Ankle arthroscopy to manage sequelae after ankle fractures

The role of ankle arthroscopy in managing the consequences of ankle fractures is yet to be fully established. This study aims to assess this procedure in terms of the accuracy of preoperative diagnosis, re-operation rate and patient-reported outcomes.

Sixty-six patients were identified [mean age 40 years (SD 13 years)] who had undergone ankle arthroscopy following a fracture of the distal tibia or fibula. Medical case notes were reviewed to ascertain details of the index injury, intra-operative findings and identify any further procedures. Patients were then contacted using a standardized questionnaire to assess satisfaction and return to normal function.

Injury occurred in a mean of 2 years 10 months before arthroscopy (SD 13 months, min 6 months). Forty-nine of 66 fractures (74 %) had been managed operatively. The commonest indication for arthroscopy was anterior impingement (45 %) followed by degenerative change (30 %) and osteochondral lesions (OCL) (18 %). Intra-operative findings revealed an unexpected OCL or frank degenerative change in 20 % of patients. Using a Kaplan-Meier estimate 1 year after arthroscopy, 10 % of patients had undergone further surgery. This had increased to 34 % by 4 years after arthroscopy. Four patients underwent ankle fusion. Questionnaires were completed by 55/66 patients (84 %). Only 28 patients (50 %) felt surgery allowed them to return to normal activity. Thirty-nine patients reported a benefit from surgery (75 %) whilst 43 were satisfied (77 %) and 48 (86 %) would recommend the procedure to a friend.

Intra-articular pathology was significantly underestimated preoperatively for one patient in five. Arthroscopy improved symptoms in 75 % of patients who complain of ankle symptoms after fracture of the ankle or distal tibia. However, further procedures were required in 34 % of patients. The findings of this study help guide patient counselling and operative decision-making in this challenging group of patients.

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