The Role of Anterior Ankle Arthroscopy in the Management of Ankle Arthritis: Literature Review, Patient Evaluation, Goals of Treatment and Technique

Effect of light walking combined with arthroscopic surgery on bone mineral density in patients with foot and ankle osteoarthritis

ObjectiveTo observe the effect of light walking combined with arthroscopic surgery on the efficacy and Bone Mineral Density (BMD) of patients with ankle arthritis. Methods 180 patients with ankle arthritis were retrospectively selected, who were divided into a control group (Group A) and an experimental group (Group B) according to treatment methods, with 90 patients in each group. Group A was treated with conventional open surgery and Group B was treated with light walking combined with arthroscopic surgery. The two groups were compared before and after treatment on scales such as the AOFAS ankle hindfoot score. Meanwhile, the patients' BMD and levels of inflammatory factors such as tumor cell necrosis factor-α (TNF-α) were compared before and after treatment. Results The Kofoed and AOFAS scale scores were higher for mild walking combined with arthroscopic surgery than for conventional treatment (P < 0.05), and their pain visual analogue VAS scores were lower than for conventional treatment (P < 0.05). In Group B, the postoperative BMD increase was significantly higher (P < 0.05). The R-value between PDGF bone growth factor and BMD was 0.957 and the R-value between VEGF growth factor and BMD was 0.903. The R-value between patient age and BMD was -0.936 and the R-value between patient BMI and BMD was -0.913. The treatment efficiency in Group B was 96.7 %. Conclusion The results prove that light walking combined with arthroscopic surgery is suitable for the surgical treatment of patients with ankle arthritis because it has a better therapeutic effect and makes patients' BMD level improved.

The Aggressive Open Anterior Ankle Cheilectomy as Joint Salvage for Anterior Ankle Impingement Syndrome and Arthritis

Anterior ankle impingement syndrome can frequently present in athletes and post-traumatic patients who have osteophytes contributing to limited dorsiflexion and pain. Surgical treatment options include arthroscopy, open arthrotomy, arthrodesis, and total implant arthroplasty. For many, joint-sparing arthroscopy or arthrotomy yield satisfactory results if significant debridement is performed. If debridement is not aggressive, patients may not obtain the desired improvement. In cases where a larger amount of bone must be removed, or the patient does not have an anatomic appearing talar neck due to osteophytic changes, we have found that an open approach is necessary to achieve good results. To the best of our knowledge, no such technique has been previously published detailing a standard approach to open ankle arthrotomy. Our technique is coined the "Aggressive Open Anterior Ankle Cheilectomy" and involves a systematic 3-step approach. First, the tibial osteophytes are resected with an osteotome; second, the ankle gutters are addressed, and all hypertrophic bones removed; and third, an anatomic talar neck is fashioned. We herein describe our surgical technique and case examples.Level of Evidence: 5.