Systematic Review
Evidence-Based Indications for Ankle Arthroscopy

https://doi.org/10.1016/j.arthro.2009.05.001Get rights and content

Purpose

The purpose of this study was to review the literature to provide a comprehensive description of the Level of Evidence available to support the surgical technique of ankle arthroscopy for the current generally accepted indications and assign a grade of recommendation for each of them.

Methods

A comprehensive review of the literature was performed (in August 2008) by use of the PubMed database. The abstracts from these searches were reviewed to isolate literature that described therapeutic studies investigating the results of different ankle arthroscopic treatment techniques. All articles were reviewed and assigned a classification (I-IV) of Level of Evidence. An analysis of the literature reviewed was used to assign a grade of recommendation for each current generally accepted indication for ankle arthroscopy.

Results

There exists fair evidence-based literature (grade B) to support a recommendation for the use of ankle arthroscopy for the treatment of ankle impingement and osteochondral lesions and for ankle arthrodesis. Ankle arthroscopy for ankle instability, septic arthritis, arthrofibrosis, and removal of loose bodies is supported with only poor-quality evidence (grade C). Treatment of ankle arthritis, excluding isolated bony impingement, is not effective and therefore this indication is not recommended (grade C against). Finally, there is insufficient evidence-based literature to support or refute the benefit of arthroscopy for the management of synovitis and fractures (grade I).

Conclusions

There exists adequate evidence-based literature to support the surgical technique of ankle arthroscopy for most current generally accepted indications; however, further studies in this area are needed.

Level of Evidence

Level IV, systematic review.

Section snippets

Methods

A comprehensive review of the literature was performed (in August 2008) by use of the PubMed database and key words “ankle” and “arthroscopy,” revealing 560 articles. The current generally accepted indications for ankle arthroscopy were also separately searched in the PubMed database along with the key words “ankle” and “arthroscopy.” Non–English language literature without English translation was excluded. The abstracts from these searches were reviewed to isolate literature that described

Results

A summary of the grade of recommendation for or against the current generally accepted indications for ankle arthroscopy is presented in Table 3. Fair evidence-based literature (grade B) exists to support a recommendation for the use of ankle arthroscopy in the treatment of ankle impingement (Table 4, Table 5) and OCL (Table 6, Table 7) and for ankle arthrodesis (Table 8, Table 9). A summary of key articles describing all the current generally accepted indications for ankle arthroscopy is

Discussion

Orthopedic surgeons are always searching for ways to improve on current methods so as to provide maximal benefit for each intervention while minimizing its impact. Such benefits have been anticipated with ankle arthroscopy and in some instances have been realized. Compared with open arthrotomy, arthroscopy has the potential to shorten recovery times and limit surgical morbidity. Because of perceived benefits, surgeons have been quick to adopt ankle arthroscopy for a number of current generally

Conclusions

A comprehensive review of the literature has provided predominantly Level III and IV evidence with far fewer Level I and II trials. This has allowed grade B recommendations for the use of ankle arthroscopy for the treatment of ankle impingement and osteochondral lesions and for ankle arthrodesis. Ankle arthroscopy for loose bodies, ankle instability, septic arthritis, and arthrofibrosis is supported by a grade C recommendation. The use of arthroscopy for ankle OA is not supported by the

Acknowledgment

The authors thank Dr. Annunziato Amendola for his support.

References (92)

  • A. Gobbi et al.

    Osteochondral lesions of the talus: Randomized controlled trial comparing chondroplasty, microfracture, and osteochondral autograft transplantation

    Arthroscopy

    (2006)
  • C.L. Baker et al.

    Arthroscopic treatment of transchondral talar dome fractures

    Arthroscopy

    (1986)
  • A. Frank et al.

    Arthroscopic treatment of osteochondral lesions of the talar dome

    Arthroscopy

    (1989)
  • S.A. Hunt et al.

    Arthroscopic treatment of osteochondral lesions of the talus with correlation of outcome scoring systems

    Arthroscopy

    (2003)
  • A. Lahm et al.

    Arthroscopic management of osteochondral lesions of the talus: Results of drilling and usefulness of magnetic resonance imaging before and after treatment

    Arthroscopy

    (2000)
  • D.J. Ogilvie-Harris et al.

    Arthroscopic treatment of osteochondritis dissecans of the talus

    Arthroscopy

    (1999)
  • D.J. Ogilvie-Harris et al.

    Arthroscopic treatment after previous failed open surgery for osteochondritis dissecans of the talus

    Arthroscopy

    (1999)
  • D.J. Ogilvie-Harris et al.

    Arthroscopic treatment of post-traumatic cysts of the talus

    Arthroscopy

    (2000)
  • B. Chuckpaiwong et al.

