Arthroscopic in situ arthrodesis (AAA) of the ankle

Fusion of the ankle is an established option for end-stage degenerative joint disease. The purpose of this paper is to present the surgical technique as well as our own results. AAA starts with removal of all the remaining cartilage and joint detritus. For this we routinely use a posterolateral portal. When opening the subchondral plate one must be careful not to remove too much bone. In our hands a small chisel is very helpful for this step. Fixation is performed with two screws. In 31 out of 35 patients, we were able to obtain a solid bony fusion. AAA of the ankle can be performed in patients without significant malalignment or bony defect. It is an "in-situ"fixation of the destroyed painful joint, which is not suitable for patients with neuropathic joints. Patients with secondary joint destruction due to rheumatoid arthritis can also be treated with AAA.