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Ankle arthroscopy has become a widely adopted minimally invasive surgical technique for diagnosing and treating intra-articular pathology of the ankle joint. The procedure relies on small portals and an arthroscope to directly visualize the joint, offering both diagnostic accuracy and therapeutic versatility while reducing soft tissue trauma compared with open approaches. This technique addresses a broad spectrum of ankle disorders that cause persistent pain, swelling, or mechanical dysfunction, particularly in patients who fail conservative management.[1] The etiology of ankle joint pathology includes traumatic, degenerative, and inflammatory processes. Acute ankle sprains and fractures frequently result in residual intra-articular damage, eg, osteochondral lesions of the talus, chondral degeneration, or posttraumatic impingement. Athletes and individuals in high-demand activities often sustain repetitive microtrauma, leading to synovitis, capsular thickening, or soft tissue impingement that compromises joint function. Degenerative changes, including osteoarthritis, may progress after instability or trauma, causing chronic pain and stiffness. Inflammatory arthritides, eg, rheumatoid arthritis, can also affect the ankle, producing synovial proliferation and progressive joint destruction. These diverse mechanisms underscore the complexity of ankle pathology and the need for precise diagnostic and therapeutic strategies. Arthroscopy provides a powerful tool for both diagnosis and management. When imaging proves inconclusive, diagnostic arthroscopy enables direct visualization of subtle cartilage damage, loose bodies, or synovial disease that may not be apparent on magnetic resonance imaging (MRI) or computed tomography (CT). Therapeutically, arthroscopy enables targeted debridement, synovectomy, removal of loose bodies, and treatment of osteochondral lesions.[2] Surgeons frequently employ this approach for anterior ankle impingement, especially in athletes, and for posttraumatic arthrofibrosis or joint infection requiring lavage. Arthroscopy also functions as an adjunct to open procedures (eg, fracture fixation or ankle arthrodesis), enhancing visualization and preparation of articular surfaces.[3]

Arthroscopy provides a powerful tool for both diagnosis and management. When imaging proves inconclusive, diagnostic arthroscopy enables direct visualization of subtle cartilage damage, loose bodies, or synovial disease that may not be apparent on magnetic resonance imaging (MRI) or computed tomography (CT). Therapeutically, arthroscopy enables targeted debridement, synovectomy, removal of loose bodies, and treatment of osteochondral lesions.[2] Surgeons frequently employ this approach for anterior ankle impingement, especially in athletes, and for posttraumatic arthrofibrosis or joint infection requiring lavage. Arthroscopy also functions as an adjunct to open procedures (eg, fracture fixation or ankle arthrodesis), enhancing visualization and preparation of articular surfaces.[3] Techniques involve the use of anterior or posterior portals to access the joint. Anterior arthroscopy remains the most common approach, with portals placed medial and lateral to the tibialis anterior tendon. Posterior portals are selected for pathology involving the posterior compartment, often performed with the patient in the prone position. Continuous irrigation promotes joint distension and clear visualization, while specialized instruments enable debridement, cartilage repair, and other interventions. Ongoing advancements in arthroscopic tools and surgical methods have broadened the indications for ankle arthroscopy while strengthening its safety profile. Clinical outcomes following ankle arthroscopy generally remain favorable, with reported improvements in pain relief, functional capacity, and return to activity across a wide range of pathologies.[4] Patients undergoing arthroscopic debridement for anterior impingement frequently achieve significant symptom reduction and restoration of athletic performance.[5] Arthroscopic management of osteochondral lesions has also demonstrated positive results in pain control and functional recovery, especially when paired with structured postoperative rehabilitation.[6] Although outcomes vary with the underlying pathology and disease severity, ankle arthroscopy consistently offers reduced morbidity, quicker recovery, and higher patient satisfaction compared with open surgery.

