Ankle Arthroscopy

IndicationAnkle Arthroscopy




Pain / Stiffness / Locking


- exclude OCD

Assess syndesmosis





Osseous lesions / Tibiotalar impingement spurs

Osteochondral defects

Anterolateral impingement lesions (soft tissue)

Loose bodies


Ankle Scope Loose BodyAnkle Scope Loose Body 2





Set up



- supine on table

- tourniquet



A.  Assistant provide traction

B.  Foot traction halter

C.  Skeletal distracter


Ankle Arthroscopy Traction



- standard knee scope or

- 2.7mm 30° scope

- small scope better for getting across joint line without chondral damage




Ankle distended first

- 20 ml syringe, normal saline

- anteromedial

- insert needle, move ankle

- if on bone and needle moves, on talus and need to redirect proximally

- if on bone and needle doesn't move, on tibia and need to redirect inferiorly

- insufflate with 15 mls to create anterior space



- usually want instrumentation on side of pathology

- exception is anterior spurs

- usually large osteophyte laterally so first portal insert medially


Ankle Scope Medial and Lateral PortalsAnkle Superficial Peroneal Nerve



- lateral to peroneus tertius

- can then transilluminate and avoid saphenous nerve on AM portal

- structure at risk is branches SPN

- Just proximal to joint line

- incision in skin only

- blunt dissect down to capsule

- insert blunt trochar

- aim anterior to joint to create space



- second portal

- medial to tibialis anterior

- structure at risk is G saphenous vein and saphenous nerve

- use transillumination to avoid

- insert and visualise needle

- skin incision, blunt dissection

- insert shaver, again anteriorly

- clear soft tisse until can visualise joint line

- beware anterior tendons and nerves




1.  Inspect anterior talus

- plantarflex foot

- look for chondral lesions


2.  Inspect distal tibia

- look for osteophytes


3.  Inspect gutters


A.  Medial


Ankle Arthroscopy Medial GutterAnkle Scope Medial GutterAnkle Scope Medial Gutter


B.  Lateral

- exclude meniscoid lesions


Ankle scope lateral gutterAnkle Scope Lateral Gutter


4.  Look across joint

- distract

- insert probe or shaver and use as level

- look at tibial plafond and syndesmosis


Ankle Arthroscopy Lateral GutterAnkle Scope Talar Dome


5.  Inspect syndesmosis

- probe and assess stability


Ankle scope syndesmosisAnkle scope syndesmosis 2


6.  Inspect posterior joint line


Ankle Scope Posteromedial CapsuleAnkle scope posterior capsule laterally


Posterior Ankle Arthroscopy


Posterior ankle arthroscopy



- just lateral to tendo achilles

- medial to fibular

- 1.2-1.5cm above tip of fibula

- sural nerve & vein anterior

- remember joint 1cm higher at back


Subtalar Arthroscopy


Subtalar arthroscopy




Nerve Injury




Anterolateral portal - SPN

Anteromedial portal - Saphenous

Posterolateral portal - Sural

Anterocentral - Deep Peroneal

Posteromedial - Posterior Tibial


Minimise by

1.  Marking of skin prior to arthroscopy

2.  Transillumination to visualise nerves

3.  Feel nerve 

4.  Use of blunt dissection


Mechanism injury

- penetration

- neural structures close to capsule

- anterior penetration by chondrotome may injure DPN

- traction device

- pins in talus and calcaneus may injure sural nerve




Compartment syndrome

- From extravasation of fluid into calf


Articular cartilage damage






Pseudoaneurysm AngiographyPseudoaneurysm MRI