ANTERIOR ARTHROLYSIS OF THE ANKLE
DEFINITION OF ANKLE JOINT CONFLICT
Ankle joint impingement, also known as anterolateral ankle impingement, refers to a condition where there is abnormal friction between the bony and/or tendon structures of the ankle during joint movements. This excessive friction can lead to irritation, inflammation, and possible damage to the soft tissues of the ankle.
Ankle joint impingement can involve several anatomical structures, but is most commonly associated with friction between the lateral malleolus (the outer ankle bone) and the peroneal retinaculum tendons (peroneal muscle tendons). or the anterior talofibular ligament (ATFL). This impingement can occur during various ankle movements, such as dorsiflexion (when the foot lifts upward) or inversion (when the foot bends inward).
Possible causes of ankle joint impingement include :
- Abnormal anatomy : Some people may have an anatomical configuration of the ankle that promotes excessive friction between bony or tendon structures, increasing the risk of joint impingement.
- Ankle Instability : Chronic ankle instability, resulting from recurrent sprains or ligamentous laxity, can lead to misalignment of joint structures, thereby promoting the development of joint impingement.
- Overuse or overload : Physical activities or sports that involve repetitive movements of the ankle, such as running, jumping, or pivot sports, can lead to overuse of tendons and bony structures, increasing the risk of joint impingement.
- Arthritis or inflammatory diseases : Certain inflammatory conditions such as rheumatoid arthritis or gout can lead to thickening of the tissues around the ankle joint, which can contribute to the development of joint impingement.
Symptoms of ankle joint impingement may include localized pain in the front or side of the ankle, a rubbing or clicking sensation when moving the ankle, swelling and tenderness in the affected area, as well as as difficulty performing certain ankle movements.
Treatment of ankle joint impingement may include conservative measures such as rest, ice, reduction of physical activity, physical therapy to strengthen the muscles and improve ankle stability, and corticosteroid injections to reduce inflammation. In cases that are severe or refractory to conservative treatment, surgical intervention may be considered to resolve the joint impingement by eliminating the structures responsible for the excessive friction or repairing the associated lesions.
WHY OPERATE ON ANKLE JOINT CONFLICT?
The ankle is a joint in constant use which allows the step to take when walking and running.
The ankle is a complex joint made up of a set of bones and ligaments, and when pain is felt, it must be treated quickly.
However, when it comes to early and significant wear as in the case of ankle joint impingement, simple drug treatment is not enough and an operation must be considered.
Ankle arthrolysis allows the motor skills of the joint to be recovered and allows the patient to return to a certain level of comfort in everyday life. Indeed, the operation must be considered to eliminate the pain and discomfort caused during simple movements that are usually easy to perform, but also to eliminate the stiffness of the joint.
Arthrolysis or ankle joint impingement surgery helps stabilize the ankle and maintain good mobility.
DEFINITION OF ANKLE ARTHROLYSIS
Ankle arthrolysis is a surgical procedure which consists of cutting the capsule and the ligaments so that the joint regains its mobility, and treating cartilage damage. The operation is carried out under general anesthesia or under loco-regional anesthesia depending on the overall state of health of the patient.
Arthrolysis is carried out arthroscopically. It is said to be a minimally invasive operation.
Arthroscopic arthrolysis allows small instruments and optical tools to be passed after making two small incisions at the joint. In certain cases, however, a traditional operation, called “open” with a larger incision, may be recommended. During this operation, the surgeon cleans the inflammation in the joint and planes the bony parts that are responsible for the joint impingement inside the ankle. Ankle arthrolysis must be followed by rehabilitation to prevent the patient from suffering from recurrence of stiffness in the ankle.
POST-OPERATIVE REHABILITATION AND RESUMPTION TO ACTIVITIES
Post-operative rehabilitation following arthrolysis must be carried out the day after the operation with the help of a physiotherapist, who helps the patient to get up and walk.
During the first days, the patient can move around using canes.
If the rehabilitation is carried out well and followed diligently, the canes can be abandoned quickly.
In most cases, the patient can expect to return to driving 3 weeks after the operation. Depending on the arduousness of the profession, the patient can return to work after a month.
Indeed, a calmer job such as an administrative job can be resumed around four weeks post-operatively, while a more physical professional activity will require medical advice prior to returning to work. At the end of the second month after ankle arthrolysis, the patient can consider resuming physical activity, provided that it is not violent.
RISKS AND COMPLICATIONS OF ARTHROLYSIS
All surgical operations involve risks and risk factors which also depend on the general health of the patient. Among the risks and complications of arthrolysis, the formation of a hematoma should be noted. A hematoma can cause bleeding and require evacuation.
An infection can also occur but it remains very rare because arthroscopy is a surgical procedure which limits the risk of infection.
In the event of an infection, washing the joint and taking antibiotics is recommended. Phlebitis is one of the possible complications, however, it can be quickly treated and controlled using anticoagulants.
Likewise, during the procedure, nerves surrounding the ankle may be accidentally injured, which causes a reduction in the sensitivity of the ankle and foot.
Inflammation can result from algodystrophy, a rare complication but which can cause pain. It is generally treated with medication. Also, inflammatory reactions can be observed and slow down the effectiveness of rehabilitation.
EXPECTED RESULTS OF ARTHROLYSIS
Arthrolysis is a surgical operation that can allow the patient to regain adequate mobility in the joint.
The resumption of normal walking can be observed from the first month post-operatively.
Some cases reveal small cartilage lesions but they are treated with medication. In 90% of patients undergoing ankle arthrolysis, the results are more than satisfactory with a disappearance of pain and discomfort in the joint.
