Ankle joints absorb a tremendous amount of stress and abuse over a lifetime. The ankles are workhorse joints that help us walk, run, jump, climb and perform a multitude of other functions that allow us to live, play and enjoy our lives. When injury or disease occurs that requires surgery to fix the problem, there are several procedures that can be performed.
Ligament Repair/Reconstruction
One of the more common injuries that can afflict the ankle is an inversion, or rollover, injury. This injury type is seen all too often in sports such as football, soccer, baseball and basketball, in which ankle stability is challenged on a regular basis.
Ankle ligament repair is an open surgical procedure in which the injured ligament tissues are exposed and repaired under direct vision. This is accomplished by sewing the torn halves back together to effect maximum healing and reduce weakness and instability.
The benefit of this procedure has been topic for heated debate within the medical and surgical communities. Ligament reconstruction is typically performed when primary repair is no longer an option. It involves the use of either the patient's own tendon structures, harvested from adjacent locations, or cadaver tendons that have been properly sterilized, frozen and processed. The reconstructive procedures attempt to restore the stability of the ankle by using the tissue grafts in a manner that best reproduces the normal mechanics and dynamics of the original ligament.
Open Reduction / Internal Fixation
The procedure known as Open Reduction with Internal Fixation (ORIF) typically is performed when an ankle has been broken to the point where the bone fragments must be restored to their normal positions and held in place with some kind of rigid technology. This surgical procedure is performed in order to restore the ankle to its prior, pre-fracture state and to restore the congruity of the all-important joint surfaces as close to perfectly normal as possible, to reduce the potential for arthritis secondary to joint surface disruption. Typical hardware used includes pins, plates and screws.
Joint Replacement
When arthritis involving the ankle joint surfaces is so severe that attempts to treat it adequately have failed, one available procedure is total ankle replacement.
This procedure involves the precise shaving and removal of the arthritic surfaces that comprise the ankle joint to accommodate the fitting of artificial components over the cut and shaved bone surfaces, recreating the joint with artificial--typically metal and plastic--surfaces. By replacing the arthritic joint surfaces with artificial materials, pain is relieved and function is improved.
Arthrodesis
Ankle arthrodesis, otherwise known as ankle fusion, is a procedure performed when most restorative surgical procedures either have failed or are no longer options, as in extreme end-stage arthritis or significant trauma.
The procedure consists mainly of preparing the opposing surfaces of the ankle joint by cutting or shaving them, in order to allow for placing them in direct contact with each other; they are then held in place with pins, screws or plates until the cut surfaces have completely healed.
Ankle arthrodesis allows for the elimination of arthritis joint pain by elimination of the joint itself. The bones are placed in a position where, once healed or fused, there will still be the ability to walk with as near to normal gait patterns as possible.
Arthroscopy
Like the knee and shoulder, minimally invasive ankle arthroscopy frequently is performed for a variety of conditions.
Arthroscopy refers to the introduction of a small, typically rigid, fiber-optic scope into the ankle joint while it is inflated, or distended, with fluid introduced under pressure to allow room for the instruments to be inserted. This scope typically is attached to a digital, high-definition camera, and the images are placed on a larger TV monitor for easier viewing.
Typical conditions that benefit from minimally invasive arthroscopy include joint debridement, removal of loose bodies or fragments within the joint, shaving of arthritic surfaces and bone spur removal.
