Ankle arthroscopy: indications, preparation, counterparts
Ankle arthroscopy is a modern manipulation, which is used for the diagnosis of diseases and their treatment. This operation is minimally invasive, i.e. not a carrier of severe complications for the patient. It also means a brief period of rehabilitation after manipulation.
The first studies of the joints using arthroscopy began in the 1920-ies. The invention of the arthroscope business is owned by a Japanese scientist. I must say that this study was a breakthrough in the field of surgery of the joints. This manipulation is currently replaced a number of complex operations, which had many complications.
Indications and contraindications for arthroscopy
These include the following:
- Inflammation of the tendons.
- Intra-articular body, leading to the blockade of the joints.
- Deforming arthrosis in the initial stages of the disease.
- Various cartilage defects.
- Fractures of the ankle.
- Articular instability.
Contraindications include lesions of the skin in the place of operation, a serious condition of the patient, the inflammatory process in the periarticular tissues.
In the appointment of arthroscopy, many patients are literally terrified, because they have let small, but the operation. Some are afraid of the fact of intervention, others get scared before anesthesia, and still others don’t want to permanently drop out of the usual rhythm of life because of the recovery period.
In this case, you should look for alternatives, but they may not always be a full replacement.
One option is arthrotomy, which is an open surgery on the joint. In this case, the risks of complications are much larger, and recovery longer.
There is also a group of non-invasive diagnostic methods, which include x-ray, CT, MRI, ultrasound. Their advantage is that they do not require special training, painless and require no recovery period. But, on the other hand, they may not always present a full picture of pathological processes in the joint. In addition, these procedures are only diagnostic, but not therapeutic.
Access to the ankle joint
There are five accesses: three front and two rear. They are used in various combinations depending on the goals of the operation.
Access to carefully designed, proven operations and are not dangerous!
The primary front access is perednezadny. It applies to any arthroscopy of the ankle. In the implementation prednimustine access may damage the terminal branches of the saphenous nerve, which comes from the femoral. If arthroscopy is performed through prednazanacheny access, there is a possibility of damaging the peroneal nerve and the tibial artery.
From posterior only recommended posteroexternal. For the most complete exploration of the joint is sufficient anterolateral approaches.
With the patient is mandatory clarifying conversation in which the attending physician and the anesthesiologist explain the course of the operation, warned about the possible consequences.
The patient must undergo a pre-operative examination, which includes:
- General analysis of blood and urine.
- Tests for HIV, hepatitis.
12 hours before the procedure you cannot eat or drink. This is important for subsequent anesthesia. Also it is recommended to perform an enema before surgery. Still need to buy crutches. Often they need immediately after surgery.
Method of operation
As with any invasive procedure, arthroscopy is performed under anesthesia. Apply wire or a spinal type of anesthesia. The limb of interest is fixed in the joint region of the middle third of the tibia. Next, handle the operational field and begin the operation.
Arthroscopy, as with any surgical intervention, performed in the operating room in compliance with the rules of asepsis and antisepsis.
To access the joint use anterolateral approaches. Simultaneously, the assistant surgeon needs to make a distraction of the joint space, i.e., its tension. First, inspect the front, then the rear parts of the ankle. Be sure to assess the condition of the bones forming the joint, ligaments, small joints, synovial pockets.
If there is the initial phenomenon of deforming arthrosis, carried out ablatio. In the case of foreign bodies in the joint, make their removal.
Complications after arthroscopy
The procedure is characterized by low traumatism. Unfortunately, sometimes complications in the form of:
- Damage due to broken tools.
- Blood accumulation in the joint.
- Damage to the nerves.
- Development of adhesions and scarring.
- Violations of the movements in the joint.
I must say that complications are very rare when performing this procedure, they are recorded less frequently than in 1% of cases.
After the surgery, the recovery period may take quite a long time, depending on the type of intervention. Usually after arthroscopy rehabilitation lasts from two weeks to several months.
In order to speed up the healing process, you need to follow some rules:
- Immediately after the surgery in the joint area is administered antibiotics.
- The limb must be immobilized.
- A few days the patient will have to wear a compression garment to reduce motor activity.
- Prohibited hot baths or hypothermia.
Rehabilitation after arthroscopy is a useful therapeutic exercise (physical therapy). The basic rule – reasonable and measured load. For the first time after the operation should use extra support during walking. Use a cane or crutches. Do not neglect them even when moving around the apartment. An active load should not to give to foot for several months after the intervention.
The first time, especially in the case of the hard intervention the past, it is possible to use a passive gymnastics. In this case, the other person kneads the operated leg of the patient with a special technique.
Physiotherapy is one of the most effective methods for recovery after difficult operations, which allows to avoid many complications.
Physical therapy is used mainly to relieve swelling, to reduce pain and to accelerate recovery. The load is chosen individually for each patient. Usually the exercises consist of movements to flexion-extension of the foot. Later joined by rotational motion. Further, there are exercise bikes, active the UPS-downs the stairs.
In conclusion, we can say that arthroscopy is a modern, efficient, replacing open surgery method. He characterizes not only a great diagnostic accuracy, but the option of carrying out of medical manipulations while its low invasiveness. Although modern medicine can offer patients the choice of methods of diagnosis and treatment, arthroscopy cannot be replaced by any other method.