever surgery is considered we always try to minimise the risks. You are already on this path by consulting an experienced orthopaedic surgeon who is a specialist in foot and ankle disorders. The body is a very complex and varied structure so although we aim for perfection, no specialist can give perfect results every time.
It is important that you read all of the information carefully. The information provided is intended to be a guide and not all-inclusive. If you have any questions, concerns, or are not certain about the benefits, risks, limitations, or alternatives to your treatment, please do not hesitate to ask your surgeon.
PREPARING FOR SURGERY
- On the morning of surgery please shower and thoroughly wash your feet and toes with soap (anti-bacterial if available) and water.
- Fast from the time instructed.
- On the day of surgery do NOT take any Insulin or diabetes tablets unless otherwise instructed. (If you are normally on Insulin please confirm with us that we have this information). Aspirin and any blood thinners (e.g. warfarin, Plavix, Iscover) should have been stopped one week before surgery.
- Otherwise please take your normal medications (e.g., blood pressure tablets) with a small sip of water.
- Attend hospital at an appropriate time – there may be some waiting time before your surgery but you need to arrive so that you can be checked in by the nursing staff and seen by the anaesthetist beforehand. Please bring a book, magazine or music in case of a moderate wait or delay.
- Remember to bring your X-rays / Scans, please.
PAIN MANAGEMENT
A local anaesthetic block may be given to you during surgery. This will produce numbness around the nerves in the region of your surgical procedure. It will provide you with pain relief for approximately 12-18 hours post-operatively, enabling you to be comfortable and allow sleep after your surgery. It will also allow time to take some of your oral painkillers prior to the block wearing off and prevent a sudden onset of pain.
It is best to take your painkillers regularly for the first 1-2 weeks. Initially, prescription medication is usually necessary and after the initial 2-3 days, regular Panadol or Panadeine is usually all that is required.
It is also worthwhile taking painkillers prior to your first post-operative visit to ensure that plaster and suture removal is more comfortable.
Remember, pain is better managed if you get on top of it before it gets on top of you.
DRESSINGS AND EXTERNAL PINS
- Please leave your bandages intact until reviewed by your surgeon at the postoperative visit (except for ankle scopes and plantar fascia release where the outer bandage can be removed after 2 days). A plastic garbage/kitchen bag sealed with tape and elastic band +-‘glad wrap’ is needed to keep it dry in the shower or bath. If there is excessive bleeding leaking through the bandage or the bandages get wet please contact the rooms and this can easily be re-bandaged if required.
- Rest and elevation of your foot (to at least the level of your hip and ideally above the level of your heart) is required for the first 10 days following surgery. This helps minimise swelling and aids healing of your wounds.
- Icing of the area (if possible) for 20 minutes 2-3 times per day for the first 3-5 days can also help reduce swelling and pain.
- If part of your wound continues to ooze, this usually only requires regular dressing changes. If you have any concerns, please contact the rooms prior to commencing any antibiotics.
- Similarly, if the pins used to straighten your toes are knocked, it is unusual to do any damage. However if the toe becomes deformed or there is prolonged pain then contact the rooms.
- Gentle leg, ankle, foot and toe movement and stretching (if possible and not in plaster) every hour will help with circulation and muscle recovery.
- If you have been instructed to be ‘non-weight bearing’ this is to allow best healing of bones/tendons/ligaments.Failure to comply may jeopardise the results of your surgery.
- Time off work and recovery will depend on the nature of your surgery. Generally a minimum of one to two weeks is required off for seated/ deskwork (unless very minor surgery). For more prolonged standing or walking this will often require at least 4-6 weeks (or longer).