Minimally invasive ankle reconstruction: current scope and indications

Minimally invasive techniques in ankle reconstruction offer the benefits of therapeutic intervention while minimizing the risks for open incisions in this region with tenuous healing capacity. Arthroscopic arthrodesis seems to result in fusion rates that are comparable to, or faster than, procedures done with open incisions. There is an acceptably low rate of complication in high-risk patient populations. Despite the promising results to date, however, there are multiple variables contained within the published studies that impede direct comparison of their outcomes. It is difficult, therefore, to definitively assess the magnitude of benefit of a minimally invasive technique. Based on this review, support exists for a prospective, randomized trial comparing arthroscopic versus open ankle arthrodesis using a similar fusion technique in matched groups of patients. There is some evidence for the usefulness of arthroscopy as an adjunct to open lateral ligament repair or reconstruction. Arthroscopy expands our understanding of the extent of intra-articular pathology resulting from acute ligamentous trauma and the sequelae of chronic instability. It provides an opportunity for treating those lesions that may go on to cause chronic pain, thereby possibly improving patient outcomes compared with carrying out a lateral ligament stabilization procedure alone.