Editorial Commentary: In-Office Needle Ankle Arthroscopy May Be Better, Simpler, and Less Expensive

Orthopaedic surgeons have always been on the cutting edge of innovation in health care delivery and technology. In turn, the orthopaedic device industry has responded with new products that deliver better quality at competitive prices. Numerous examples of collaboration exist such as in outpatient joint replacement and minimally invasive orthopaedic procedures. In-office needle arthroscopy (IONA) for knees and ankles has been in existence since the 1990s but was hampered by poor image quality and a cumbersome-to-use technology. Now with improved technology for IONA, ankle IONA allows adequate visualization of all pertinent ankle joint structures, allowing reach of 96% of the talus surface and 85% of the tibia plafond, and may show greater accuracy than preoperative magnetic resonance imaging. The majority of cost of an arthroscopy episode of care may reside with the "facility" fee charged for the use of an operating room, personnel, and related equipment. Surgeons and their patients pay higher fees to use hospital or outpatient centers, sometimes with increased inefficiency or more adverse events. IONA may allow orthopaedic surgeons to deliver better services at a reduced cost for ankle arthroscopy.