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Arthroscopy of the Foot & Ankle

Indications for Diagnostic Ankle Arthroscopy  Indications for Operative Ankle Arthroscopy
1.  Persistent post-traumatic disorders
2.  Arthritis
3.  Non-specific synovitis 
4.  Osteochondritis dessicans and osteonecrosis of the talus
5.  Joint evaluation prior to some ligamentous reconstruction procedures
1.  Chondral lesions
2.  Osteoarthritis
3.  Impingement exostosis
4.  Meniscoid lesions of the ankle
5.  Chronic lateral instability of the lateral collateral ligaments
6.  Septic arthritis
7.  Rheumatoid synovitis
8.  Post-traumatic synovial impingement

Positioning &

A good joint distraction allows up to 5 to 10mm of joint opening.  With increased joint opening there is less chance for operative complications and lessens the need for accessory portals.  

Several positioning alternatives exist: 

  • supine position
  • supine with the leg hanging dependent over the edge of the table
  • supine with a bolster under the hip to internally rotate the ankle into a neutral position. 

Distraction methods may either be non-invasive or invasive: 

Non-invasive methods applies force by traction onto the skin. A sterile commercially produced strap is applied with one loop at the heel and one loop over the dorsum of the midfoot. This strap is then attached using a velcro strap to a sterile bar attached to the operative table. The velcro strap allows easy variation of distraction force during the case.

Invasive distraction involves pins placed proximal and distal to the joint. This can cause direct neurovascular injury & traction nerve injury.  

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