What to know about ankle arthroscopy

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Doctors recommend ankle arthroscopy for people with ankle problems that have not improved with nonsurgical treatment methods such as physical therapy, rest, medication, and steroid injections. Ankle arthroscopy may be helpful for the following conditions:

• Ankle impingement: Soft tissue or bone impingement in the ankle can lead to pain and restricted movement. This can occur in the front (anterior impingement) or back (posterior impingement) of the ankle.
• Ankle instability: Chronic ankle instability due to weakened or damaged ligaments can lead to recurrent ankle sprains and joint deterioration.
• Arthritis: In some cases, surgeons can use arthroscopy to treat arthritis symptoms in the ankle, such as by removing inflamed tissue or bone spurs that cause pain and limit movement.
• Cartilage damage: Treatment for damage to the cartilage in the ankle joint, such as osteochondral lesions, may involve arthroscopy. This damage can lead to arthritis if a person does not receive treatment.
• Injuries: Ankle injuries, such as sprains or fractures that cause continued instability, pain, or limited range of motion, may require arthroscopy.
• Loose bodies: Arthroscopy can be helpful if a person has loose fragments of bone or cartilage within the ankle joint that cause pain, swelling, and impaired joint movement.
• Persistent ankle pain and stiffness: If a person has unexplained ankle pain, swelling, or stiffness that does not improve with conservative treatments, a surgeon may use arthroscopy to diagnose and address the underlying cause. The surgeon may take a biopsy to help determine the cause of the pain.
• Scar tissue formation: People who have excessive scar tissue formation (arthrofibrosis) within the ankle joint that has led to stiffness and reduced mobility can benefit from arthroscopy.
• Synovitis: Inflammation of the synovial lining of the ankle joint may cause pain and swelling.
• Avascular necrosis of the talus: A surgeon may use arthroscopy to address inadequate blood supply to the talus, which is the ankle bone.

Surgeons typically perform an ankle arthroscopy on an outpatient basis, meaning a person can go home the same day. The procedure usually involves the following steps:

1. Anesthesia: An anesthesiologist gives the person general anesthesia, regional anesthesia, or a combination of the two.
2. Incision: The surgeon makes small incisions, or cuts, near the ankle joint.
3. Insertion of arthroscope: The surgeon inserts the arthroscope through one of the incisions to view the ankle joint on a video monitor.
4. Surgery: The surgeon inserts miniature surgical instruments through other incisions to perform the necessary repairs or removals.
5. Closure: The surgeon closes the incisions with stitches or small bandages.

In advance of the procedure, a person should inform their doctor about all medications, supplements, and over-the-counter drugs they are currently taking.

The doctor may adjust some medications or advise a person to stop taking them before surgery. This is especially the case for medications that can increase the risk of bleeding, such as aspirin, anti-inflammatory drugs, and certain herbal supplements.

People should also take the following steps to prepare:

• Arrange for someone to drive them home.
• Organize help around their home for a few days after the surgery.
• Have ice packs ready to help manage swelling and pain.
• Prepare their home by gathering all necessary items to reduce the need for excess movement.

Healthcare professionals will tell a person what else they need to do to prepare for the procedure, and the person should follow these instructions closely.

Recovery from ankle arthroscopy varies according to the specific procedure and the person’s overall health. Depending on what a surgeon finds during the ankle surgery, they may need to perform different surgical procedures, which may have different rehabilitation protocols.

General guidelines include:

• Immediate postoperative period: A person may need a splint or boot to protect their ankle. They may not be able to bear weight and may need to use crutches or a walker.
• Pain management: Over-the-counter pain relievers or prescription medications can typically manage the pain.
• Physical therapy: A person may start rehabilitation exercises a few days after surgery to help restore ankle strength and flexibility.
• Return to activities: People can often return to light activities within a few weeks, but full recovery may take several months, especially for athletes and other people who require optimal physical performance.

Generally, ankle arthroscopy is highly effective at treating ankle problems, offering benefits such as reduced pain, improved function, and quicker recovery times compared with open surgery.

According to a 2024 research review, ankle arthroscopy is up to 90% successful at treating ankle conditions. The complication rate ranges from 3.5% to 14%.

The effectiveness of ankle arthroscopy may depend on the condition, its severity, and the person’s overall health.

While ankle arthroscopy is generally safe and effective, it carries certain risks and possible complications, as all surgical procedures do. These include:

• Infection: Infections are rare but can occur at the incision site or within the ankle joint. Possible symptoms include redness, swelling, increased pain, and fever.
• Nerve damage: During the procedure, the surgeon may inadvertently damage small nerves surrounding the ankle joint. This damage can lead to temporary or permanent changes in sensation, such as numbness, tingling, or pain in the foot or ankle.
• Blood vessel damage: While this is also rare, the procedure can cause damage to blood vessels near the surgical site, potentially leading to bleeding and hematoma formation.
• Ankle stiffness: Postoperative stiffness is common, particularly if the surgeon immobilizes the ankle after surgery. Physical therapy is often effective in restoring range of motion, but some people may experience a long-term decrease in flexibility.
• Deep vein thrombosis: Surgery increases the risk of a blood clot forming in a deep vein, usually in the leg. This can be life threatening if the blood clot travels to the lungs.
• Anesthesia-related complications: Reactions to anesthesia can range from mild, such as nausea and a sore throat, to severe, including allergic reactions and respiratory or cardiovascular complications.
• Complex regional pain syndrome: This is a rare but serious condition in which a person develops chronic, intense pain after surgery. Symptoms include prolonged pain, swelling, and changes in skin color and temperature.

If a person has health insurance, their out-of-pocket costs for ankle arthroscopy will depend on the specifics of their insurance plan, including deductibles, copayments, and coinsurance. Some people may be responsible for only their deductible and a copayment or coinsurance for the procedure, which could significantly reduce their financial contribution.

A person should consult their insurance provider to get a full outline of the costs.

Additional costs a person may incur include:

• Preoperative costs: Consultations, diagnostic imaging (X-rays, MRI), and presurgery tests can add to the total expense.
• Postoperative costs: The total cost should also include medications, follow-up visits, and rehabilitation or physical therapy sessions.
• Potential complications: Though rare, complications that require additional treatment or surgery can increase costs.

People without health insurance can speak with their surgical team for more information.

Many people experience long lasting relief from symptoms after ankle arthroscopy. However, the outcome may depend on the type and severity of a person’s condition, their activity level, and how well they stick to lifestyle changes that doctors recommend.

Outcomes tend to be more favorable when doctors diagnose and treat conditions early, before significant joint damage occurs.

Ankle arthroscopy is a minimally invasive surgery that can help diagnose and treat various ankle issues. It is usually an outpatient procedure, which means a person can go home the same day.

Recovery times vary depending on the extent of the surgery and other factors, such as a person’s overall health.

The outlook for people who undergo ankle arthroscopy is good, but complications can occur and people may need further surgeries.