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.