A tourniquet is usually used during ankle arthroscopy to allow for improved visibility and reduced operation time. However, clinical studies on knee arthroscopy have not demonstrated this to be true. In addition, Zengerink and van Dijk emphasized a limited tourniquet time in ankle arthroscopy as a possible factor to lower the complication rate even more. The purpose of this prospective randomized controlled trial was to examine the effect of tourniquet use on arthroscopic visualization, operative time, postoperative intra-articular bleeding, postoperative pain scores and outcome of anterior ankle arthroscopy. A consecutive series of 50 patients who were scheduled for anterior ankle arthroscopy were randomized to have the surgery done either without the tourniquet inflated (25 patients) or with the tourniquet inflated (25 patients). The patients were evaluated by the course of the surgery, postoperative intra-articular bleeding, pain during the early postoperative period and by using the subjective and objective functional scores to evaluate the condition of the ankle before and 3 and 6 months after the surgery. The statistical analysis was performed with the normality of distribution tested by both Kolmogorov-Smirnov and Shapiro-Wilk tests. Appropriate parametric or non-parametric methods were then used to test statistical hypotheses, while the statistical significance (alpha, Type I error) was set at .05. Fourty-nine patients were present at the final follow-up, 6 months after the surgery. The results between the groups were comparable regarding the duration of the operative procedure, consumption of sterile saline, visualisation and functional scores. Notable difference between the groups in favour of the non-tourniquet group was present regarding postoperative bleeding, but was not statistically significant. Statistically significant difference in favour of the non-tourniquet group was found regarding postoperative pain during several days in the early postoperative period. Our study has shown that anterior ankle arthroscopy may be performed adequately without the use of a tourniquet and that it has the same operative course as in cases in which the tourniquet is used and functional outcomes which are not worse than in cases in which the tourniquet is used

Ankle arthroscopy is generally performed through anterior portals and provides good access to the anterior aspect of the ankle joint. However, the structure of the talus and the anatomical confines of the ankle joint limit access to posterior structures via this approach. Developments in the technique of posterior ankle arthroscopy have determined the appropriate site for portals with minimal risk of iatrogenic neurovascular injury. This facilitates treatment of conditions such as flexor hallucis longus (FHL) release, excision of os trigonum for posterior impingement, treatment of retro-calcaneal bursitis and treatment of ankle and subtalar joint pathology. Posterior ankle arthroscopy is a relatively new technique and has recently been adopted by the senior author. This study was performed to explore the benefits and limitations of this procedure and to identify early post operative results. We describe our experience of this technique in treating 9 patients with varied posterior ankle pathology. 2 patients had excision of os trigonum; 2 had FHL release; 1 had both excision of os trigonum and FHL release; 3 had curettage for posterior osteochondral defect (OCD) of the talus; and 1 had resection of Haglund’s deformity. The mean pre-operative AOFAS scores (Ankle-Hindfoot Scale) was 73 (range 47 to 85). The mean post operative AOFAS score at 3 months was 82 (range 75 to 87). 4 patients had recent surgery and await follow up. There were no complications. Two cases exposed the limitations of this procedure: Incomplete resection of (i) a Haglund’s deformity required conversion to an open excision and (ii) a posteromedial OCD lesion will require further anterior ankle arthroscopy due to inadequate exposure. We conclude that for the experienced arthroscopic surgeon this is a safe technique that facilitates treatment of a variety of ankle and hindfoot problems that would otherwise require open procedures

