Ankle arthrodesis using the arthroscopic technique.

OBJECTIVE

Fast, safe and reliable ankle fusion through minimally invasive technique.

INDICATIONS

Painful ankle arthritis unresponsive to conservative treatment.

CONTRAINDICATIONS

Severe axial malalignment of ankle. Significant anteroposterior talar translation. Extensive bone defect.

SURGICAL TECHNIQUE

Standard anteromedial and anterolateral arthroscopic portals. Excision of all anterior hypertrophic synovium using a soft-tissue shaver. Removal of anterior osteophytes with a motorized arthroscopic abrader (burr) to get better access to the joint. Removal of the remaining ankle cartilage using a sharp curette. Superficial opening of the subchondral bone with a motorized burr and deeper opening with an osteotome. Without arthroscopy but under image intensification, ankle fixation in neutral position by inserting two (or three) 6.5-mm cancellous lag screws from the tibia (medial and lateral) into the talus.

POSTOPERATIVE MANAGEMENT

Partial weight bearing (15 kg) with a removable boot for 6 weeks. Then, first radiologic follow-up and in the presence of evidence of consolidation, full weight bearing with the boot for additional 2-4 weeks.

RESULTS

Between September 1998 and February 2003, 28 arthroscopic ankle arthrodeses were performed. 23 ankles (82%) showed definite radiologic evidence of consolidation at 6 weeks postoperatively; patients were allowed to bear full weight without any consequences. All patients except two (93%) showed complete ankle fusion at their last radiologic follow-up at 1 year. Both patients with absent fusion were smokers; one of them was asymptomatic (stable fibrous union) and the other's ankle finally fused after surgical revision with open technique and bone grafting.