What is Arthroscopic Ankle Joint Cartilage Repair?
Arthroscopic ankle joint cartilage repair is a minimally invasive surgical procedure designed to repair damaged cartilage within the ankle joint using arthroscopic guidance and small incisions. The procedure enables your physician to detect the damaged cartilage and make repairs to your ankle without making large cuts in the skin and tissue as in an open ankle surgery. An arthroscope is a small, fiber-optic instrument consisting of a lens, light source, and video camera. The camera projects an image of the inside of the joint onto a large screen monitor, allowing the surgeon to look for any damage, assess the type of injury and repair the problem.
Anatomy of the Ankle Joint
The ankle joint connects the leg with the foot and provides free movement to the foot. It is formed by connecting the bones of the lower leg, tibia, and fibula, with the talus, or ankle bone. Articular cartilage is the white tissue lining the end of bones where these bones connect to form joints. Cartilage acts as cushioning material and helps in the smooth gliding of bones during movement. An injury to the ankle joint may damage this cartilage which cannot repair itself on its own due to its avascular nature (absence of blood supply). Cartilage can be damaged with increasing age, normal wear and tear, or trauma. Damaged cartilage cannot cushion the joints during movement and the joints may rub over each other causing severe pain and inflammation.
Indications for Arthroscopic Ankle Joint Cartilage Repair
Arthroscopic ankle joint cartilage repair is usually indicated for patients when less-invasive treatment options, such as bracing, physical therapy, anti-inflammatory medications, or steroid injections have failed to provide pain relief from cartilage damage. Your physician will typically order a computed tomography (CT) or magnetic resonance imaging (MRI) scan for a thorough analysis of the cartilage damage and determine if surgery is the right option for your ankle cartilage injury.
Arthroscopic ankle joint cartilage repair surgery treats the damaged cartilage and restores normal ankle function by relieving pain and improving joint mobility with a quicker recovery time and fewer complications than traditional surgery (open ankle surgery). This procedure has eliminated or delayed the need, in many patients, to have additional surgeries including total joint replacements or fusions.
Preparation for Arthroscopic Ankle Joint Cartilage Repair
Preparation for arthroscopic ankle joint cartilage repair may involve the following steps:
- A review of your medical history and physical examination is performed to check for any medical issues that need to be addressed prior to the procedure.
- You may also need to undergo diagnostic tests such as blood work to help detect any abnormalities that could compromise the safety of the procedure and imaging of the foot and ankle to plan the procedure.
- You will be asked if you have allergies to medications, anesthesia, or latex.
- You should inform your doctor of current medications or supplements you are taking, or any recent illnesses or conditions you have such as a heart or lung disease.
- Your physician may alter the dosage of your medications or ask you to stop taking certain medications, such as blood thinners for a defined period if contraindicated for the procedure.
- You should refrain from alcohol and tobacco for at least a few days prior to surgery and several weeks after, as these can hinder the healing process.
- You should not consume any solids or liquids at least 8 hours prior to the surgery.
- You should arrange for someone to drive you home after the procedure.
- A signed informed consent form will be obtained from you after the pros and cons of the surgery have been explained.
Procedure for Arthroscopic Ankle Joint Cartilage Repair
Surgical treatment is dependent on the nature and severity of the cartilage damage. In general, arthroscopic ankle joint cartilage repair is performed by a foot and ankle surgeon under general or regional anesthesia and involves the following steps:
- You will be placed on the procedure table in a position that offers the best possible angle for your surgeon to perform the ankle joint cartilage repair.
- Two to three small surgical incisions called portals are made on the front of the ankle, and the joint is inflated with sterile saline solution so that the structures of the joint can be clearly seen with the arthroscope.
- An arthroscope is inserted through one of the portals to provide images of the joint on the monitor for your surgeon to view the inside of your ankle. The entire joint will be inspected to evaluate damage to the cartilage.
- Specialized miniature instruments are then introduced into the joint through other portals to repair the damaged cartilage or stimulate new cartilage growth.
- The most common minimally invasive ankle cartilage repair surgery is called the microfracture procedure in which your surgeon removes damaged cartilage and drills small holes into the ankle bone to stimulate new cartilage growth.
- The other method involves replacement of the damaged cartilage in which the damaged cartilage is entirely removed, and the site is prepared for placing a cartilage graft of donor tissue.
- Once satisfactory ankle joint cartilage repair is confirmed, the scope and the instruments are withdrawn, and the wound is closed with sterile bandages.
Postoperative Care and Recovery
In general, postoperative care instructions and recovery after arthroscopic ankle joint cartilage repair will involve the following steps:
- You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anesthetic reactions and monitor your vital signs as you recover.
- The treated ankle will be immobilized with the help of splints and a bulky dressing. You are advised not to bear weight on the ankle for at least 6 weeks and use crutches for walking.
- You may notice pain and swelling in the ankle area. Swelling and discomfort can be managed with prescription pain medicines, applying ice packs, and elevating your ankle above heart level while resting.
- Antibiotics may also be prescribed to address the risk of surgery-related infection.
- An individualized physical therapy regimen will be started once you are off crutches to strengthen your foot and ankle muscles and optimize joint function.
- Instructions on surgical site care and bathing will be provided to keep the wound clean and dry.
- Refrain from strenuous activities for at least 6 months. A gradual increase in activities is recommended, with your doctor’s guidance.
- A periodic follow-up appointment will be scheduled to monitor your progress.
Benefits of Arthroscopic Ankle Joint Cartilage Repair
Some of the benefits of arthroscopic ankle joint cartilage repair over traditional open ankle surgery include:
- Smaller incisions
- Minimal muscle trauma
- Smaller scars
- Minimal blood loss
- Lower risk of infection
- Less postoperative pain
- Shorter hospital stay
- Faster recovery
- Lower risk of complications associated with open surgery
Risks and Complications
Arthroscopic ankle joint cartilage repair surgery is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:
- Postoperative pain
- Damage to surrounding structures
- Stiffness or restricted joint motion
- Blood clots or deep vein thrombosis (DVT)
- Adverse reactions to anesthesia