Arthroscopically assisted arthrodesis of the upper ankle joint

Objective To obtain a pain-free, fully weight-bearing ankle joint in a functional position through minimally invasive arthrodesis. Indications Symptomatic osteoarthritis of the upper ankle joint, which is no longer treatable conservatively or by joint-preserving surgical procedures. Contraindications Revision arthrodesis, infections in the surgical area, circulatory disorders; extensive malalignment, large bony defects (relative contraindications). Surgical technique Anteromedial and anterolateral standard portal to the upper ankle joint. Soft tissue debridement and, if necessary, removal of large ventral osteophytes and free joint bodies. Removal of the remaining tibiotalar articular cartilage using curettes, sharp spoons, chisels, or reamers. Opening of the subchondral bone with bone awls or chisels to expose the former joint surfaces. Anatomical adjustment of the joint, transfixation with 2 to 3 Kirschner wires for percutaneous stabilization with cannulated double-threaded screws or cancellous bone screws with short threads under X-ray control. Postoperative management Postoperative immobilization in an orthosis or plaster cast with unloading for 6 weeks; after X-ray control, gradual increase in weight-bearing over a further 2-6 weeks. Results In all, 30 arthroscopically assisted arthrodeses of the ankle joint performed between 2014 and 2017 were retrospectively evaluated. Of these, 22 patients were very satisfied, 5 patients were satisfied, and only 2 patients were not satisfied with the surgical outcome. The evaluation using postoperative scores (American Orthopaedic Foot and Ankle Society Score [AOFAS], Foot and Ankle Outcome Score [FAOS], Visual Analogue Scale Foot and Ankle [VAS-FA]) also yielded good results on average. The complication rates were comparable to those in the literature, with 2 pseudarthroses, 3 superficial wound healing disorders, and 2 irritations caused by the osteosynthesis material.