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Launch MovieArthroscopy is a type of keyhole surgery where the internal structures of a joint is examined for diagnosis and treatment. This is in contrast to an ‘Open’ procedure, involving a much larger incision. During the examination, one or more small incisions are made in the skin through which pencil-sized instruments and a fibre optic camera (arthroscope) are passed. The arthroscope is attached to a high definition monitor which displays the interior of the joint as a magnified image.
Mr Gordon is a strong believer that key hole surgery produces excellent results with a faster return to activity than traditional ‘open’ methods and where possible, utilises these techniques. He has undertaken specific training at internationally renowned centres and teaches and lectures on arthroscopic techniques.
Ankle arthroscopy can be used in diagnosis and treatment of many conditions including:
Injuries to the cartilage (microfracture)
Removing excessive scar tissue impingement
Removing abnormal bone growth due to repeated injury eg. ‘Footballers ankle’
Removing loose bodies of bone or cartilage that cause pain or locking
Fusion of an arthritic ankle joint
Removing synovitis (inflammation of the lining of the ankle joint)
Risks of Arthroscopic Surgery
Although rare, complications can occur, these include (but not limited to) infection and nerve injury
Recovery
This is usually Day Case surgery (no overnight stay). Puncture wounds take 2 weeks to heel. A rehabilitation program will be advised for a speedy recovery of normal joint function.
Going Home After Surgery
You can walk after the operation as soon as you are comfortable, which is normally within a few hours. Once you have been assessed by a physiotherapist or nurse and are deemed safe (with or without crutches), you can go home the same day. Someone will need to pick you up.
Weight Bearing Status and Elevation
Mr Gordon will advise you on your weight bearing status and length of elevation (in days) as this will depend on the type of surgery you have had
Day of the Operation at Home
You may experience some discomfort and should take pain killers, such as Codeine with Diclofenac. These should be taken regularly (3-4 times/day) especially before physiotherapy or exercise sessions. There may be some swelling in the ankle and if so, place ice (or frozen vegetables) on the ankle for 10 minutes in every hour, especially before and after physiotherapy or exercise sessions.
Day after the Operation, Bandage, Dressings and Showering
48 hours after the operation, you can remove the bandage, wool and gauze around the ankle yourself. Underneath will be 2 waterproof dressings. There may be some blood staining on the dressings, this is normal. Keep the dressings dry for 3 whole days after the operation. On the 4th day you can have a shower, taking care not to soak the dressings although they can get wet. Avoid a bath until Mr Gordon has seen you in clinic at 10 days to 2 weeks to review your wounds. Once you have removed the bandage, you can wear a normally shoe.
Physiotherapy and Exercise
Adhere to your weight bearing status detailed above. You are encouraged to perform the Rehabilitation Exercises detailed below, as much as you feel comfortable. Exercise should start as soon as you are comfortable, on the day of surgery. More formal exercises or dedicated physiotherapy may commence 2 weeks after the operation if required.
Driving
You need to be able to control the vehicle in an emergency. Can you stamp your foot down on the ground? For left sided surgery and no clutch is required, driving is probably safe after a few days post operatively. For right sided surgery, driving is probably safe at 2 weeks post operatively, unless you are non weight bearing. You should check with your insurance company. If you are unsure, please ask Mr Gordon.
Returning to Work
This will depend on exactly what has been performed and how you are following surgery
Sedentary jobs: Return after 3 days
Standing/walking jobs: Return after 2 weeks, but may be sooner depending on comfort and swelling
Manual/labouring jobs: Return after 2-4 weeks, but may be sooner depending on comfort and swelling
Out Patient Visits to see Mr Gordon
2 weeks – to assess wound healing
6 weeks – to assess pain, swelling, muscle bulk and range of motion
12 weeks – to assess pain, swelling, muscle bulk and range of motion and to advise on increasing activity level
4-6 months – final review depending on progress
Rehabilitation Exercises – to be done every 2 hours
1. Active Circumduction
Rotate the foot so the toes ‘draw’ a circle in the air, clockwise and anti-clockwise
20 circles over 60 seconds
2. Active Ankle Dorsiflexion (foot up) and Plantarflexion (foot down)
Move foot up and down (1 repetition)
Repeat 20 times over 60 seconds
3. Triple Flexion/Extension (hip, knee, ankle)
Bring knee toward chest bringing foot and ankle up
Straighten leg, pointing toes
Repeat 30 times
The following should NOT be done if Non Weight Bearing
4. Static Strengthening of :
4a: Invertor muscles (DO NOT DO IF NON WEIGHT BEARING)
Push both feet together and hold for 10 seconds
Repeat 5 times
4b: Evertor muscles (DO NOT DO IF NON WEIGHT BEARING)
Cross legs over
Push both feet together and hold for 10 seconds
Repeat 5 times
Swap over feet
4c: Dorsiflexion and Plantarflexion muscles (DO NOT DO IF NON WEIGHT BEARING)
Place once foot over the other
Push up with lower foot, resisted by upper foot
Hold for 10 seconds
Repeat 5 times
Swap over feet and repeat
5. Triceps Surae Stretch (DO NOT DO IF NON WEIGHT BEARING)
Place feet apart and put hands on a wall
Have injured leg toward the rear
Keep feet in place on ground
Lean forward, keeping the heel of the rear (injured) foot on the ground
Hold for 20 seconds
Repeat 3 times
Swap feet