ORTHOPEDICS

Arthroscopy of the ankle

Our orthopedic team led by Dr. Milan Milošević has been successfully performing ankle arthroscopy for many years
ANTHROSCOPY OF THE ANKLE

What is ankle arthroscopy?

Am I a candidate for this type of treatment?


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Ankle arthroscopy, or arthroscopy as such, is a type of surgery that has experienced a major boom in recent decades. Modern medicine prefers a minimally invasive approach with as little trauma per patient as possible, and arthroscopy allows for just that – maximum effect with minimal damage. It is about the so-called “One-day surgery”, where the patient is discharged for home treatment only a few hours after the surgery. At the same time, potential complications of this type of treatment are few and extremely rare, and the postoperative recovery is significantly shortened, which makes this type of treatment especially popular among young people and athletes. It is not only about the surgery of the future, but also, judging by the number of performed procedures and the constant improvement of various performance techniques, about its present. Medicine can proudly say – the future is at the door!


Anatomyof the ankle


When we refer to the ankle in colloquial speech, we are talking about the joint that connects the lower leg region and the foot region and one of the key parts of the trigger system. The joint itself actually consists of three different smaller joints, whose basic functions and range of motion are connected to each other, allowing the ankle joint to function properly as a whole. The smaller joints that make up the ankle are:

  • The talocrural joint (articulatio talocruralis), also called the upper ankle joint, is the articulated whole of the lower leg (tibia) ,ankle (talus) and represents the most important part of the overall ankle as a joint.
  • The subtalar joint (articulatio subtalaris), also called the lower ankle joint or talocalcaneal joint, plays an extremely important role in positioning the foot on the ground, providing much-needed stability in the joint itself, and is the joint of the ankle and heel bone.
  • The lower tibiofibular joint (articulatio tibiofibularis inferior) is an articulated whole of the lower parts of the leaf and tibia


Due to the large number of components, each of which can function as a separate whole, in humans, the evolution of the joint has developed several mechanisms that allow their adequate interaction. First of all, here we mean the strong ligament-tendon organ, which holds a large number of ankle components in place, allowing for proper function and range of motion. At the same time, due to the large forces acting on the joint itself (weight bearing), a thick layer of cartilage tissue is present in the upper ankle joint, which has the role of absorbing static-dynamic forces acting on the ankle. range. The most important ligaments responsible for stabilizing the ankle joint as a whole are:

  • Deltoid ligament (ligamentum deltoideum) – located on the medial(inner) side of the foot, consists of most of the bundles of ligament tissue and gives maximum stability to the joint by fixing it on its inner side. The strongest is the ligament of the ankle joint. It extends from the medial maleolus (a bump on the inside of the ankle) and spreads fan-shaped all over the inside of the joint, catching up in as many as four different places.
  • Anterior and posterior talofibular ligament – together with the calcaneofibular ligament form a whole that provides stability on the lateral(outer) side of the joint. Although it is an extremely strong ligament, its ability to absorb abnormal movements is weaker than that of the deltoid ligament, which is why most traumatic ankle injuries occur by turning the foot “inward”. Most patients refer to this situation when they say “I stepped wrong”.
  • Calcaneofibular ligament – strengthens the connection between the heel and the fibula and together with the previously mentioned talofibular ligaments stabilizes the ankle from the outside.


Clinical picture and diagnostics


Ankle arthroscopy is a type of ankle surgery that is mostly used to relieve symptoms and treat disorders such as ankle osteoarthritis, surgically removing formations that have led to osteoarthritis (cartilage defects), as well as formations resulting from the development of arthrosis (bone defects). called osteophytes), then in the reconstruction of the ankle ligaments, for the purpose of rinsing the ankle in case of suspected intra-articular infection and sometimes, although extremely rare lately, exclusively for the purpose of diagnosing diseases and injuries of the ankle. The later use of arthroscopic technique is used extremely rarely today mostly due to advances in radiological diagnostics and the development of new imaging technologies, which is why it is extremely rare that the cause of illness or injury cannot be confirmed except in this way.

The most common indication for arthroscopic ankle surgery is arthritic changes in the joint itself. Due to the specificity in the structure and function of the joint (primarily the function of bearing the complete body weight of a person), the cartilage in this joint is extremely susceptible to damage. If the damage is frequent, and the capacity of the cartilage for self-renewal is insufficient to repair the damage, the first signs of joint degeneration occur.

We mentioned earlier that the basic role of cartilage is amortization in the interaction of the bones that make up the joint. If the cartilage did not exist, every time they stood on their feet, due to the direct collision of two bones and the great friction that would occur between them, which would prevent their mutual “sliding”, not only would they have extremely little, almost no mobility in the ankle itself, they would already suffer truly unimaginable pain just as they stood on their feet. Needless to say, any additional movement in the form of walking would be practically impossible. From this data we can conclude how important the function of cartilage tissue is, not only in the ankle, but also in all joints in the body, and how important it is to maintain the continuity of cartilage structure.



