Ankle arthroscopy is keyhole surgery. A small camera and fine instruments are passed into the joint through incisions of a few millimetres, so the cause of persistent ankle pain can be seen directly and, in most cases, treated in the same operation.
When an ankle still hurts, swells or catches months after a sprain, the problem often lies inside the joint. Arthroscopy is a way to reach it without a large incision.
What is ankle arthroscopy?
An arthroscope is a camera about the width of a pencil. Two small portals are made, one for the camera and one for instruments, and the image is magnified on a screen. The joint is gently expanded with fluid so the cartilage, ligaments and joint lining can be examined in detail.
Anterior arthroscopy treats problems at the front of the ankle. Posterior (hindfoot) arthroscopy is used for structures at the back, such as an os trigonum or the flexor hallucis longus (FHL) tendon.
Which conditions can be treated with ankle arthroscopy?
- Anterior ankle impingement from bone spurs or scar tissue
- Posterior ankle impingement and os trigonum
- Osteochondral (cartilage) lesions of the talus
- Loose fragments of bone or cartilage inside the joint
- Ligament repair in chronic ankle instability
- Assessment and release of scar tissue after a fracture
- Long-standing ankle pain without a clear cause on scans
What symptoms suggest a problem inside the joint?
Deep pain that does not settle weeks after a sprain, swelling after walking or sport, a catching or locking feeling, and pain at the front of the ankle when you squat or climb stairs are the most common. Not every one of these needs surgery. The first step is an accurate diagnosis.
How is the problem diagnosed?
Assessment begins with your history and a careful examination of the painful area, range of motion, ligament stability and foot alignment. Weight-bearing X-rays come next, because some problems only show when the foot is loaded. MRI shows cartilage, ligaments and tendons, and a CT scan is used when the bone structure or the size of a lesion needs a closer look.
Can it be treated without surgery?
Many of these conditions are first managed without an operation: adjusting activity, anti-inflammatory medication, physiotherapy, balance and strengthening exercises, an ankle brace when needed, and suitable footwear. Surgery is considered when symptoms continue despite a few months of proper treatment, or when there is a mechanical problem such as a loose body or a bony spur that blocks movement.
What happens during arthroscopic surgery?
The operation is usually done under regional or general anaesthesia. The whole joint is inspected first, then the specific problem is addressed:
- Removing bone spurs and thickened tissue that cause impingement
- Taking out loose fragments
- Debridement, microfracture or cartilage repair for cartilage lesions
- Arthroscopic repair of the outer ankle ligaments in selected patients
- Removing an os trigonum and releasing the FHL tendon through posterior arthroscopy
Because the incisions are small, there is less damage to the soft tissues, and recovery is often more comfortable than after open surgery. Every operation still carries its own risks, and these are discussed in detail at your consultation.
What is recovery like, and when can I return to sport?
Recovery depends on what was done. After a simple impingement clean-out, most people walk with support within a few days. If cartilage or ligaments were repaired, a protective boot and limited weight-bearing may be needed for the first weeks.
Physiotherapy is a central part of recovery. Return to sport is planned step by step once you can walk without pain, have full movement and have regained strength. This usually takes a few weeks after simple procedures and a few months after cartilage or ligament repair, and it varies from person to person.
Frequently asked questions
How soon can I walk after ankle arthroscopy?
It depends on the procedure. After a simple clean-out, most patients walk with support soon after surgery. After cartilage or ligament repair, a boot and crutches may be needed for a while.
My MRI is normal but the pain persists. Do I need arthroscopy?
MRI does not show everything; impingement and small cartilage injuries can be missed. The decision rests on examination findings and how long symptoms have lasted. Arthroscopy is not always the first option.
Will there be a scar?
The incisions are a few millimetres long and usually fade over time, although this varies with skin type.