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Jay Crary, MD
Orthopedic surgery, Rebound Orthopedics
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Ankle sprains are one of the most common sports-related injuries. Literally
millions occur in the United States each year. During a sprain, the ligaments
holding the ankle in place are injured. The joint itself can also be damaged. In
mild sprains the ligaments are just stretched, while in severe sprains they are
completely torn.
Although most sprains usually heal in 2-6 weeks, occasionally the pain and
even instability persists long beyond that time. Poorly healed ligaments and
subtle injuries to the cartilage and bone of the ankle joint may be the cause of
persistent problems. Surgery may be necessary to alleviate these symptoms.
Procedures to address a painful and unstable ankle have improved
significantly in recent years. Utilizing advanced imaging techniques, such as
MRI, a more definitive diagnosis is able to be made prior to needing a surgical
procedure. This also allows a more specific and detailed operative plan.
Arthroscopic surgery of the ankle, in which a camera and instruments are
inserted into the joint through small incisions, has improved dramatically as a
result of developments in techniques and instrumentation specifically for
smaller joints such as the ankle. The procedure may involve removing scar tissue
from an inflamed joint. Or, it may smooth injured cartilage and bone to
encourage new fibrocartilage to form, recreating a smooth joint surface.
Ligament repair may also be required.
In rare situations where disabling pain and failed
previous interventions limit a patients function, a piece of bone and cartilage
from the knee is transplanted to the ankle (OATS
procedure
) in order to prevent the joint from
having to undergo a fusion.
The appropriate treatment course depends not only on the type of problem, but
on the patient’s goals. Education and appropriate, timely interventions
ensure that each patient will have the best chance of restoring his/her function
and quality of life.
Arthroscopy is a surgical
procedure by which the internal structure of a joint is examined for diagnosis
and/or treatment using a tube-like viewing instrument called an arthroscope.
Arthroscopy was popularized in the 1960s and is now commonplace throughout the
world. Typically, it is performed by orthopedic surgeons in an outpatient
setting. Usually performed in the outpatient setting, patients most often return
home after the procedure.
The technique of arthroscopy involves inserting the arthroscope, a small tube
that contains optical fibers and lenses, through tiny incisions in the skin into
the joint to be examined. The arthroscope is connected to a video camera and the
interior of the joint is seen on a television monitor. The size of the
arthroscope varies with the size of the joint being examined.
If procedures are performed in addition to examining the joint with the
arthroscope, this is called arthroscopic surgery. There are a number of
procedures that are done in this fashion. If a procedure can be done
arthroscopically instead of by traditional surgical techniques, it usually
causes less tissue trauma, results in less pain, and may promote a quicker
recovery.
For what diseases or conditions is arthroscopy
considered?
Arthroscopy can be helpful in the diagnosis and treatment
of many noninflammatory, inflammatory, and infectious types of arthritis
as well as
various injuries within the joint.
Noninflammatory degenerative arthritis, or osteoarthritis
, can be
seen using the arthroscope as frayed and irregular cartilage. Bone spurs and injured
cartilage can be removed using the arthroscope..
In inflammatory arthritis, such as rheumatoid arthritis
, some patients with isolated chronic joint swelling can
sometimes benefit by arthroscopic removal of the inflamed joint tissue (synovectomy).
The tissue lining the joint (synovium) can be biopsied and examined under a microscope
to determine the cause of the inflammation. Arthroscopy can
provide more information in situations which cannot be diagnosed by simply
aspirating (withdrawing fluid with a needle) and analyzing the joint fluid.
Common joint injuries for which arthroscopy is considered include cartilage
tears (meniscus tears), ligament strains and tears, and cartilage deterioration
underneath the kneecap (patella). Arthroscopy is commonly used in the evaluation
of knees and shoulders, but can also be used to examine and treat conditions of
the wrist, ankles, and elbows.
Finally, loose tissues, such as chips of bone or cartilage, or foreign
objects, such as plant thorns, that become lodged within the joint can be
removed with arthroscopy.
OATS procedure
In patients who don’t get pain relief from the arthroscopic surgery, there
are other, more advanced treatment options available. The most common advanced
procedure involves transferring cartilage and bone from your own knee joint, to
the damaged area.
This procedure is known as an osteochondral autograft transfer, or OATS
procedure. The OATS procedure can be an extensive operation, and often requires
cutting through a part of the tibia bone to gain access to the ankle
joint.
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