Ankle surgery treats injuries, deformities, or degenerative conditions affecting the ankle joint. The primary goals of these interventions are to restore stability, reduce chronic pain, and recover the functional capacity of the joint. Because the ankle is a complex structure of bones, ligaments, and tendons, the choice of procedure depends entirely on the specific tissue damaged and the severity of the condition.
Minimally Invasive Techniques
Minimally invasive techniques address certain ankle issues using smaller incisions, often leading to reduced recovery times. Arthroscopy, sometimes called keyhole surgery, involves inserting a thin tube with a camera, known as an arthroscope, into the joint through small puncture wounds. This allows the surgeon to visualize the joint structures directly on a monitor without a large open incision.
Arthroscopy is frequently used for Ankle Debridement, which involves cleaning out the joint space. During debridement, the surgeon removes inflamed soft tissue, loose fragments of bone or cartilage, or trims away bone spurs (osteophytes) that cause pain or impingement. Arthroscopy is reserved for diagnostics or treating less complex issues, offering the benefit of less trauma to surrounding tissues.
Procedures for Stabilization and Repair
When the ankle suffers from chronic instability or specific soft tissue damage, the focus shifts to surgically restoring the integrity of the ligaments and tendons. Chronic instability, often resulting from repeated ankle sprains, is commonly addressed by Lateral Ankle Ligament Reconstruction, such as the Brostrom procedure. This procedure tightens and reattaches the stretched or torn ligaments on the outside of the ankle, most frequently the anterior talofibular ligament, using sutures and tiny anchors placed into the bone.
The surgeon may reinforce this repair by incorporating an adjacent tissue layer, such as the retinaculum, a technique often called the Brostrom-Gould modification. This approach is considered a primary repair because it uses the patient’s existing tissue. If the ligaments are too damaged or of poor quality, a reconstruction may be necessary, involving a tendon graft, sometimes taken from elsewhere in the body or from a donor, to create a new, strong ligament structure.
Tendon damage, such as a tear in the Achilles tendon, also requires specific surgical repair. When a tendon is acutely torn, a primary repair involves stitching the two torn ends back together. If the tear is chronic or involves significant tissue loss, a more involved reconstruction may be needed, utilizing local tendon transfers or a tissue graft to bridge the gap and restore the tendon’s length and power.
Procedures Addressing Bone and Joint Damage
For severe issues like end-stage arthritis or complex fractures, surgical interventions focus on restructuring or replacing the damaged skeletal components. Arthrodesis, or ankle fusion, is a procedure where the remaining damaged cartilage is removed, and the ankle bones (tibia and talus) are permanently fused together. This effectively eliminates the painful bone-on-bone friction of severe arthritis, resulting in reliable pain relief.
The trade-off for this pain relief is the loss of motion in the fused joint, which can slightly alter a person’s walking pattern and may lead to increased stress on the adjacent joints over time. Fusion is often preferred for younger, more active individuals or those with significant ankle deformity, as the resulting joint is extremely durable. The bones are held securely in place using internal hardware like plates and screws during the healing process.
Alternatively, Arthroplasty, commonly known as total ankle replacement, involves surgically removing the damaged joint surfaces and replacing them with a prosthetic device. The main advantage of replacement is the preservation of motion in the joint, which allows for a more natural walking gait compared to fusion. This option is considered for older patients or those who want to maintain a higher degree of ankle mobility.
While total ankle replacement aims to restore a natural range of motion, it carries the risk of the artificial components wearing out or loosening over time, potentially requiring a future revision surgery. For severe bone trauma, such as a complex fracture, Open Reduction and Internal Fixation (ORIF) is a common procedure. This involves an open incision to manually realign (reduce) the broken bone fragments into their correct anatomical position. The fragments are then held firmly in place using internal fixation devices, such as metal plates, screws, or rods, allowing the bone to heal in a stable and proper alignment.