[Value of arthroscopy in the treatment of upper ankle arthritis].

OBJECTIVE

The purpose of this retrospective study was to evaluate arthroscopy in upper ankle osteoarthritis.

METHODS

In the period from 1988 to 1997, 358 arthroscopies of the upper ankle joint were performed in 178 cases due to arthritis. Of 132 accessible patients, 124 replied to our questionnaire: 90 (73%) of the responders underwent clinical examination 94 (37-152) months following the initial arthroscopy and were graded according to the score of Evanski and Waugh. All arthroscopies were performed under fluid filling using anterolateral and anteromedial approaches. In only five cases was the posterior compartment additionally investigated. Generally, neither tourniquet nor mechanical joint distraction were applied.

RESULTS

Of a total of 12 (6.7%) complications, only 3 (1.7%) hematomas needed surgical revision. One hematoma was due to an arteriovenous fistula treated by double ligation. All complications including five hypesthesias were temporary and subsided spontaneously. The 124 patients of the questionnaire group assessed the result of arthroscopic surgery as excellent in 11%, good in 46%, fair in 22%, and poor in 21%. Of all patients, 22% required further surgery of the upper ankle: in 9% further arthroscopy, in 3% arthrodesis, and in 10% microsurgical denervation. The total range of motion increased from 10/0/40 degrees (extension/flexion) preoperatively to 15/0/44 degrees at the follow-up examination. The Evanski score improved significantly (p<0.001) from 41 to 76 points.

CONCLUSION

Due to minimal invasiveness and low risk of complications, arthroscopy is recommended for the following indications of upper ankle osteoarthritis: focal arthrosis, limited range of motion caused by osteophytes, soft tissue impingement, corpora libera, and synovitis. Severity and extent of upper ankle arthritis, range of motion, pain, local bone and soft tissue quality as well as the age, physical activity and compliance of the patient concerned are decisive for the individual therapeutic protocol. Alternative surgical techniques in upper ankle osteoarthritis are assessed such as denervation, distraction arthroplasty, correction osteotomy, ankle arthrodesis and total ankle replacement.