Ankle Arthroscopy

Ankle arthroscopy is keyhole surgery of the ankle. A small camera is passed into the joint through an incision usually around 5mm, and the inside of the ankle is viewed on a screen while fine instruments are used through a second small incision to carry out the treatment.

Because the joint is not opened, there is less disruption to the surrounding soft tissues. For many people this means less post-operative pain, a smaller wound and a quicker return to activity than an equivalent open operation.

What is it used for?

Ankle arthroscopy may be recommended for:

• Anterior ankle impingement: Removing bone spurs at the front of the ankle that block movement and cause pain when the ankle bends upwards. Common in footballers and dancers.

• Osteochondral lesions: Treating areas of damaged cartilage and underlying bone, often following a previous ankle sprain or fracture.

• Loose bodies: Removing fragments of bone or cartilage that catch within the joint.

• Synovitis: Removing inflamed joint lining that is causing pain and swelling.

• Scar tissue: Releasing soft tissue impingement following injury.

• Ankle fusion: Where alignment is suitable, a fusion can be performed arthroscopically rather than through an open incision.

• Assessment: Directly inspecting the joint where imaging has not given a clear answer.

When is it not the right operation?

Arthroscopy is not a treatment for established ankle arthritis on its own. Where the joint surfaces are widely worn, keyhole surgery is unlikely to provide lasting relief, and other options such as bracing, injections, fusion or replacement are more appropriate.

It is also less suitable where there is significant deformity requiring correction, or where the soft tissues around the ankle are in poor condition. Careful assessment beforehand matters, and Dr Janan will tell you if arthroscopy is unlikely to help in your case.

What does the operation involve?

The procedure is usually performed as day surgery under general or regional anaesthetic and commonly takes under an hour, depending on what needs to be done. Two or three small incisions are made at the front of the ankle. Most people go home the same day.

Recovery

Recovery depends on what was treated inside the joint:

1. Simple procedures: After removal of a loose body, bone spur or inflamed lining, many people are walking comfortably within one to two weeks and back to most activities by four to six weeks.

2. Cartilage procedures: Where an osteochondral lesion has been treated, weight-bearing is often restricted for around six weeks to protect the healing surface, with return to sport taking several months.

3. Arthroscopic fusion: Follows the longer fusion recovery — protected weight-bearing for around six weeks and solid healing at around three months.

4. All procedures: Some swelling is normal for several weeks and elevation helps considerably. Physiotherapy is used to restore movement, strength and confidence.

Risks

Ankle arthroscopy is generally a low-risk operation, but no surgery is without risk. Possible complications include infection, blood clots, stiffness, ongoing pain, and injury to the small nerves that run across the front of the ankle, which can leave an area of numbness. These are uncommon and will be discussed with you beforehand.

Dr Janan's approach

Dr Janan completed fellowship training in Bristol, a major United Kingdom foot and ankle centre, and in Tokyo under Professor Satoru Ozeki, past president of the Japanese Society for Surgery of the Foot. He uses arthroscopic and minimally invasive techniques where they are appropriate for the problem being treated.

Keyhole surgery is not automatically the better option in every situation, and part of the assessment is determining whether it is the right approach for your ankle or whether an open procedure would give a more reliable result.