    Microfracture for osteochondral lesions of the ankle: Outcome analysis and outcome predictors of 105 cases

    Arthroscopy

    (2008)
  • S.E. Cameron et al.

    Arthroscopic arthrodesis of the ankle joint

    Arthroscopy

    (2000)
  • S.J. Corso et al.

    Technique and clinical evaluation of arthroscopic ankle arthrodesis

    Arthroscopy

    (1995)
  • J.M. Glick et al.

    Ankle arthrodesis using an arthroscopic method: Long-term follow-up of 34 cases

    Arthroscopy

    (1996)
  • J.E. Zvijac et al.

    Analysis of arthroscopically assisted ankle arthrodesis

    Arthroscopy

    (2002)
  • M. Maiotti et al.

    The use of arthroscopic thermal shrinkage to treat chronic lateral ankle instability in young athletes

    Arthroscopy

    (2005)
  • G.C. Berlet et al.

    Thermal-assisted capsular modification for functional ankle instability

    Foot Ankle Clin

    (2002)
  • L.M. Oloff et al.

    Arthroscopic monopolar radiofrequency thermal stabilization for chronic lateral ankle instability: A preliminary report on 10 cases

    J Foot Ankle Surg

    (2000)
  • C.F. Hyer et al.

    Arthroscopic repair of lateral ankle instability by using the thermal-assisted capsular shift procedure: A review of 4 cases

    J Foot Ankle Surg

    (2004)
  • K. Utsugi et al.

    Intra-articular fibrous tissue formation following ankle fracture: The significance of arthroscopic debridement of fibrous tissue

    Arthroscopy

    (2007)
  • D.J. Ogilvie-Harris et al.

    Arthroscopic debridement for the osteoarthritic ankle

    Arthroscopy

    (1995)
  • M.M. Jennings et al.

    Arthroscopic assisted fixation of juvenile intra-articular epiphyseal ankle fractures

    J Foot Ankle Surg

    (2007)
  • A. Ono et al.

    Arthroscopically assisted treatment of ankle fractures: Arthroscopic findings and surgical outcomes

    Arthroscopy

    (2004)
  • M. Watanabe

    Arthroscopic diagnosis of intra-articular injuries of the knee

    Nippon Seikeigeka Gakkai Zasshi

    (1968)
  • J.G. Wright et al.

    Introducing levels of evidence to the journal

    J Bone Joint Surg Am

    (2003)
  • J.G. Wright et al.

    Grades of recommendation

    J Bone Joint Surg Am

    (2005)
  • P.E. Scranton et al.

    Anterior tibiotalar spurs: A comparison of open versus arthroscopic debridement

    Foot Ankle

    (1992)
  • C.N. van Dijk et al.

    Arthroscopy for problems after ankle fracture

    J Bone Joint Surg Br

    (1997)
  • S.H. Kim et al.

    Arthroscopic treatment for impingement of the anterolateral soft tissues of the ankle

    J Bone Joint Surg Br

    (2000)
  • M. Takao et al.

    Arthroscopic treatment for anterior impingement exostosis of the ankle: Application of three-dimensional computed tomography

    Foot Ankle Int

    (2004)
  • M.H. Baums et al.

    Clinical outcome of the arthroscopic management of sports-related “anterior ankle pain”: A prospective study

    Knee Surg Sports Traumatol Arthrosc

    (2006)
  • S.H. Han et al.

    Chronic tibiofibular syndesmosis injury: The diagnostic efficiency of magnetic resonance imaging and comparative analysis of operative treatment

    Foot Ankle Int

    (2007)
  • D. Akseki et al.

    The distal fascicle of the anterior inferior tibio-fibular ligament as a cause of anterolateral ankle impingement: Results of arthroscopic resection

    Acta Orthop Scand

    (1999)
  • M. Bonnin et al.

    Arthroscopy of the ankle: Analysis of results and indications on a series of 75 cases

    Foot Ankle Int

    (1999)
  • A. Branca et al.

    Arthroscopic treatment of anterior ankle impingement

    Foot Ankle Int

    (1997)
  • J.C. Clasper et al.

    Chronic ankle pain in soldiers: The role of ankle arthroscopy and soft tissue excision

    J R Army Med Corps

    (1996)
  • R.D. Ferkel et al.

    Arthroscopic treatment of anterolateral impingement of the ankle

    Am J Sports Med

    (1991)
  • H.A. Gulish et al.

    Arthroscopic treatment of soft-tissue impingement lesions of the ankle in adolescents

    Foot Ankle Int

    (2005)
  • Cited by (94)

    View all citing articles on Scopus

    Supported by an unrestricted educational grant from Smith & Nephew.

    View full text