Ms Julie Kohls
Consultant Orthopaedic Surgeon
Part of the group
information to guide your decision making about treatment & to help you plan your recovery
Ankle
Arthroscopy
Ankle Soft Tissue Impingement-
Debridement of Scar Tissue
Scar tissue can form inside the ankle joint following an ankle sprain. The scar tissue and also the lining inside the ankle joint can then become trapped or pinched by the bone surfaces of the joint (impingement). When the extra soft tissue is 'pinched' there can be very sudden extreme pain that makes a patient feel the ankle is about to give way.
Osteochondral Lesions (OCLs)-
Debridement of OCL and Microfracture
An osteochondral lesion is a small area of bone and cartilage that has lost its blood supply. Osteochondral lesions can become loose and detach from the ankle. Also OCLs can develop a fluid filled cyst under the cartilage which places pressure on the bone.
Bony Impingement -
Arthroscopic Cheilectomy
Over time large lumps of bone can form along the edges of the ankle joint. The bone can form due to arthritis, impact sports such as football or due to a longstanding ligament injury. The extra bone can trap soft tissue in between it and pinch it.
Ankle Arthroscopy
What exactly is key hole surgery on the ankle?
Key hole surgery is another name for an arthroscopy. During an ankle arthroscopy the surgeon looks inside the ankle joint.
Two instruments (about the thickness of a biro) are inserted into the ankle. One of the instruments is a small camera. The other instrument allows the surgeon to treat problems found within the ankle joint.
Key hole surgery is an excellent way of removing anything that has formed in the ankle that should not be there.
The surgeon can remove:
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Scar tissue from inside the joint
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Loose cartilage/bone to stimulate healing (Micofracture of OCL)
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Extra bone which is blocking joint movement (Cheilectomy)
What can I expect on the day of surgery?
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The surgery will normally be under a general anaesthetic.
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Normally this is a day surgery case (unless the ankle arthroscopy is part of a bigger surgery).
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I will numb the ankle with local anaesthetic so that you will be comfortable when you wake.
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There will be a big bandage on your ankle which you will later remove
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You will be given crutches
When can I drive?
The best guide that you are safe to return to driving is that you are able to walk well without crutches. The usual time scale also depends on whether you had surgery on your right or left foot and whether you drive a manual or an automatic
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Right side and all car types: 2-3 wks
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Left side and manual car: 2-3 wks
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Left side & automatic car: 1 week
What are the risks and complications?
The vast majority of patients do extremely well. A small group of patients need extra physio due to swelling or stiffness. Rare complications include infection, blood clots (DVT), nerve damage, tendon injury & failure to improve.
How long should I take off work?
You will need to be at home for two weeks. Many patients do some work from home via a laptop and emails but a break from commuting to work is a must!
The Recovery after Ankle Arthroscopy
What are my Weight bearing Instructions?
Soft tissue Debridement >> Weight bear as Tolerated
Cheilectomy >> Start Touch Weightbearing- progress as able
OCL Debridment >> Touch Weight bear for 2 weeks
Instructions for the first two weeks
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Elevate Leg Above Heart
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Keep dry for two weeks
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Reduce outer dressing at 48 hrs & apply tubigrip
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Keep Adhesive dressing intact
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Ice Ankle (Wrap ice in towel) for 15 minutes each time. Do this every few hours
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Physio Exercises: Get your ankle moving! Do the following every waking hour 10-15 times
A) Alternate the ankle between dorsiflexion and plantarflexion
B) Alternate the ankle between inversion and eversion
C) Draw the Alphabet with your big toe. This will encourage the ankle to move in all directions.
D) Seated Calf Raise
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Sit in a chair
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Lift your heel as far as possible while keeping your toes on the floor.
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Repeat 10 x
AT 2 WEEKS
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I will arrange to have your sutures removed and to check your wound
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You will then be able to wash the ankle
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You should schedule your first physiotherapy session for 2 weeks
PHYSIOTHERAPY 2-6 WKS
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Continue to work on range of motion but progress to towel or standing stretches
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Contrast bathing,
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Wound massage (self) for 3 months
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Local modalities to reduce swelling
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Start to work on strengthening
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Theraband Resistance
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Cycling on stationary cycle
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Progressing to double heel rises
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Swimming, Hydrotherapy
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Start some early proprioception (balance) work by standing on skipping rope to create a slightly uneven surface
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Progress to the Surrey Stages to Strengthen Ankle
THE ‘SURREY STAGES’ PHYSIOTHERAPY STRENGTHENING PROGRAM
BRONZE AWARD
DOUBLE HEEL RISES (DHR)
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You can go up and down on tiptoes in sets of 3, slowly and 15 reps in each
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You can stand on a skipping rope and adjust your foot position
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You can hold a DHR for 15 seconds
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It can be difficult to progress to the next award level because the ankle will take double the weight when you move to lifting the good leg to lower only on the operated leg.
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You are better to stay at the bronze award level but to add in a back pack with increasing weight as you feel ready for more
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When you have done this for some time you will be ready to progress to the silver award level
SILVER AWARD
DOUBLE HEEL RISES WITH A LIFT
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May need to add weight in backpack on DHR to reach silver level
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You go up on both feet but lift unoperated leg and lower slowly only on operated leg
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3 sets, working up to 15 reps in each
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You can stand both feet on a wobble board
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You can hold a solid DHR for 20 seconds
GOLD AWARD
SINGLE HEEL RISES
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3 sets, working up to 15 reps in each
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You can stand on one foot on wobble board
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You can hold a solid DHR for 40+ seconds
PLATINUM AWARD
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Progress to hopping in all directions
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Double Hops
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Gentle jogging to reintroduce running