Introduction: Previous studies on ankle arthroscopy have reported the results of treatment in adult patients. To our knowledge there are no studies reporting the out-come in children. Aim: To analyse retrospectively the outcome of ankle arthroscopy in children. Method: Between March 2005 and September 2007, twenty-two children (14 boys and 8 girls) underwent ankle arthroscopy for post-traumatic pathology. Their average age was 13.5 years (range 8.6 to 18). The symptoms were ankle pain (21 out of 22), instability (7) or clicking (6). Indications for arthroscopy were no response to conservative treatment, including physiotherapy, for at least 12 weeks or a grade 3 or 4 osteochondral defect (OCD) on imaging. In five patients radiographs revealed an OCD. MR scans were obtained in eleven patients, which revealed OCDs in five, evidence of tarsal coalition in two, features suggesting posterior ankle impingement in 1 and normal scans in the remaining three. At arthroscopy OCDs were visualised in nine cases, two of which were grade 4, four were grade 3 and three were grade 2. The grade 4 lesions were debrided and drilled, the grade 3 lesions had their edges debrided and the rest were stable. There were 3 false positive MRI scans where an OCD was reported but not seen on arthroscopy. Impingement lesions were seen in twelve ankles (8 antero-lateral, 2 syndesmotic, 1 medial and 1 posterior), which were debrided. MRI scans had been performed in eight of these twelve cases but only one suggested an impingement lesion. Results: Seventeen of our twenty- two patients had complete relief of symptoms at 3 months. They were back to their normal activity including sports. Three patients had persistent pain at 3 months. Two of these showed features of instability, one of which went on to have a Brostrom repair; the second had a repeat arthroscopy and debridement while the third improved with restricted activity. The average AOFAS score improved from 52 pre-operatively to 79 at 3 months following surgery. Conclusions: Ankle arthroscopy has a successful outcome in paediatric patients with a painful ankle where conservative treatment has failed. MR imaging lacked sensitivity for diagnosing soft tissue impingement of the ankle

Background: The incidence of nerve injury following ankle arthroscopy has a documented rate of 1% to 24%1-15. The intermediate branch of the superficial peroneal nerve is at most risk with an antero-lateral portal incision 6, 9–12. The superficial peroneal nerve (SPN) is often marked as part of pre-operative planning,1 despite there being little evidence of the effectiveness of this simple measure in reducing nerve injury in ankle arthroscopies. Methods: We reviewed 100 consecutive cases who had an anterior ankle arthroscopy between February 2005 and April 2009. All arthroscopies were performed by a single surgeon (PFR) with pre-operative marking of the SPN. All patients were interviewed by telephone to find out if there had been any temporary or long-term neurological problems following the surgery. Any patients with neurological complications were reviewed in clinic. Patients’ notes were reviewed for any documented complications. Their level of satisfaction and improvement of symptoms were also assessed. Results: We were able to trace 98% of patients. The average follow up was 15.3 months (1 to 39 months). The only neurological deficit in this series was in one case (1%) who developed sensory loss in the distribution of the medial branch of the SPN. 61% of the cases were highly-satisfied/satisfied, 23% were moderately satisfied and 16% were not satisfied with the outcome of their surgery. The reason quoted by the 16% unsatisfied patients was failure to improve their symptoms to their expected level or their need for another operation (41% of the unsatisfied group). Conclusion: The incidence of nerve injury in our series was 1%. This is a dramatic improvement on the majority of published studies 1–15. We believe that marking the SPN prior to surgery is a simple and essential measure in reducing the neurological complications of ankle arthroscopy

Introduction. Anterior ankle arthroscopy currently provides the best chance of restricting local anatomy damage during ankle surgery. The anterior working area (AWA) of the ankle is restricted by the Dorsalis Pedis Artery (DPA) and the extensor muscle tendons when the procedure is conducted both in dorsiflexion and plantarflexion. During surgery, iatrogenic damage to the DPA can lead to the formation of a pseudoaneurysm, which can be difficult to identify intraoperatively. Our study investigates whether dorsiflexion or plantarflexion provides variability in the movement of the DPA to determine the positions at which anterior ankle arthroscopy provides the greatest anterior working area (AWA) without causing vascular damage. The current study expects the distance of the DPA from the inferior border of the medial malleolus (IBMM) (ankle joint) to be greater on ankle dorsiflexion than in ankle plantarflexion. Materials and Methods. Twelve cadaver ankles embalmed with a mixture of phenol and glycerol, allowing greater motion, were dissected to access the DPA. The ankles, while in a distracted position (in accordance with common surgical practice), were forced into dorsiflexion from a plantarflexion position at 5° intervals. The distance between the IBMM and the DPA was measured at the 5° intervals. Results. The mean amount of ankle flexion achieved was 24.58° (Range = 20–35). All twelve ankles showed positive range of movement (ROM) anteriorly from the IBMM with a mean ROM of 3.58mm (SE = 0.29mm) dorsiflexion. Discussion and Conclusion. Anterior movement of the Dorsalis Pedis Artery during dorsiflexion puts it at a lower risk of iatrogenic damage in a dorsiflexed position compared to plantarflexion. The increased AWA allows the surgeon more manoeuvrable space, possibly allowing the use of larger diameter surgical instruments

