Ankle joint arthroscopy, also known as a “scope procedure” is an advanced, minimally invasive modality. This procedure allows for visualization of the ankle joint through very small incisions that are usually around 5-mm in length. When a procedure is tackled “arthroscopically”, it allows for smaller incisions, less scar tissue, and depending on the procedure, typically a shorter recovery.
This is a procedure of interest to me and I have taken additional courses in this field, including the arthroscopy course offered by the American College of Foot and Ankle Surgery.
So what kind of ankle problems can be addressed “through the scope”? There are many.
One of the more common reasons to perform an ankle joint scope is to perform a synovectomy. As a primer, the synovium is the inner lining of the joint capsule that produces synovial fluid, which is responsible for lubricating and providing nutrients to the joint. After an injury, the synovial lining can become inflamed to produce synovitis. Synovitis can either be acute or chronic, both of which have different appearances.
Acute synovitis is redder/pinker due to increased vasculature and resembles anemones of the ocean.
Chronic synovitis is less pink/red. It typically presents after a protracted period of time from the injury.
Whether you have acute or chronic synovitis doesn’t matter, both are sources of pain and can cause impingement in the joint.
Other common pathologies encountered in the ankle joint include fibrous bands and osteochondral lesions. Fibrous bands also cause impingement and are a source of pain in the ankle joint. Certain fibrous bands are consistently found in many ankles and will thus have their own names. One example would be a Wollen lesion.
Osteochondral lesions are areas of damage to the cartilage that lines the joint. This is such an expansive topic that it definitely deserves its own blog entry. With that being said, when they are simple and easy to access, they can be addressed via arthroscopy. There are many different treatment options for this entity, one example being bone marrow stimulation. While being visualized through the arthroscopic camera, the area of damaged cartilage is cleaned. After this is complete, a communication hole is created between the ankle joint proper and the inner medullary bone (deep bone). This allows for passage of growth factors and progenitor cells within the bone to the surface of the joint to create a reparative-type cartilage known as fibrocartilage. This is the simplest way to address an osteochondral lesion and is reserved for smaller lesions. More advanced options will be discussed elsewhere in the future.
Arthroscopy is a valuable tool and can be used in joints other than the ankle including the subtalar joint and the great toe joint.
I would like to reinforce that surgical options are typically reserved after conservative treatment options have failed. My protocol for addressing lateral ankle sprains surgically is to always include ankle joint arthroscopy because it is a very common to find unsuspecting pathology (that both a clinical examination and MRI did not reveal).