Dr. Samir Pilankar is an Ankle Arthroscopy specialist in Mumbai. Contact us for An Ankle arthroscopy to fix the harm to the ankle.
About Ankle Arthroscopy
Usually, ankle arthroscopy is indicated after failure of conservative measures, such as physical therapy, NSAIDS, ankle braces, heel lifts, or wedges. It is also indicated in cases in which symptoms persist and study results are inconclusive.
- Osteochondral loose body
- Anterior impingement
- Synovitis
Operative Details
Ankle Distraction
This provides better visualization of the joint and of structures otherwise poorly seen, such as the posterior talofibular ligament, flexor hallucis longus tendon, and calcaneofibular ligament. Dr. Pilankar does not prefer distraction pins but uses a distraction device attached to the operating table by straps.
Tourniquet
A sterile tourniquet is usually applied on the leg just above the ankle. However, the ankle joint distention with the irrigation fluid may be enough to provide a bloodless field and is sufficient in some cases.
Arthroscopy Pump
A high inflow and outflow system is helpful in obtaining hemostasis; it permits improved visualization and irrigation of debrided material; and it can be adjusted throughout the operative procedure.
Arthroscopy Portals
The 2 most commonly used anterior portals are the anteromedial and anterolateral. The anteromedial portal is placed just medial to the anterior tibial tendon at the joint line. The anterolateral portal is placed just lateral to the peroneus tertius tendon. This is at the level of, or slightly proximal to, the joint line.
Posterior portals and transmalleolar portals may be needed in exceptional circumstances.
Dr Samir Pilankar will help you for Ankle Arthroscopy in Mumbai
Arthroscopy Portals
Surgical Technique
Debridement includes the removal of the inflamed synovium, thickened adhesive bands, inflamed capsular bands and ligamentous tissue, osteophytes, and loose bodies. Debridement is performed to expose the underlying cartilage (see Image above).
Bony spurs causing impingement are shaved using arthroscopic burrs and shavers. Extreme caution is necessary when using these instruments; never direct them dorsally into the soft tissues, to prevent injury to the neurovascular structures.
Osteochondral lesions of the talus that are located anterolaterally can be approached through the anterior portals for curettage and for microfracture or drilling. Lesions that are located posteromedially can be visualized by plantarflexion of the ankle. If a direct approach is required for antegrade or retrograde drilling, a microvector drill guide is used to establish a transosseous portal.
Preparation of surfaces for arthroscopic ankle arthrodesis requires thorough denudation of all hyaline cartilage exposure of vascular subchondral bone. In addition, multiple puncture holes in the prepared surfaces allow easy vascular ingress across the surfaces to be fused.
After completion of the arthroscopic procedures, the joint is thoroughly irrigated with the remaining fluid expressed out of the joint. The portals are closed using absorbable sutures and are covered with sterile gauze and soft, bulky dressing.
Postoperative Details
A posterior splint is applied for comfort and to allow the portals to heal. Patients are instructed to keep the limb elevated and exercise the toes, knees, and hips. Cryotherapy can help minimize and reduce the postoperative swelling.