The current status of ankle arthroscopy Introduction
Burman in 1931 brought three pins using a sheath 4.Omm without distraction, he found it too tight for good viewing. Arthroscopy of the ankle really matured in the 90s with the development of 2.5mm arthroscopes, distraction techniques and non-invasive irrigation systems.
Historical Evolution
Tagak was the true father of the arthroscope. He has developed a 2.7 mm arthroscope. However other issues Watanabe developed to produce a self-focusing 1.7mm arthroscope and ankles arthroscoped 28, describing the standard portals and normal anatomy.
Andrews wrote one of the many texts on the subject in the late 80s. Guhl developed a decoy skeleton of the ankle and has written an excellent text.
Yates was the first to develop a noninvasive technique of distraction.
Pros and cons-indications
BENEFITS
Arthroscopy allows direct assessment + joint inspection of the ligaments and synovial change. We can perform stress testing during surgery.
The following diagnoses can be made. OCD - 23.5%, Impingement - 21.3%, Chrondromalacia - 7.9%, unstable - 7.2%, DJD - 7.2%, acute fracture - 6.5%, Arthrofibrosis - 4.8 %, foreign bodies, osteophytes, synovitis, bones, Torn ATFL, cryptogenic pain, cyst, subchondral fracture, peroneal subluxation, torn peroneal tendons.
The following procedures can be performed. Unleashing lateral groove - 21.8%, excise / Drill OCD - 19.4%, chondroplasty - 13.3% of the excise fibrous bands - 6.8%, the bulk bodies - 5.7%, Rx fracture, diagnosis, synovectomy, bone spurs, bones, fusion, stabilization CONTRAINDICATIONS - on - DJD, edema, impaired blood supply.
Absolute - soft tissue infections, advanced DJD.
Instrumentation
Arthroscopy of the ankle to develop principles of arthroscopy of the knee and therefore at first the same instruments were applied. However, as experience developed with smaller instruments, distraction, and fluid management systems, arthroscopy evolved.
Irrigation - Gravity, gravity assist, pumps.
Athroscopes - Hopkins 2.3mm, 2.7mm and 1.9mm in diameter, 30 and 70 degrees.
Distraction - noninvasive.
Instrumentation - spinal needles, probes, dissectors - elevating OCD lesions, ossicles, pliers - flat or sloped pitbull for small and large foreign body (2.7 3.Omm), Basket forceps - straight, right and left, downward angle (2.53 0.00 mm), knives, scrapers, bone, Power Tools, thigh / ankle Holder, Stepping templates.
Diagnostic arthroscopic examination of ankle
Ankle arthroscopy is a useful diagnostic modality for evaluating the pathology and determine the correct treatment. It should not be used as a substitute for careful history taking, examination and investigation. Its main advantages are that it allows direct inspection and survey of all intra-articular structures and dynamic evaluation. As such, it is virtually 100% in the diagnosis of intra-articular disorders.
The ankle is first distended with 30 cc of saline. Then the anteromedial portal is established just medial to the tibialis anterior at the joint line, carefully avoiding the saphenous nerve. Then the anterolateral portal is established using transillumination, avoiding the superficial peroneal nerve. A complete inspection of the anterior diagnosis is then performed. Then the posterolateral portal is the location of the point of entry with a spinal needle. Then, a complete inspection of the posterior compartment is made. With these three portals full item 21 of ankle system can be made.
Soft tissue injuries of the ankle
They are difficult to dia.
Posted on March 6, 2010.
