Ankle Arthroscopy: An Update

A number of evidence-based arthroscopic techniques have been advocated to treat ankle pathology, including ankle instability, impingement, osteochondral lesions, and end-stage osteoarthritis. For anterior ankle arthroscopy, one technique that has gained favor involves insertion of the arthroscope with no distraction of the ankle and with the ankle in dorsiflexion to prevent damage to the anterior structures. Subsequent distraction can assist with visualization of the middle and posterior portions of the ankle joint while paying attention to avoid any damage to the articular cartilage. Hindfoot endoscopy is recommended for posterior ankle abnormalities. Complications can be minimized by the surgeon's sound knowledge of ankle anatomy and a systematic surgical approach. Ankle instability can be complex and involve the deltoid and lateral collateral ligaments. The understanding of ligamentous pathology is evolving. Careful inspection of the ligaments during arthroscopy will allow the surgeon to better understand the instability pattern present and treat it accordingly by open or arthroscopic techniques. Newer diagnoses within instability include microinstability and rotational instability. The role of arthroscopy for managing patients with the recently described diagnoses of rotational instability and microinstability of the ankle needs further investigation.