Ankle arthroscopy for managing the sequelae of fractures involving the ankle and distal tibia

E.J.C. Dawe, C.P. Jukes, K. Ganesan, A. Wee, N. Gougoulias

Introduction: The role of ankle arthroscopy in managing the consequences of ankle fractures remains controversial. This study aims to assess this procedure in terms of the accuracy of pre-operative diagnosis, reoperation rate and patient-reported outcomes.

Methods: We identified 66 patients (mean age 40 years, range 17-81) 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 standardised questionnaire to assess satisfaction and return to normal function.

Results: Injury occurred a median of 2 years 8 months before arthroscopy (Range 6 months to 24 years). 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 lesion(OCL) (18%). Intra-operative findings revealed an unexpected OCL or frank degenerative change in 20% of patients. Using a Kaplan Meier estimate one year after arthroscopy 10% of patients had undergone further surgery. This had increased to 34% by four 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.

Conclusions: Intra-articular pathology was significantly underestimated pre-operatively for one patient in five. Arthroscopy may improve symptoms in 75% of patients who complain of ankle symptoms after fracture of the ankle or distal tibia. However further procedures may be required in 34% of cases.