Introduction: When conservative treatment of posterior ankle impingement syndrome (PAIS) fails, operative intervention is indicated. Traditionally this involved an open approach. More recently posterior ankle arthroscopy has been employed. We report the first series of results from an exclusively elite athlete population. Method: We looked retrospectively at a prospectively compiled database of a consecutive series of elite professional soccer players on whom we have performed posterior ankle arthroscopy for both bony and soft tissue PAIS over the past 5 years. We reviewed our clinical and operative notes and those of the Football Association medical team. Statistical analysis was performed using MedCalc for Windows, version 9.6.4 (MedCalc software, Mariakerke, Belgium). Results: One player was lost to follow up leaving 27 out of 28 players in the study. The mean time to return to training post operatively was 34 days (24–54) and to playing was 41 days (29–72). Significant correlations were found between the length of symptoms and the number of pre operative injections (Spearman’s rank correlation coefficient = 0.806. p< 0.001) and the length of symptoms pre-operatively and return to training (Correlation coefficient = 0.383. p=0.048) and return to play (Correlation coefficient = 0.385. p=0.048). Return to training was significantly faster after soft tissue debridement with FHL release than after bony surgery (p=0.046 Kruskal-Wallis test). There was one surgical complication in the form of a persistent portal leakage. This was successfully treated by resting the ankle in a boot for 2 weeks. One patient had recurrent symptoms 3 months after surgery; this was successfully treated with an ultrasound guided injection. There were no infections and no neurovascular injuries. Conclusion: Posterior ankle arthroscopy is safe and effective in the treatment of posterior ankle impingement syndrome in the elite soccer player with return to training expected at an average of 5 weeks

Purpose: Posterior Ankle Arthroscopy (PAA) is a relatively new operative technique for a specific and under-recognized ankle problem, posterior ankle impingement. Prospective data on the old technique, posterior ankle arthrotomy, have shown an unacceptable high complication rate. Literature review on PAA found reports on surgical techniques and anatomical studies only. The purpose of this study was to perform a retrospective study, with short-term follow-up to determine the quality of life, function and clinical results after posterior ankle arthroscopy. Methods: Twenty-three patients underwent a PAA between 1998 and 2004 at our centre. Fifteen patients (16 PAA) were available for follow-up. They filled out the LEFS-score, the AOFAS clinical rating systems, the SF-12, 3 satisfaction scales and also underwent an examination of their ankle. Results: The mean follow-up time was 32 months (6–74 months). The mean age at time of surgery was 25 years (19–43 years). After surgery they spent on average two weeks on crutches needing pain medication for 1 week. The mean return to work was 1 month (0–3 months) and return to sport was 5 months (1–24 months). 94% of the patients returned to their preoperative level of sport. Complications included five patients with temporary numbness around their scar and one patient with temporary ankle stiffness. There were no permanent neurovascular injuries. The mean LEFS score at follow-up was 75 (65–80; best = 80). The mean AOFAS score was 91 (77–100: 100 = best). The mean SF-12 score was 51.80 PCS (30.77–60.53); 55,80 MCS (44.26–63.33). All reported they had improved after their surgery and would have the surgery again. Conclusions: Functional and clinical evaluations after a PAA revealed that all of the patients were very satisfied with the result and showed excellent quality of life. Posterior ankle impingement is an under-recognised clinical entity which now has an effective treatment available. Increased clinical focus on this condition may reveal a higher incidence associated with other diagnosis. We are currently evaluating patients pre and postoperative in a prospective study