Clinical outcomes following ankle arthroscopy generally remain favorable, with reported improvements in pain relief, functional capacity, and return to activity across a wide range of pathologies.[4] Patients undergoing arthroscopic debridement for anterior impingement frequently achieve significant symptom reduction and restoration of athletic performance.[5] Arthroscopic management of osteochondral lesions has also demonstrated positive results in pain control and functional recovery, especially when paired with structured postoperative rehabilitation.[6] Although outcomes vary with the underlying pathology and disease severity, ankle arthroscopy consistently offers reduced morbidity, quicker recovery, and higher patient satisfaction compared with open surgery. Overall, ankle arthroscopy represents a significant advancement in the management of ankle pathology, combining diagnostic precision with therapeutic benefits through minimally invasive techniques. As evidence continues to validate its efficacy and as podiatric surgical expertise and technology evolve, its role in orthopedic practice continues to expand.

Infection Infection after ankle arthroscopy is a known complication necessitating detailed management to reduce risks and promote positive outcomes. Infections range from superficial portal wound infection to septic arthritis.[21] Early detection and appropriate treatment are crucial for preventing complications, eg, joint damage and prolonged recovery times. Neurovascular Injury Neurological injuries are the most common complications after ankle arthroscopy, most frequently involving the superficial peroneal nerve injury.[22][23] Most nerve injuries occur through direct injury by portal or distractor pin placement.[24] Anterolateral portal The anterolateral portal serves as a commonly used entry point in ankle arthroscopy, providing access to the lateral and anterior regions of the joint. Placement of this portal requires meticulous attention to prevent complications, particularly injury to the superficial peroneal nerve, which supplies sensory innervation to the dorsum of the foot and lateral lower leg. The dorsal intermediate cutaneous branch of the superficial peroneal nerve runs superficially along the lateral aspect of the leg and crosses the anterior ankle joint, placing it at high risk during portal insertion or tissue manipulation. Injury to this nerve can result in sensory disturbances, including pain, numbness, or tingling, in the areas it innervates. Additionally, damage may cause weakness in foot dorsiflexion and eversion due to impaired function of the peroneal muscles, highlighting the critical importance of careful portal placement and protective technique. Anteromedial portal Placement of the anteromedial portal carries multiple risks that require careful management to prevent complications. One primary concern involves injury to the saphenous nerve, a branch of the femoral nerve that runs medially and provides sensory innervation to the medial lower leg and foot.[25] Injury to this nerve can produce postoperative pain, numbness, or tingling in its distribution.

Placement of the anteromedial portal carries multiple risks that require careful management to prevent complications. One primary concern involves injury to the saphenous nerve, a branch of the femoral nerve that runs medially and provides sensory innervation to the medial lower leg and foot.[25] Injury to this nerve can produce postoperative pain, numbness, or tingling in its distribution. The saphenous vein, which accompanies the saphenous nerve, also faces potential injury during portal placement. Trauma to this vein may result in bleeding or hematoma formation, complicating both the surgical procedure and postoperative recovery. Another structure at risk, the tibialis anterior tendon, lies immediately medial to the portal site. This tendon contributes to dorsiflexion of the foot and stabilization of the ankle joint, and injury can impair foot function, potentially leading to long-term motor deficits. Careful anatomical identification and precise portal placement technique are essential to minimize these risks. Anterocentral portal During ankle arthroscopy, the anterocentral portal requires careful attention to avoid injury to the dorsalis pedis artery. Trauma to this artery can result in serious vascular complications, including compromised blood flow to the foot. Accurate portal placement, guided by anatomical landmarks or imaging, helps protect the artery and maintain proper vascular function throughout the procedure. Posterolateral portal The posterolateral portal in ankle arthroscopy provides access to the posterior and lateral aspects of the ankle joint but poses risks, including potential injury to the sural nerve and the short saphenous vein. The sural nerve, which is responsible for sensation in the lateral foot and posterior lower leg, can be affected, potentially resulting in sensory issues, eg, pain or numbness. Additionally, damage to the short saphenous vein may lead to vascular complications (eg, bleeding or hematoma). To mitigate these risks, surgeons should use careful anatomical landmarks and imaging techniques to accurately place the portal and avoid these critical structures, thus reducing the risk of complications and improving patient outcomes. Po steromedial p ortal Inserting the posteromedial portal during ankle arthroscopy requires a precise technique to minimize the risk of damaging the posterior tibial artery. Ankle Joint Stiffness

