What conditions can it treat? Ankle arthroscopy is a versatile procedure. Common reasons for surgery include:

• Ankle impingement — pinching of soft tissue or extra bone (bone spurs) at the front or back of the ankle, causing pain on movement. This is one of the more common sports injuries of the ankle, and is frequently seen in footballers, runners and dancers.
• Osteochondral lesions — damage to the smooth cartilage surface and the bone beneath it, often after an ankle sprain or fracture.
• Persistent synovitis — inflammation of the joint lining that has not settled with rest, physiotherapy or medication.
• Loose bodies — small fragments of bone or cartilage floating in the joint, which can cause catching, clicking or locking.
• Early ankle arthritis and joint stiffness — to remove inflamed tissue and bone spurs, and to help stage the joint before considering larger procedures such as ankle fusion or total ankle replacement.

What are the benefits?

• Small incisions, minimal scarring and less soft tissue damage than open surgery.
• Usually performed as a day case, so most patients go home the same day.
• Faster recovery and earlier return to work, walking and sport than open surgery.
• Accurate diagnosis, as the camera allows direct inspection of the whole joint.
• Published results are encouraging, with good or excellent outcomes reported in around 85% of patients, depending on the underlying condition.

The operation is usually performed under a general anaesthetic, often combined with a local anaesthetic nerve block around the knee so the ankle stays numb and comfortable for many hours afterwards. In selected cases the procedure can be done with a nerve block and light sedation alone.

Once you are asleep and comfortable:

• The joint is gently filled with sterile fluid to open up the space and give a clear view.
• Two small incisions, each around 5 mm long, are made at the front of the ankle. Occasionally additional small incisions at the back of the ankle are needed, depending on where the problem lies.
• The camera is inserted through one incision and fine instruments through the other. The whole joint is carefully inspected on a screen.
• The problem is then treated: bone spurs are shaved away, inflamed lining is removed, loose fragments are retrieved, and damaged cartilage can be tidied or stimulated to heal (a technique called microfracture).
• The incisions are closed with one or two fine stitches each, and the ankle is wrapped in a well-padded bandage or splint.

General recovery

• First week: rest with the leg elevated above heart level as much as possible (‘toes above nose’). You will usually be in a padded bandage or splint and may walk short distances with crutches, putting weight through the foot as comfort allows.
• 1–2 weeks: the bandage is reduced and the wounds are checked. Gentle ankle movement is encouraged early, which is one of the advantages of keyhole surgery.
• 2–6 weeks: swelling gradually settles; most patients return to a desk-based job within 2 weeks and can drive once they can perform an emergency stop safely (typically 2 weeks for the left ankle, 2–4 weeks for the right).
• 6–12 weeks: physiotherapy builds strength, balance and confidence. Return to impact sport is usually possible from around 6–12 weeks, guided by your progress.

Recovery by condition

• Impingement, bone spur removal or synovitis: weight bearing as tolerated almost immediately; return to sport commonly from 6 weeks.
• Osteochondral (cartilage) lesions treated with microfracture or grafting: a period of protected or non-weight bearing, usually 6 weeks, is needed to allow the new cartilage surface to form, followed by a graded physiotherapy programme. Return to sport is slower, typically 3–6 months.
• Arthroscopy for early arthritis: recovery of comfort can be more gradual, and the procedure is sometimes a staging step before definitive surgery such as fusion or total ankle replacement.

What are the risks? Ankle arthroscopy is a well-established procedure and serious complications are uncommon, but no operation is risk-free. The main procedure-specific risks are:

• Nerve injury (the most important specific risk): small skin nerves run very close to the keyhole incisions. Temporary numbness or tingling over the foot occurs in a small proportion of patients and usually recovers; permanent injury is rare. Overall complication rates in published series range from under 1% to around 9%, and nerve-related problems account for most of these.
• Infection: superficial wound infection is uncommon and usually settles with antibiotics; deep joint infection is rare.
• Persistent swelling, stiffness or incomplete relief of symptoms, particularly where there is established cartilage wear.
• Cartilage damage, fluid leak (sinus formation), blood clots (DVT/PE) and complex regional pain syndrome — all rare but recognised.

A full discussion of the general risks of foot and ankle surgery can be found in our Guide to the Risks of Hindfoot Surgery Patient Leaflet (PDF).

Mr Welck sees private patients across London and North London, with an NHS tertiary referral practice based at the Royal National Orthopaedic Hospital, Stanmore.

• Email: secretary@matthewwelck.com
• Telephone: 07547 395 270
• Hospital: Royal National Orthopaedic Hospital, Stanmore
• Areas served: London & North London

This leaflet is for general information and does not replace individual medical advice. Please contact the practice with any questions about your own care.