A retrospective review of 57 military patients undergoing ankle arthroscopy between 1999 and 2011 was performed. A case-note review of medical records was undertaken pertaining to military role, ankle injury sustained, mechanism, presenting symptoms and their duration. Arthroscopic findings were compared to findings on radiographs and MRI scans. At first presentation 23 patients had features of arthritis on radiographs. We found MRI was both highly sensitive (97.7%) and specific (93.4%) in detecting osteochondral defects (OCD). 16 of the patients had evidence of osteochondral injury. All OCDs picked up on MRI were confirmed at arthroscopy. Ankle injury may not be a benign injury in military personnel, with over half of these young patients having radiological features of osteoarthritis at presentation. We found MRI an effective tool for identifying occult injuries not seen on radiographs. Lateral ligament injury with associated gutter scarring can be successfully treated with arthroscopic debridement. This suggests pseudoinstability rather than a true mechanical instability as the main cause for patient's symptoms in this cohort

Purpose: The aim was to determine whether intra-articular bupivacaine provides effective analgesia following ankle arthroscopy and whether it reduces the need for supplemental analgesia. Methods: A power calculation revealed that 40 patients were required to provide a 5% significant level using a visual analogue scale. 40 patients were therefore randomised to receiving 20 mls of either bupivacaine or saline (control) after routine anterior ankle arthroscopic surgery. The tourniquet was released 10 minutes later. In recovery, supplementary analgesia of 2 tablets of co-codomol 30/500 orally or 50–100mg tramadol IV was available on request. A 10 day supply of 50mg diclofenac (8 hourly) and co-codomol 30/500 2 tablets (6 hourly) was provided. A visual analogue scale (VAS) was employed as a direct indicator of pain and indirectly, supplemental analgesic requirement. Measurements were made pre-operatively and postoperatively. Age, weight and tourniquet times were compared with Mann Whitney U test and Chi-square. Pain scores and analgesic requirements were compared using ANOVA at a 5% significance level. Results: Pain scores were lower in the bupivacaine group compared to the control as was the need for supplemental analgesia. Significance: We conclude that postoperative intraarticular bupivacaine provides effective analgesia following ankle arthroscopy

Introduction: Arthroscopic management of posterior ankle impingement syndrome (PAIS) is now commonly practiced. Scanty information about the results of this procedure in a district hospitals is available.

Aim: We present the results of our series of patients treated with hindfoot arthroscopy for PAIS, and describe the complications encountered.

Patients and Method: Twenty procedures were performed on 19 patients (12 males, 7 females) between January 2006 and September 2008. Patients were followed up for an average of 7.9 months. Return to sport, patient satisfaction, relief of symptoms and the American Orthopaedic Foot and Ankle Society (AOFAS) hind-foot score were all assessed.

Results: Procedures performed included excision of an os trigonum, flexor hallucis longus decompression, and microfracture of the posterior talus. The average age of the patients was 35 years. Return to activity occurred at an average of 4 weeks. Four patients were dissatisfied, 1 was unsure and all the other patients were satisfied with their outcome. The average pre-operative AOFAS score was 73.8 and the post operative score was 84.5. There were no neurovascular injuries.

Conclusion: There was a significant incidence of dissatisfied patients in the absence of major complications. This might reflect technical difficulties early in the early learning curve for this procedure.

Between 1998 and 2007, fifteen patients with haemophilia A underwent 21 ankle arthrosco-pies+/− arthroscopic cheilectomy in order to attempt symptomatic relief of arthrosis and to increase the range of motion. All patients had severe degenerative changes radiologically.

Perioperative management was shared with our local dedicated Haemophilia service and the management algorithm will be presented.

Outcome data for pain and range of motion shows only moderate benefits.

Two patients had good relief of symptoms for 6 months. Two patients however chose to return for arthroscopies to the contralateral ankle and two had arthoscopies to the same ankle.

