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Diagnostic Ankle Arthroscopy

Ankle arthroscopy is a useful diagnostic modality to evaluate pathology and determine correct treatment. It should not be used as a substitute for careful history taking, examination and investigation. Its main advantages are that it allows direct inspection and probing of all intra-articular structures and their dynamic assessment. As such it is virtually 100% accurate in diagnosing intra-articular disorders.

The ankle is first distended with approx 30cc of saline.

The anteromedial portal is established just medial to tibialis anterior at the level of the joint line carefully avoiding the saphenous nerve.

Then the anterolateral portal is established using transillumination, avoiding the superficial branch of the lateral popliteal nerve. A full diagnostic inspection of the anterior compartment is then carried out.

Then the posterolateral portal is made, localising the entry point with a spinal needle. A full inspection of the posterior compartment is then made.

Using these three portals, a full systematic ankle examination can be carried out.