People with more extensive acute cartilage damage, such as those caused by major ankle trauma, as well as people with chronic cartilage damage who have already had initial degenerative changes, very often present with similar symptoms, most often dominated by pain, swelling, and decreased range. movement in the joint. It is important to note that in a large number of cases, acute cartilage damage, most often due to an unrecognized condition and inadequate treatment, will progress to chronic cartilage damage. Likewise, in the case of ankle trauma, the development of chronic cartilage damage is possible, although initially there was no major acute damage!

Ankle traumas, which we see almost constantly on a daily basis, and which include various forms of ankle sprains (when a person “steps wrong”), can lead to distension (stretching), partial rupture or total rupture of ligaments that stabilize the joint itself. Due to the lack of stabilizing function of the damaged ligament, pathological movement occurs in parts of the joint itself, which can ultimately lead to cartilage damage. If the damaged ligament is not adequately treated, this pathological movement from the anomaly will become commonplace and will eventually lead to extensive cartilage damage and symptoms of osteoarthritis.

Diagnosis and indication for ankle arthroscopy are made on the basis of anamnesis, thorough clinical examination and radiological processing in the form of AP, LL or oblique images of the ankle, where X-rays can clearly identify arthritic changes of the ankle (narrowed joint space, subchondral sclerosis, cystic bone changes, existence of osteophytes). Additionally, magnetic resonance imaging can be very useful in making a diagnosis, which can indicate the existence of hidden cartilage deformities invisible to X-rays.


SURGICAL TREATMENT

Preparationfor ankle arthroscopy


It is important to come to the procedure on an empty stomach. If the procedure is scheduled in the morning, it is best not to consume any food in the evening before the procedure. It is allowed to drink water, although not immediately before the procedure. Arthroscopic ankle surgery is performed under local anesthesia, which means that you are awake during the entire procedure and you are free to communicate with the operator, who will kindly answer all your questions. Likewise, if you do not want to hear or see anything, you can request headphones and enjoy the music of your choice for the duration of the operation.

Before the procedure, you will undergo a detailed examination by our anesthesiologist, all in order to ensure the best possible outcome of the procedure. Before the operation, the operator will explain the whole procedure in detail and show you what we expect from the procedure itself.

Given the measures prescribed by the Civil Protection Headquarters of the Republic of Croatia, before the procedure it is necessary to perform PCR testing based on nasopharyngeal swabs for the presence of SARS CoV-2 virus.



SURGICAL TREATMENT

The course of ankle arthroscopy


Once you are comfortably seated on the operating table, a local anesthetic is applied. Once the anesthetic begins to act, sterile washing and covering the operative field follows.

During the procedure, two smaller holes are made on the inside and outside of the ankle, on average no larger than 5 mm, which allow the operator to visualize the inside of the joint and modify pathological structures. A camera is inserted through one hole, while an instrument is inserted through the other hole, located on the opposite side, to perform surgical treatment. The instrument that is introduced is usually a type of grinder, which removes excess synovial membrane of the joint, removes bone defects (osteophytes) that limit the range of motion in the joint and repairs and removes any cartilage tissue defect. It is important to “smooth” the cartilage during the operation, so that the joint regains its original function.



RECOVERY

Postoperative recoveryand rehabilitation


After the arthroscopy is over, you stay in our day hospital for a few hours on postoperative observation, after which you are discharged for home treatment. After the operation, the surgeon will provide you with detailed information about the course of the operation as well as give you instructions for further treatment and recovery. 24 hours after the operation, a control examination and dressing follow.

Globally, it is important to mention that arthroscopy, compared to open surgery, carries much fewer potential complications, while its advantages in terms of shorter recovery time, smaller incisions and minimal chances of developing infection are quite prominent.

Risks after arthroscopy include bleeding, damage to local nerves, infection, reaction to an anesthetic, while potential complications that should be reported to a doctor include increased physical activity. temperature, fertilization of the operative field, redness of the skin around the incision, pain that intensifies in the days after surgery, tingling and swelling in the leg, change in skin color compared to the other leg and the difference in temperature of one foot compared to the other (cold).



The operation is followed by rehabilitation, which usually lasts from three to six months, depending on the condition of the joint, although the possibility of shorter or longer treatment is not excluded, since no joint is the same. In our Polyclinic we offer you the possibility of complete static-dynamic rehabilitation and physical therapy with our physiotherapists and kinesiologists. Additionally, in order to increase the chances of a good outcome, surgical treatment can be combined with conservative methods such as platelet rich plasma, which we apply in the treatment of various orthopedic conditions for more than 15 years in a row. Our experts will provide you with the best conditions for treatment and recovery. Contact us with full confidence.

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In short


Polyclinic Ribnjak is a unique institution in the Republic of Croatia. It unites different branches of medicine, all in order to stay true to its slogan “Health and Beauty. Together”. Orthopedics, advanced sports diagnostics, functional and kinesiological rehabilitation, cosmetic surgery and treatments are the services we provide on a daily basis, professionally and in accordance with the latest professional standards.






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