Follow up data is not currently available for 4 patients and the rest required fusion with a median time to fusion of 1 year.

Two patients had a documented increased range of motion, but one of these patients had an increased level of pain associated with the increased mobility.

There was 1 major complication, namely an aneurysm of the tibialis anterior artery.

Two patients had recurrent bleeds following surgery requiring ongoing and prolonged factor VIII treatment.

Average patient stay was 3.1 days, range 2 to 5 days and this stay is shorter for later years than earlier years.

The post-operative requirement for extra factor VIII ranged from 4 postoperative doses to 3 weeks ongoing treatment, median 10 doses. The average cost per dose was approximately £1128, giving a median cost of £11280 per case.

In summary, this procedure seems to be expensive in terms of QALY gains and has low rates of success in terms of function and pain relief.

Introduction. Acute ankle injuries are commonly seen in musculoskeletal practice. Surgical management is the gold standard for lateral ligament injury in those with failed conservative treatment for a minimum of six months. Several studies have shown good functional outcome and early rehabilitation after MBG repair with an internal brace augmentation which is a braided ultrahigh molecular weight polyethylene ligament used to enhance the repair that acts as a secondary stabiliser. Hence the aim of the study was to compare the results with and without augmentation. Methods. A single centre retrospective review conducted between November 2017 and October 2019 and this included 172 patients with symptomatic chronic lateral ligament instability with failed conservative management. The diagnosis was confirmed by MRI. All patients had an ankle arthroscopy followed by open ligament repair. Patients were grouped into isolated MBG and internal brace groups for analyses and all had dedicated rehabilitation. Results. A total of 148 patients were available for final follow up with 87 patients in the MBG group and 61 patients in the IBA group. Mean Age was 38 years and mean follow up was 22 months. The internal brace group showed better Manchester Oxford foot and ankle score (19.7 vs 18.2) and more patients returning to preinjury activity levels (73 vs 55) as compared to isolated repair. Conclusion. Internal brace augmentation with MBG repair facilitated early rehabilitation and return to pre injury activity level in majority of patients compared to isolated MBG repair

PURPOSE. Osteochondral talar defects (OCDs) are sometimes located so far posteriorly that they may not be accessible by anterior arthroscopy, even with the ankle joint in full plantar flexion, because the talar dome is covered by the tibial plafond. It was hypothesized that computed tomography (CT) of the ankle in full plantar flexion could be useful for preoperative planning. The dual purpose of this study was, firstly, to test whether CT of the ankle joint in full plantar flexion is a reliable tool for the preoperative planning of anterior ankle arthroscopy for OCDs, and, secondly, to determine the area of the talar dome that can be reached by anterior ankle arthroscopy. METHODS. In this prospective study, CT-scans with sagittal reconstructions were made of 46 consecutive patients with their affected ankle in full plantar flexion. In the first 20, the distance between the anterior border of the OCD and the anterior tibial plafond was measured both on the scans and during anterior ankle arthroscopy as the gold standard. Intra- and interobserver reliability of CT as well as agreement between CT and arthroscopy were assessed by intraclass correlation coefficients (ICCs) and a Bland and Altman graph. Next, the anterior and posterior borders of the talar dome as well as the anterior tibial plafond were marked on all 46 scans. Using a specially written computer routine, the anterior proportion of the talar dome not covered by the tibial plafond was calculated, both lateral and medial, indicating the accessible area. RESULTS. The distance between the anterior border of the OCD and the anterior tibial plafond ranged from −3.1 to 9.1 mm on CT and from −3.0 to 8.5 on arthroscopy. The intra- and interobserver reliability of the measurements made on CT-scans were excellent (ICC > 0.99, p < 0.001). Likewise, agreement between CT and arthroscopy was excellent (ICC=0.97; p < 0.001); only one patient showed a difference of more than 2.0 mm. The anterior 47.3 ± 6.8% (95%CI, 45.2–49.3) of the lateral talar dome, and 47.7 ± 7.0% (95%CI, 45.7–49.8) of the medial talar dome was not covered by the tibial plafond. CONCLUSIONS. Computed tomography of the ankle joint in full plantar flexion is an accurate preoperative planning method to determine the arthroscopic approach for treatment of OCDs of the talus. Almost half of the talar dome is directly accessible by anterior ankle arthroscopy

