Anterior ankle arthroscopy: state of the art

Abstract

Increased sports and recreational activity levels have caused a rise in ankle injuries associated with trauma and overuse, requiring orthopaedic management. In athletes, 40% of all injuries consist of ankle and foot injuries. The incidence of residual problems ranges from 20% to 30%. Over the past decade, arthroscopic surgery of the ankle has developed as a minimally invasive alternative to open surgery for a broad range of indications. Whereas open surgery requires a long period of rehabilitation and possible plaster cast immobilisation, arthroscopic surgery enables patients to recover in a shorter period of time and to start functional exercises within a week of surgery. The aim of this article is to discuss anterior ankle arthroscopy with regard to the diagnostics prior to the intervention, the techniques, complications and pitfalls, any regional or geographical differences, and future directions. Open surgery is more frequently replaced by arthroscopic surgery. The number of indications which are treated arthroscopically is rising. The main indications for anterior ankle arthroscopy are ankle impingement, osteochondral and chondral defects, joint instability, synovitis and severe cartilage degeneration. To perform adequate arthroscopic surgery, knowledge of anatomy, diagnostics, ankle pathology and surgical techniques are required. Preoperative planning and correct use of diagnostic tools increase the chance of success. If conservative treatment fails, surgery is often the treatment of choice. Depending on the location of the ankle pathology, an anterior approach can be used. Some surgeons prefer a combined anterior and posterior approach depending on the indication for surgery. Since techniques have improved over time, complication rates have dropped. Geographical variation exists in techniques for anterior ankle arthroscopy. In Europe and Asia, surgeons use the dorsiflexion method, whereas in the USA the non-invasive distraction method is widely used. Arthroscopy as a diagnostic tool has been abandoned for a variety of reasons. A diagnosis must be made before the arthroscopic procedure is performed. Currently, there is need of patient-specific guided implants. In the near future, more dedicated ankle instruments will come on the market. These will be sized and shaped to accommodate the specific contours of the ankle and subtalar joint and take the limited joint space into account.