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mahadevan
consultant foot and ankle surgeon
What is an arthroscopy?
Arthroscopy is a surgical technique for looking inside the joint or cavity with a small telescope (“keyhole surgery”). When the telescope is used to inspect the inside of a tendon sheath to treat tendon disorders, it is called tendoscopy. It is normally performed under general anaesthetic (you are asleep) and allows a good view of the joint or cavity and small operations can be carried out through it. It is particularly useful in the diagnosis and treatment of cartilage and ligament problems of the ankle.
The aim of arthroscopic / tendoscopic surgery is to correct or assess the mechanical problems. The surgeon is able to confirm the nature of the injury and may be able to remove or repair the damaged part whilst causing minimal disruption to the joint. In some cases, surgery will not be able to reverse the damage which has already occurred. In the majority of cases the speed of your recovery will be dictated by the degree of damage and how well you can rehabilitate your ankle.
What are the benefits of arthroscopy / tendoscopy?
The keyhole technique of arthroscopy / tendoscopy has a lower risk of complications than traditional surgery and usually results in less pain after the procedure, a shorter hospital stay and a quicker recovery (this will be variable dependent on what procedure is undertaken).
Common findings during arthroscopy/ tendoscopy:
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Articular cartilage damage (osteochondral defect)
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Inflammation of lining of joint or tendon (synovitis / tenosynovitis)
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Bone spurs
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Arthritis
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Tendon tear / instability
Osteochondral defect
Synovitis
Normal peroneal tendons
Inflammation around tendon
Common procedures performed during arthroscopy / tendoscopy:
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Removal of bone spurs (cheilectomy) (see images below)
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to reduce impingement pain and improve movement
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Removal of loose bodies (loose cartilage / bone fragment)
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to reduce 'catching / locking' sensation
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Cartilage debridement and microfracture (see videos below)
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to reduce pain by stimulating exposed bone to fill cartilage defect
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Synovectomy (removal of inflamed tissue)
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to reduce pain and inflammation
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Video showing cartilage defect in big-toe joint
Video of microfracture on cartilage defect. Take note of release of bone marrow products (bone marrow stimulation) to encourage scar-cartilage formation
Aftercare and FAQs
You will usually be able to go home when you feel ready. You will need to arrange for someone to drive you home. You should try to have a friend or relative stay with you for the first 24 hours.
Wound care - Your ankle will be bandaged. Arthroscopy keyhole incisions are about half a centimetre long and are usually closed with a single stitch. The stitches should be removed 12 – 14 days after the operation either at your GP practice or in clinic. In most circumstances, the bandage should be kept on until your stitches are due to be removed.
Walking - You will need to rest your ankle for the first two to three days after your arthroscopy and try to keep your leg elevated as much as possible to prevent swelling. You will be able to walk on the day of your surgery unless advised otherwise. You may mobilise freely around the house but long walks or standing for long periods should be avoided. You may need to use a stick or crutches for a few days (or longer, dependent on the type of surgery performed).
Work - Depending on your job you may return to work after a few days. If you have a sedentary job you should be able to return to work within 7 days. If your job is physical and involves climbing and squatting, you may need to stay off work for up to 2 weeks. More complex procedures will require longer periods of being off work.
Driving - You will not be able to drive for 1 to 3 weeks following surgery (depending on nature of operation). However, if you drive an Automatic and it was your LEFT side that was operated on; then you may start short drives 2 days following surgery. It is advisable to check the terms of your car insurance to ensure your cover is valid, as some policies state that you must not drive for a specific time period after an operation.
Flying after surgery - It is generally recommended to wait at least four to six weeks to fly after any lower limb surgery. It may be possible to fly on short-haul or domestic flights at an earlier time, but you should always check with your GP or surgeon. Always consult your doctor, your health insurance provider and the airline you are flying with before making your flight reservation.
What are the surgical risks?
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Infection
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Nerve damage – causing numbness and painful scar
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Deep vein thrombosis (DVT) and pulmonary embolism (PE) – blood clots in the vein or lungs – rare
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Swelling
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Residual or recurrent pain
It is beyond the scope of this document to list rarer risks (less than one in a thousand) but I will be very happy to discuss any worries about specific concerns and also about any family history or your past health problems. If there is anything you do not understand or if you have any questions or concerns, please feel free to discuss them with me.