Advantages of arthroscopic surgery in orthopaedic practice are well documented. The use and scope of ankle arthroscopy has evolved in the last decade. Its role in both the evaluation and treatment of chronic ankle pain has become more important with identification of newer pathologies. We aimed to identify the indications and complications of ankle arthroscopy in chronic ankle pain and to correlate the arthroscopic findings with pre-operative MRI/CT. A retrospective analysis of all procedures done in our unit from 2005-2009. Patient records, X- rays and scans were reviewed. 77 patients were included in the study (46 male/31 female). The commonest age group was the 4. th. decade. There was a male preponderance in the younger age group (<50y), and a female preponderance in the older age groups (>50y). The commonest indication was impingement syndrome (44%/mean age 38y), followed by osteochondral lesions of the talus (23%/mean age 36y) and Osteoarthritis (22%/mean age56y). Other pathology included synovitis, Rheumatoid Arthritis, instability, AVN and combined pathologies. Pre-op MRI scans correlated with arthroscopic findings in 59%. The pathology most missed by MRI was impingement. 1 patient developed wound infection and another iatrogenic tendon rupture. 78% reported improvement in their symptoms following the procedure. Ankle arthroscopy is a safe and effective procedure. It is particularly useful in the diagnosis and treatment of impingement syndromes and osteochondral lesions. Although there are serious recognised complications, their incidence is low. Patients with chronic symptoms and normal MRI/CT may have treatable pathology on arthroscopy

Background: Ankle sprains are common with the majority resolving with simple measures. Some patients may have residual pain and instability caused by functional instability. Intraarticular scar formation has been implicated in these patients. Few studies have shown the effectiveness of arthroscopic procedure in treatment of this condition. Aim: Our aim was to assess the role of arthroscopy in functional instability of the ankle. Methods: We performed retrospective analysis of case-notes of patients who presented with functional ankle instability from 2005 – 2007 who had failed a trial of conservative therapy and who had ankle arthroscopy, provided there was no true instability as determined by EUA and stress xrays. Results: Out of 77 patients with a mean age of 38.1, 5 patients had true mechanical instability. They underwent open repair of the lateral ligaments and were excluded from the study. 21 had steroid injections which gave temporary improvement in 11 of them but eventually all of the 72 remaining stable patients underwent ankle arthroscopy. 67 (76.7%) had significant amounts of scar tissue present which needed debridement, most commonly in the antero- lateral corner (58.3%). 52 patients improved (72.2%), 20 patients (27.8%) did not improve. 2 patients suffered a superficial wound infection. 17 patients had an osteochondral talar lesion. Of these, 14 patients improved, 2 did not and 1 patient did not attend follow up. Outcome: Our study supports the role of arthroscopy in the treatment of functional ankle instability resistant to conservative treatment. Significant improvement in symptoms can be expected in about 70% of patients following arthroscopic debridement of scar tissue rising to approximately 90% if there is an associated talar osteo-chondral lesion. Ankle arthroscopy is associated with a low complication rate and should be offered to patients with functional instability when conservative measures have failed especially if an osteochondral lesion has been identified

