Ankle arthroscopy is a minimally invasive operation in which a camera and fine surgical instruments are inserted into the joint through two or three small incisions (portals). The camera projects the inside of the joint onto a screen, and the surgeon makes the diagnosis and performs the necessary intervention under this view. Its main advantages over open surgery are less tissue damage, less pain, and faster recovery.
Arthroscopy is most often indicated in the following conditions: intra-articular loose bodies (detached cartilage or bone fragments), anterior or posterior impingement syndrome, synovitis (inflammation of the joint lining), osteochondral lesions (cartilage damage), and intra-articular adhesions. In patients with chronic ankle pain who cannot be definitively diagnosed by MRI, arthroscopy is used as both a diagnostic and a therapeutic tool.
Anterior impingement syndrome causes pain and a pinching sensation at the front of the ankle when bending it upward (dorsiflexion). It is usually caused by bony outgrowths (osteophytes) or scar tissue forming on the front of the joint after repeated sprains. Because it is common in football players, it is also called "footballer’s ankle." Arthroscopic debridement removes these bony outgrowths and scar tissue; in more than ninety percent of patients, pain decreases significantly.
Posterior impingement, on the other hand, is pain at the back of the heel when bending the ankle downward (plantar flexion). It is common in ballet dancers and in football players who kick with the toe. The presence of an accessory bone called the os trigonum frequently accompanies this condition. With an arthroscopic posterior approach, the os trigonum is removed and the tissues causing the impingement are cleaned. Return to sports after this surgery is usually possible in six to eight weeks.
The operation is performed under general or spinal anesthesia and takes an average of thirty to forty-five minutes. The patient is usually discharged the same day. For the first two weeks, the patient walks with crutches bearing partial weight on the foot. From the second week, dressings are removed and joint range-of-motion exercises begin. By the fourth week, most patients return to normal walking.
The situations in which arthroscopy is preferred over open surgery are clear: if the intra-articular pathology is limited in size, if soft-tissue repair is not required, and if bone correction (osteotomy) is not planned, arthroscopy is the first choice. However, in patients with large osteochondral defects, advanced arthritis, or severe axis deformity, open surgery or combined approaches may be necessary.
The complication rate after arthroscopy is low — below three percent in published series. The most common problem is temporary numbness due to superficial nerve irritation at the portal site, which usually resolves on its own within a few weeks. Infection and joint stiffness are rare. Early movement after surgery and adherence to the physical therapy program are the keys to a successful outcome.