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As temperatures rise, so do ankle injuries

By Dr. Steven J. Lawrence

UK HealthCare

With the recent spate of beautiful summer weather we've been having in Central Kentucky, it's normal for people to become more active. However, with that rise in activity comes a rise in the risk of injuries. Especially with outdoor activities like running or hiking, the chances of twisting or seriously injuring an ankle are more likely when folks are on the go during summer months.

For a simple injury to the ankle, try an ice pack and elevating the bruised joint. However, if your accident results in something more serious, a new surgical technique may be the answer to getting you back on your feet quickly.

Arthroscopic procedures employ a small and slender fiber optic camera to directly view the inner aspects of the damaged joint.  Specially designed hand instruments, as well as motorized burrs and shavers, can be introduced into the joint, allowing operations to be performed through small incisions. 

While this minimally invasive approach is most frequently used on the knee and shoulder, arthroscopic procedures for smaller joints, such as the ankle and wrist, are becoming more common. In select ankle problems, ankle arthroscopic surgery is preferred over more traditional open surgery to treat certain conditions.

Obviously, the ankle is subject to considerable stresses, especially in young, athletic individuals. A prime indication for ankle arthroscopy is the bone cartilage defect of the talus, or anklebone. With a severe ankle sprain, the edge of the joint surface of the talus may impact against surrounding bones, resulting in a localized area of damage to the cartilage and the underlying bone. This injury results in significant pain and swelling.

In this type of injury, a segment of the smooth joint surface is damaged, similar to a pothole in the road. The defect is often difficult to access with traditional surgery, which is why arthroscopic intervention may be a better approach. Since the lesion largely involves the joint lining, X-rays will commonly fail to detect it, so an MRI may be necessary to determine the proper diagnosis. MRI can distinguish the size, depth and location of the injury. 

Arthroscopy allows a surgeon to inspect the joint surface, remove the damaged fragments, and drill the underlying bone. Drilling small channels in the bottom of the lesion allows bone marrow elements from the center of the talus to fill the "pothole" and form a new joint surface. Other types of arthroscopic procedures can be performed including soft tissue debridement, painful spur removal, ligament repair, and joint fusion.

The primary advantages of the technique over traditional ankle surgery are excellent visualization of the joint for the surgeons, much small incisions, decreased pain and shorter recovery times. Of course, not all ankle problems can be addressed with these methods, especially advanced arthritis and most ankle fractures.

Arthroscopic procedures in the ankle can be technically challenging due to the size and configuration of the curved joint surface. Since ankle arthroscopy is a relatively new procedure, sports medicine and foot and ankle orthopaedic specialists are usually most experienced in this technique.

Dr. Steven J. Lawrence  is associate Professor of Orthopaedic Surgery in the UK College of Medicine and head of UK HealthCare's foot and ankle service.