Scope it out!

December 17, 2010
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Last week we reviewed the topic of Post-Traumatic Osteoarthritis.  We defined the condition of PTOA as an arthritic condition that occurs within a joint sometime after the joint has been injured.  Proper realignment of the initially injured joint helps to cut down on the occurrence and progression of PTOA, but sometimes it is inevitable!

There are several injuries, specific to the lower extremity that are infamous for causing PTOA, and they are as follows:

–          Ankle fractures: PTOA in the ankle joint

–          Heel bone fractures: PTOA in the Subtalar joint (the joint just below the ankle)

–          Midfoot fractures: PTOA within the joints across the middle of the foot

This week, I wanted to focus on Arthroscopy as a treatment modality for PTOA in the ankle joint, following an ankle joint fracture. Arthroscopy is a procedure that utilizes a small camera to access and view the joint on a larger monitor, while allowing the surgeon to “scope” the joint and remove debris from the joint space.  The end result and goal of Arthroscopy is to decrease the patient’s joint pain secondary to PTOA and to allow the joint to glide more easily through its typical range of motion.

When you suffer from PTOA, the joint becomes clouded with debris coming in the form of lose cartilage pieces, or in the form of synovitis.  Synovitis describes inflammation of the “joint synovium;” a.k.a. the joint fluid that helps with easy gliding of the joint surfaces.  Each of these components leads to painful range of motion in patients, thus eliminating or decreasing their presence within the joint space, through Arthroscopy, can be very beneficial!

The joint will be prepared with a distraction device, meaning an external device will be applied to both your leg and foot, with a gentle pull placed on each side, to increase the ankle joint space.  This allows for easier insertion of instruments and for better visualization of the joint damage, so that debris is not missed during the procedure.

Local anesthetic will be injected into the ankle joint, with continual sterile saline flushing through the joint space during the procedure.  The saline is important to create a “fishbowl-like” appearance of the joint, essentially floating the pieces of debris inside the joint that might otherwise adhere to the joint surfaces making it difficult to remove them.

The typical approach to Ankle Arthroscopy is from the front of the leg through two small incisions, measuring about 1cm in length.  A camera will be inserted into one of the incisions entering the ankle joint capsule.  In the other incision, a small cannula (hallow tube) will be inserted, which can be used to feed surgical instruments into the joint, helping to clear debris.  A small ‘burr’ is the typical instrument of choice used by surgeons performing these procedures.  The burr rotates back and forth eating debris as it is moved around the joint.  Envision Pac-Man!

Post-operatively you will have two sutures in place, one over each of the small incision sites.  Depending on surgeon preference, you will be placed in am immobilization device and will be required to remain non-weight bearing until your first follow-up appointment.  Physical therapy is often initiated in patients who undergo Ankle Arthroscopy to help strengthen the muscles surrounding the ankle joint while improving joint function and getting you back on your feet, with range of motion to the ankle joint that is much less painful than prior to your “scope!”

There are risks to any procedure, although the risks of arthroscopy are minimal and rare.  However, you should discuss all options for treating your Ankle Joint PTOA with your Podiatrist prior to any surgical intervention.

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