The posterolateral portal in ankle arthroscopy provides access to the posterior and lateral aspects of the ankle joint but poses risks, including potential injury to the sural nerve and the short saphenous vein. The sural nerve, which is responsible for sensation in the lateral foot and posterior lower leg, can be affected, potentially resulting in sensory issues, eg, pain or numbness. Additionally, damage to the short saphenous vein may lead to vascular complications (eg, bleeding or hematoma). To mitigate these risks, surgeons should use careful anatomical landmarks and imaging techniques to accurately place the portal and avoid these critical structures, thus reducing the risk of complications and improving patient outcomes. Po steromedial p ortal Inserting the posteromedial portal during ankle arthroscopy requires a precise technique to minimize the risk of damaging the posterior tibial artery. Ankle Joint Stiffness Patients undergoing ankle arthroscopy may experience postoperative joint stiffness due to incomplete resolution of the pathology or scar tissue formation, necessitating rehabilitative measures, eg, structured physical therapy and additional interventions, to restore a full range of motion and functionality. Deep Vein Thrombosis Patients undergoing ankle arthroscopy, particularly those at higher risk, should be assessed and monitored for the development of deep vein thrombosis.[23] Early mobilization and risk assessment for pharmacological thromboprophylaxis are strategies to mitigate this potential complication and promote optimal postoperative recovery. Iatrogenic Articular Cartilage Injuries Ankle arthroscopy poses the potential for inadvertent damage to articular cartilage, which can lead to significant complications, secondary degenerative joint disease, and prolonged recovery times.[26] Employing meticulous surgical techniques and maintaining vigilant monitoring are essential strategies to minimize the occurrence of such injuries. Synovial Cutaneous Fistula A rare complication that warrants attention is the development of a synovial cutaneous fistula, characterized by an abnormal connection between the synovial lining and the skin. The risk of this complication can be reduced by surgical closure of portal sites and consideration of ankle immobilization in the early postoperative period.

Ankle arthroscopy has become a cornerstone in the diagnosis and management of intra-articular ankle pathology, offering minimally invasive access for conditions such as osteochondral lesions, synovitis, impingement, and posttraumatic arthrofibrosis. The procedure provides direct visualization of joint structures, enabling precise assessment and targeted intervention while minimizing soft tissue trauma and promoting faster recovery. Its applications extend to both diagnostic evaluation when imaging is inconclusive and therapeutic management, including debridement, osteophyte resection, cartilage repair, and adjunctive use in fusion procedures. Successful outcomes rely on careful patient selection, meticulous surgical technique, and structured postoperative rehabilitation to restore function and reduce complications. Effective ankle arthroscopy requires coordinated skills and strategies across the interprofessional healthcare team. Orthopedic and podiatric physicians and advanced practitioners contribute technical expertise, clinical judgment, and ethical decision-making to ensure surgical indications align with patient goals. Nurses provide perioperative care, monitor for complications, and educate patients on recovery and rehabilitation, while pharmacists optimize medication regimens, manage analgesia and anticoagulation, and prevent drug interactions. Clear interprofessional communication and shared documentation facilitate early recognition of infection, thromboembolism, or neurovascular injury, and coordinated care ensures seamless transitions from preoperative assessment through postoperative rehabilitation. By integrating ethical practice, patient-centered planning, and team collaboration, the healthcare team enhances safety, improves functional outcomes, and fosters high-quality, evidence-based care throughout the ankle arthroscopy continuum.