Ankle Arthroscopy - Ortosom · 2007-04-03 · Ankle Arthroscopy Symptoms of chronic ankle pain that...
Transcript of Ankle Arthroscopy - Ortosom · 2007-04-03 · Ankle Arthroscopy Symptoms of chronic ankle pain that...
PAULO ROCKETT, M.D.
Porto Alegre Brazil
AnkleArthroscopy
Ankle sprains are among the most
common injuries in sports and at work.
Between 20 and40% of patients
treated withconservative
therapy may haveresidual problems.
Ankle Arthroscopy
Articular injurySoft tissue impingementBony impingementSome types of fractures (mild displacement)
indications
SynovitisLoose bodies and
osteophytesChondromalaciaOsteochondral lesions
of the talus
Ankle Arthroscopy
Ankle Arthroscopyindications
May also be used for:
Ankle stabilizationArthrodesis
Ankle ArthroscopyAuthor’s techniquePatients are placed in supine positionLeg is secured in midportion with the leg-holder
Noninvasive joint distraction
Establish portals -dull disection
Cannula system
Ankle ArthroscopyportalsAnterior
AnterolateralAnteromedial
Anterocentral
Ankle ArthroscopyportalsAnterior
Ankle ArthroscopyportalsPosterior
PosterolateralTrans-Achilles tendonPosteromedial
Ankle ArthroscopyportalsPosterior
Ankle ArthroscopyportalsTransmalleolar
MedialLateral
Ankle Arthroscopycomplications
Damage to neurovascular structures and tendonsChondral injuriesSynovial fistula
Anterior bony impingement (arthritic conditions, loose bodies and fractures)Anterolateral soft tissue impingement (synovitis or scar tissue)Osteochondritis dissecans
Ankle Arthroscopy
Pain on forced dorsiflexionX-Rays confirm exostoses
Ankle Arthroscopyanterior bony impingement
PrePos
Tibia
Talar neck
Osteoarthritis of the ankleOsteophytes of anterior lip of the tibiaOsteophytes at the talar neckChondral lesion of the talar dome (tram track)Loose bodies
Ankle Arthroscopyanterior bony impingement
Excision of exostoses (tibial and talar neck)Distraction is essential in avoiding injury to the talar articular surfacePartial synovectomyAbrasion or drilling of chondral lesion (tram track)
Ankle Arthroscopyanterior bony impingementtreatment
History of sprain and pseudo-instabilityPain and tenderness anterolateral jointPain with eversion and dorsiflexionPositive response to local injectionMRI has minimal benefit
Ankle Arthroscopyanterolateral soft tissue impingement
Injuries to lateral capsuleTorn anterior ligaments (tibiofibular, talofibular)Synovitis or scar tissue that becomes trappedbetween bony structuresMay erode lateral talar dome ridge
Ankle Arthroscopyanterolateral soft tissue impingement
Partial synovectomyDo not resectcapsuleDo not resectremained ligamentChondrectomy –talar dome ridge
Ankle Arthroscopyanterolateral soft tissue impingementtreatment
Ankle Arthroscopyosteochondritis dissecans
PainCatchingGrindingIntermitentswelling
Ankle Arthroscopy
Stage I, II or III (Berndt and Hartyclassification) with persistent symptoms afteran adequate nonoperative therapy ( up to 3 months) would benefit with arthroscopy.Stage IV should be treated surgically.
osteochondritis dissecans
Ankle Arthroscopyosteochondritis dissecans
Removal of loose bodiesCurettage or drillingFixation (>2cm)
Ankle Arthroscopy
Symptoms of chronic ankle pain that had failed to respond to conservative treatment for
at least 6 months.
method37 patients
Ankle Arthroscopy
Sex! 11 women! 26 men
Age: !minimum 13 y.o.!maximum 81 y.o.
method37 patients
Follow-up: ! minimum 2 years! maximum 10 years! average 6 years
Ankle Arthroscopymethod 37 patients
6Osteochondritis dissecans (OCD)
Bleeding
Ankle Arthroscopymethod 37 patients
3Post ankle fracture
Ankle Arthroscopymethod 37 patients
3Post ankle fracture
Chondromalacia IV grade
Ankle Arthroscopymethod 37 patients
3Post ankle fracture
Debridement and abrasion
Ankle Arthroscopymethod 37 patients
2Osteoarthritis and chondromalacia
Ankle Arthroscopymethod 37 patients
7Anterior bony impingement
Ankle Arthroscopymethod 37 patients
7Anterior bony impingement
Osteophyte
Ankle Arthroscopymethod 37 patients
4Loose bodies
Ankle Arthroscopymethod 37 patients
4Loose bodies
Ankle Arthroscopymethod 37 patients
4Loose bodies
Flexion Extension
Ankle Arthroscopymethod 37 patients
14Anterolateral soft tissue impingement
Ankle Arthroscopymethod 37 patients
14Anterolateral soft tissue impingement
Ankle Arthroscopymethod 37 patients
1Artrhroscopic subtalar arthrodesis
Indicated for instability(neuropathic conditions)
Ankle Arthroscopymethod 37 patients
1Artrhroscopic subtalar arthrodesis
Ankle Arthroscopymethod 37 patients
1Artrhroscopic subtalar arthrodesis
Pre
Post
Ankle Arthroscopyresults 37 patients
3%
3%
46%
48%
1Poor
1Fair
17Good
18Excellent
Improvement in: pain, swelling, stiffness, activity and instability
Ankle Arthroscopy
36 patients benefited in some way fromthe procedure1 patient with degenerative joint diseasehad the worst result
results 37 patients
Improvement in: pain, swelling, stiffness, activity and instability