Arthroscopy of the ankle
General
Arthroscopy of the Ankle includes the endoscopic diagnosis of this joint by inspecting all joint structures using the keyhole technique.
Only small incisions are necessary to insert the required instruments into the ankle. The arthroscopy of the ankle is used more and more often for therapy and only less often for pure diagnostics because of the many possible uses Magnetic resonance imaging largely fulfills this task.
construction
Arthroscopy of the ankle joint is an invasive procedure for visualizing the ankle joint cavity and the structures there and, compared to open surgery of the ankle joint, for example, offers the advantage of less pain after the procedure.
In arthroscopy of the upper ankle joint (Articulatio talocruralis) can with cartilage coated distal articular surfaces of the Tibia (Shin), of the Fibula (Fibula) and the upper articular surface of the Talus (Ankle bone) be assessed.
In addition, the Outer and inner bands as well as the front and the rear Syndesmosis tape can be viewed and assessed.
The lower ankle is divided into an anterior (Articulatio subtalaris) and a rear joint chamber (Articulatio talocalcaneonavicularis) divided.
The two chambers are bound by the talus-calcaneus ligament (Interosseous talocalcaneum ligament), which can also be viewed in the arthroscopy.
The articular surfaces of the Navicular bone (Scaphoid), the lower articular surfaces of the talus (Ankle bone) and the anterior articular surfaces of the calcaneus are assessed. At the bottom of the anterior joint chamber is the acetabular ligament covered with cartilage, which can also be seen in the arthroscopy.
In the posterior joint chamber, the upper joint surface of the calcaneus and the posterior joint surface of the talus articulate with one another. The joint capsule of the lower ankle is reinforced by various ligament structures.
The pathological changes in the joint cavity of the ankle found by arthroscopy do not necessarily have to correlate with the symptoms or functional limitations of the patient.
indication
If that MRIImage of the ankle joint is ambiguous, an arthroscopy of the ankle joint can be performed for purely diagnostic purposes.
A Arthroscopy of the ankle joint can also be used for therapy, since during the procedure there is the possibility of instabilities of the ankle joint, for example due to damaged Tendons or Tapes to repair.
Free joint bodies can be fastened, diseases and damage to the cartilage can be treated and inflamed, purulent joints flushed become.
Another possible use is in diseases of the synovial membrane as well as in a arthrosis of the ankle. Arthroscopy of the ankle is increasingly used due to its wide range of therapeutic options.
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Athletes (joggers, soccer players, etc.) are particularly often affected by diseases of the foot. In some cases, the cause of the foot discomfort cannot be identified at first.
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Arthrosis ankle
Arthroscopy of the ankle is indicated, for example, in cases of osteoarthritis of the ankle.
Arthrosis in the ankle is caused in a large number of cases by a previous one Fracture injurythat healed in a deformity.
Does the so-called "Twist“In the ankle joint not only to an injury to the ligamentous apparatus, but also to one Dislocation fracture of the Malleole fork, osteoarthritis of the ankle joint can result.
After a fracture of the heel bone, malpositions can gradually lead to osteoarthritis of the lower ankle joint after the bone has healed.
In the case of fractures in the area of the ankle joint, care must therefore be taken to ensure that the fragments involved are correctly positioned.
Arthrosis of the ankle joint does not only affect older patients, but can of course also occur without a previous injury due to normal signs of aging of the cartilage and joint surfaces. Patients with osteoarthritis of the ankle often complain of pain Climb stairs or Go uphill.
The painful restriction of movement worsens over time, so that an accompanying malalignment can develop in the ankle.
procedure
Ankle arthroscopy is performed in either general anesthetic or in regional anesthesia carried out.
In consultation with the surgeon and the anesthetist, the appropriate anesthetic method is selected for the respective patient.
The procedure is performed in the operating room under sterile conditions. It is possible to inspect only the upper ankle or only the lower ankle, a combination is also possible. The upper ankle becomes about twice as often subjected to arthroscopy like the lower one.
The arthroscopy of the ankle is done after applying a Tourniquet began. The tourniquet is necessary to prevent blood from escaping from small vessels in the operating area, as this blood would significantly restrict the view.
Since the ankle is very tightly spaced, a distraction (Pull apart) of the lower leg and foot.
This distraction can be done manually or with weights.
Two small incisions are made in the front of the ankle to insert the instruments.
A blunt guide rod is inserted into one of the two access points through which the camera is inserted into the joint.
The second access route serves as a working channel for instruments. Due to the keyhole technique used, muscles and tendons are not injured, but pushed aside by the instruments, which significantly reduces the complication rate compared to open operations.
It may be necessary to create additional access routes for instruments; these are either also located on the front of the ankle or are attached to the rear side. The camera transmits the images from the ankle, so the surgeon can always see where he is and which structures he is working on with the instruments.
During the arthroscopy of the ankle, the surgeon identifies the pathological structures and, if necessary, treats them by inserting suitable instruments through the working channel.
The examiner identifies, for example Cartilage damage in the entire ankle and analyzes this with regard to congenital malpositions or previous injuries. If the surgeon detects excessive growth of Mucosal changes or offshoots, he can remove them.
Torn or loosened band structures can be fixed or sewn. The arthroscopy of the ankle takes 30-60 minutes, depending on the therapeutic intervention, and in many cases it can be performed on an outpatient basis.
Risks
Arthroscopy can be performed under local anesthesia and is relatively low-risk. Of course, due to its invasiveness, arthroscopy should only be used in patients for whom this procedure is absolutely necessary.
Aftercare
After the arthroscopy is one Full load in principle possible, but the patient should take it easy in the two weeks after the procedure and Avoid heavy loads.
Pain can be reduced from taking Painkillers be alleviated. The doctor may prescribe partial loading of the ankle, physiotherapy or thrombosis prophylaxis.
The prognosis depends on the underlying disease and cannot be generally predicted.
