73 - Ankle Arthroscopy Flashcards
Anatomy involved in ankle arthroscopy
Anatomy involved in ankle arthroscopy
- Surface
- Neurovascular
- Tendon
- Osseous
- Ligamentous
- Capsular
Portals for ankle arthroscopy
- Definition: portals are the incisions which allow us to insert a camera and instruments
- ***Anteromedial (COMMON ) = just medial to anterior tibial tendon
- ***Anterolateral (COMMON) = just lateral to peroneus tertius tendon
- ***Anterocentral (not a go-to for ankle arthroscopy due to neurovascular compromise – very specific location between hallucis and digitorum tendons)
- Posteromedial
- Posterolateral
- Accessory
- ** KNOW THIS: OVER 90% of your arthroscopies can be done with an anteromedial and anterolateral portal **
Indications for ankle arthroscopy
- 25% of all diagnostic cases provide benefits (due to joint capsule insufflation which breaks up adhesions)
- When there is absence of a diagnosis in a symptomatic ankle
- To evaluate chronic pain
- Trauma or non-traumatic
Traumatic indications of ankle arthroscopy
- Limited ROM
- Loose bodies
- Intra-articular adhesions
- Post fracture evaluation
- Osteochondral or chondral impingement
- Exostosis
Non-traumatic indications of ankle arthroscopy
- Neoplastic lesions – rare
- Metabolic disease – gout, etc.
- Infection (i.e. septic joint)
- Fusions (arthroscopic – not as common as open)
- Stabilizations (for lateral ankle joint sprains)
Contraindications of ankle arthroscopy
- Local skin infection or systemic infection
- If you have an infection within the joint, it is an indication (i.e. spetic joint)
- Ankylosis (no joint space – bone on bone means you can’t get instruments into the joint)
- DJD with joint space narrowing
Advantages of ankle arthroscopy
- Early ROM
- Less morbidity Vs. Open surgery
- Less post-op recovery Vs. Open surgery
- No ligament damage
- Cost (often cheaper, less OR time, less rehab needed, less time off work, etc.)
Non-invasive ankle distraction
- “Uncontrolled” method using either gravity or force
- “Semi-controlled” method using Guhl device - No more than 30# (135N) can be applied, Recommended that you relax every 30-40 minutes
- Dowdy et al - This study showed that nerve conduction can be reduced within 1 hour of non-invasive ankle distraction – need to be careful and follow rule of relaxing every 30-40 minutes
Invasive ankle distraction indications
o Noninvasive ankle distraction was inadequate
o Ex-fix with controlled distraction
Invasive ankle distraction contraindications
o RSD (reflex sympathetic dystrophy – a form of regional pain syndrome)
o Open Physis (kids)
o Osteopenia
o Infection
Disadvantages for invasive ankle distraction
o Risk of neurovascular damage
o Pin site infection
o Pin Failure
o Stretching of Ligaments (ligamentous disruption)
o Inability to manipulate ankle positioning
Instrumentation for ankle arthroscopy
- Scope (long camera which gets inserted into joint with a strong light source)
- Light Source
- Camera
- Monitor
- Recorder (to record images, or do a video)
- Cannula (metal tube which slides into incision and into joint which creates a pathway for insertion of the camera and instruments)
- Trochar(long spikes that slide into the canula)
- Obturator (rounded spike that slide into the cannula)
- Hand Instruments
- Power Instruments
NOTE: BE PREPARED FOR AN OPEN ARTHROTOMY
- Really big pet peeve of his
- Things can happen in surgery that change the plan of action
- You need to be prepared to open the joint
- There may be a piece of cartilage or bone that is too big to come out through the cannula or an instrument breaks and needs to be opened up to retrieve it
Principles of arthroscopy TEST QUESTION ***
- Pistoning-Increases or decreases magnification (moving the scope in and out)
- Rotation-Allows for an oblique view (rotate to increase field of view with angled scope)
- Sweeping (sweep from medial to lateral or lateral to medial to visualize entire joint surface)
- Triangulation (knowing where things are in space in relation to your hands – by looking at screen – a type of proprioception – your mind knows where you are without looking)
- There is a huge learning curve for arthroscopy because you do not look at the foot – you look at the screen
Arthroscopic ankle procedures
- Synovectomy (removing scarred, thickened, hypertrophic synovial lining of joint capsule)
- Chondroplasty (removing pieces or bits of cartilage that have flaked off)
- Abrasion Arthroplasty (using an abrator to get rid of any soft spots in the cartilage, subchondral bleeding leading to fibrocartilage – not as resilient as hyalin cartilage, but better than nothing)
