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The minimally invasive surgical technique is being applied in new ways by podiatric foot and ankle surgeons to relieve different ankle problems, including ligament damage, bone chips and recurrent pain from end-stage arthritis.
An arthroscope is a tubular instrument with a lighted tip that's inserted through a small incision. The arthroscope projects an enlarged image on a monitor screen, allowing the surgeon to see inside the joint to diagnose and treat problems.
Arthroscopy has been used for about 25 years and was first used for knees, says Dr John Stienstra, a podiatric foot and ankle surgeon at the Permanente Medical Group in Union City. Over the years, arthroscopy instruments have become smaller and techniques improved.
Stienstra started doing ankle arthroscopy in the mid-1980s when that type of procedure was considered experimental.
Arthroscopy has a number of benefits compared with conventional surgery in treating damaged ankles, including eliminating the need for large incisions.
"To do anything in a joint requires that you are able to get in there, see what you're doing and manipulate tissue. The clear advantage to arthroscopy is that you do much less tissue damage in order to accomplish the work," Stienstra says.
For example, arthroscopic surgery can be done through a few small punctures in the skin, compared to having to make a 6-to-7 centimetre incision and possibly having to break a bone to get into a joint, Stienstra says.
Sparing patients from surgical injury and lengthy recovery and rehabilitation time not only saves patients from pain and inconvenience, it also saves them money, Stienstra says.
Patients with ankle damage caused by arthritis or injury can be treated with arthroscopy and resume normal activities in a week or less. That compares to a minimum of six to eight weeks of recovery after open ankle surgery.
One example of the benefits of arthroscopy is fusion surgery, used as a last resort to relieve persistent and debilitating pain in the ankle for patients with end-stage arthritis. Stienstra says arthroscopy improves the success of ankle fusion surgery compared to traditional surgery.
New technologies such as electrothermal and laser probes have expanded the ability of arthroscopy to remove bone chips and repair tissue damage in the ankle.
And in many cases, a severe ankle sprain never heals properly, leaving scar tissue or damaged ligaments and cartilage that can cause periodic pain and swelling.
The arthroscope can first be used to diagnose the problem without having to use invasive surgery. If tissue damage is found, electrothermal and laser probes can be used to treat the damaged areas.
"The beauty of these instruments is that they're small and very manipulative in the sense that you can get in and just vaporise tissue," Stienstra says. "You can get into small nooks and crannies and do things you would not otherwise be able to do."
While arthroscopy is effective and safe, not everyone is a candidate for this type of procedure, says Dr Bruce Werber, a podiatric foot and ankle surgeon.
But if you have chronic ankle problems that haven't responded to treatments like physical therapy or bracing, then arthroscopy may be an option.
"A lot of patients with chronic ankle pain are good candidates for arthroscopy," Werber says.
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