Arthroscopic-assisted ankle arthrodesis: A surgery simplified

APME-323; No. of Pages 3

Arthroscopic-assisted ankle arthrodesis: A surgerysimplified

Raju Vaishya a,*, Vipul Vijay b, Gyanendra Kumar Jha c,Amit Kumar Agarwal b

a Senior Consultant, Department of Orthopaedics, Indraprastha Apollo Hospital, New Delhi 110067, IndiabConsultant, Department of Orthopaedics, Indraprastha Apollo Hospital, New Delhi 110067, IndiacClinical Fellow, Department of Orthopaedics, Indraprastha Apollo Hospital, New Delhi 110067, India

a p o l l o m e d i c i n e x x x ( 2 0 1 5 ) x x x – x x x

a r t i c l e i n f o

Article history:

Received 30 September 2015

Accepted 7 October 2015

Available online xxx

Keywords:

Ankle

Arthrodesis

Arthroscopy-assisted

Complications

Minimal invasive

a b s t r a c t

Ankle arthrodesis is a salvage procedure for end-stage ankle arthritis. Arthroscopic-assisted

ankle arthrodesis is a novel technique over open methods, as it is a minimally invasive

procedure with insignificant blood loss, rapid union, less chances of infection, and soft tissue

complication rates. We describe our experience of special surgical technique of arthrodesis

of ankle using arthroscopy and also discuss technical tips and pearls for the procedure.

# 2015 Indraprastha Medical Corporation Ltd. Published by Elsevier B.V. All rights

reserved.

Available online at www.sciencedirect.com

ScienceDirect

journal homepage: www.elsevier.com/locate/apme

1. Introduction

Ankle arthrodesis is an established procedure for end-stagearthritis of ankle.1 Arthroscopic-assisted technique of arthrod-esis has many advantages over open methods, being aminimally invasive technique.2,3,4

2. Surgical technique

Firstly, the arthroscopic surgery is done in the supine position(under tourniquet) using a 308, 4.5 mm telescope. Distension ofankle joint is done using pressure bags, throughout the

* Corresponding author. Tel.: +91 9810123331.E-mail address: raju.vaishya@gmail.com (R. Vaishya).

Please cite this article in press as: Vaishya R, et al. Arthroscopic-assistedx.doi.org/10.1016/j.apme.2015.10.001

http://dx.doi.org/10.1016/j.apme.2015.10.0010976-0016/# 2015 Indraprastha Medical Corporation Ltd. Published by

procedure. An anteromedial portal (medial border of tibialisanterior tendon) and antero lateral portal (lateral to peroneustendon) are used (Image 1). After making a general survey ofthe ankle joint, thorough joint debridement is done byremoving all the loose articular cartilage (Image 2), osteo-phytes, loose bodies, and fibrous tissue using motorisedshaver and a radio-frequency coablator. Hard burned boneis roughened using a burr until bleeding bone is exposed(Image 3). The ankle joint may require manoeuvring (i.e.,plantar flexion, varus, valgus) during surgery to reach todifferent parts of joint. After completing debridement andshaving of the joint surfaces, the arthroscope is removed andankle is maintained in a neutral position (908), 5–108 valgus and5–108 of external rotation.

d ankle arthrodesis: A surgery simplified, Apollo Med. (2015), http://

Elsevier B.V. All rights reserved.

Image 1 – Clinical photograph showing the position of theanteromedial (white arrow) and anterolateral portal (yellowarrow).

Image 2 – Arthroscopic image showing the use of burr forroughening of sclerotic bone.

Image 3 – Final arthroscopic view of the ankle joint showingthe bleeding bone after debridement.

Image 4 – Fluoroscopic image showing the guidewires beingpassed in a criss-cross manner under images control fromtibia towards the talar dome.

Image 5 – Fluoroscopic image showing the cannulatedcancellous screws being inserted over guidewires toachieve compression across articular surfaces.

a p o l l o m e d i c i n e x x x ( 2 0 1 5 ) x x x – x x x2

APME-323; No. of Pages 3

Please cite this article in press as: Vaishya R, et al. Arthroscopic-assistedx.doi.org/10.1016/j.apme.2015.10.001

Under image intensifier, two percutaneous guidewires arepassed from the tibia to the talar, done in a criss-cross fashion(Image 4). After drilling and tapping, 7.0 mm cannulatedcancellous screws (16 mm thread) are put over guidewires(Image 5). A below knee cast is given for six weeks.

3. Discussion

Arthroscopic-assisted ankle arthrodesis is a minimally inva-sive procedure with insignificant blood loss, rapid union, andlesser chances of infection and soft tissue complications. It is,however, not a suitable procedure in the presence of severedeformity and significant bone loss, which requires bonegrafting.

d ankle arthrodesis: A surgery simplified, Apollo Med. (2015), http://

a p o l l o m e d i c i n e x x x ( 2 0 1 5 ) x x x – x x x 3

APME-323; No. of Pages 3

4. Learning points/take home message

1. End-stage ankle arthritis can be effectively managed withankle arthrodesis.

2. Arthroscopy-assisted ankle arthrodesis decreases the inci-dence of wound complications, morbidity and results inearlier recovery postoperatively.

3. This technique for arthroscopy-assisted ankle arthrodesiscan be easily performed without the use of any specialinstruments like ankle distractor.

Conflicts of interest

The authors have none to declare.

Please cite this article in press as: Vaishya R, et al. Arthroscopic-assistedx.doi.org/10.1016/j.apme.2015.10.001

r e f e r e n c e s

1. Cottino U, Collo G, Morino L, et al. Arthroscopic anklearthrodesis: a review. Curr Rev Musculoskelet Med.2012;5:151–155.

2. Winson IG, Robinson DE, Allen PE. Arthroscopicankle arthrodesis. J Bone Joint Surg Br. 2005;87(B):343–347.

3. Stone JW. Arthroscopic ankle arthrodesis. Tech Foot AnkleSurg. 2002;1(September (1)):2–7.

4. Elmlund AO, Winson IG. Arthroscopic ankle surgery. FootAnkle Clin. 2015;20(March (1)):71–78.

d ankle arthrodesis: A surgery simplified, Apollo Med. (2015), http://