[Ankle arthrodesis using the arthroscopic technique].
OBJECTIVE
Fast, safe and reliable ankle fusion through minimally invasive technique.


METHODS
Painful ankle arthritis unresponsive to conservative treatment.


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


METHODS
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.


METHODS
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.
Rippstein
Pascal
P
Zentrum für Fusschirurgie, Schulthess Klink, Lengghalde 2, CH-8008 Zürich, Switzerland. pascal.rippstein@kws.ch
Kumar
Bharat
B
Müller
Markus
M
D000328:Adult; D000368:Aged; D000843:Ankle Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D018771:Arthralgia / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D001174:Arthrodesis / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D001182:Arthroscopy / Q000379:methods*; D001863:Bone Screws; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010000:Osteitis / Q000000981:diagnostic imaging / Q000209:etiology; D010003:Osteoarthritis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography; D020127:Recovery of Function; D013628:Talus / Q000000981:diagnostic imaging / Q000601:surgery; D013977:Tibia / Q000000981:diagnostic imaging / Q000601:surgery; D016896:Treatment Outcome