Arthroscopy of ankle is becoming a common procedure for the diagnosis and treatment of ankle pain. Little information exists regarding the long term prognosis following ankle arthroscopy, particularly in avoiding further major surgery. The purpose of this study is to evaluate the prognosis of arthroscopic ankle treatment, based on survival analysis. Also we will formalise the relationship between the arthroscopic treatment and time for a further major ankle surgery. Type of study. Consecutive Case Series study using prospectively gathered data. Methods. Eighty consecutive patients (80 ankles) having ankle arthroscopy (between 1998 and 2000) with the finding of OA or impingement were identified and their outcome at five years ascertained. Results. Fifty-five (69%) patients had soft tissue impingement, and 25 (31%) patients had osteoarthritic degenerative changes. Seven (9%) patients had further major surgery (arthrodesis or arthroplasty) and 6 (8%) had repeat arthroscopy. The surgery was required for 7 arthritic ankles within five years of arthroscopic procedure. Survival analysis showed no statistical significance between those under 50 and those over 50 years in the OA group. Seven (28%) of osteoarthritic patients progress to major ankle surgery, within 5 years of arthroscopic treatment. None of the patients with impingement symptoms required further major surgery. Conclusion. Arthroscopically treated impingement ankles have an excellent prognosis, while osteoarthritic ankles have a less favoured prognosis, with a high proportion requiring further major surgery. Age does not affect prognosis in the OA group

Introduction: Osteochondral lesions of the talus may cause persistent joint pain requiring surgical treatment, which today can be performed arthroscopically. The purpose of this study is to evaluate the effectiveness of arthroscopic treatment of these lesions. Material and Method: Seventeen patients (7 males and 10 females) underwent ankle arthroscopy from 1998 through June 2002 for treatment of osteochondral lesions of the talus. Their age ranged from 11 – 68 years. The right talus was affected in 12 and the left in 5 patients. All but one had a history of previous trauma, for which they had been treated conservatively for at least 6 months. Bone scanning, CT and MRI were performed for lesion staging according to Brent and Harty. One patient was stage I, 2 were stage II, 7 were stage III, and 7 were stage IV. The patients underwent ankle arthroscopy without use of a distractor. Inspection of the joint was followed by shaving and debridement of the lesion with or without drilling. Results: Follow-up had a mean duration of 15 months (range 8 – 24 months). Outcome was evaluated with the Ogilvie-Harris score for pain, swelling, stiffness, limp and patient activity level. All patients had excellent or good results. In all cases there was a reduction in lesion size. Conclusions: Arthroscopy is effective for treatment of osteochondral lesions of the talus. It causes less morbidity than open surgery and patients are able to follow an early mobilization and rehabilitation protocol. However, specialized surgical tools, as well as an in-depth knowledge of joint anatomy are required to avoid iatrogenic damage

Background. MRI is the preferred modality for the diagnosis of ankle joint pathology. Musculoskeletal radiologists aim to determine and report both chondral and/or osseous stability/instability of each lesion. The aim of this study was to specifically analyse the reliability of MRI reported findings in predicting the stability of OCL's in symptomatic patients. Methods. A single centre, single surgeon consecutive series of patients who had undergone an ankle arthroscopy procedure preceded by an MRI scan for symptomatic ankle pathology were included in this retrospective clinical study. All MRI scans were reported by a musculoskeletal radiologist. MRI reports and arthroscopic findings were extracted and analysed. Arthroscopy findings were taken as the gold standard. Results. Between April 2012 and July 2016, 48 patients who fulfilled the above criteria were included. There were 27 male and 21 female patients, the average age was 43.4 (SD 14.1). The average time interval between MRI scan and arthroscopy was 9 months (2–49 months), 28 patients (58.3%) had a right sided pathology. There was a significant negative relationship between OCL's reported as stable on MRI to arthroscopic findings, r=−.31, p=0.03. Of the 21 patients who had OCL's reported as stable on the MRI scan, all had unstable lesions on arthroscopic evaluation (100%). One patient had an unstable OCL reported on the MRI scan and it was also found unstable arthroscopically. In 27 patients, where there was no mention of the stability of the reported OCL on the MRI, 22 patients (81.5%) had unstable lesions and 5 patients (18.5%) had stable lesions on intra-operative arthroscopic findings. Conclusion. This study demonstrates that MRI has a poor predictive value for the stability of OCL's of the ankle. Therefore we recommend that in the symptomatic patient an arthroscopy is indicated irrespective of MRI findings. Evidence. retrospective case review, level IV

Introduction:. The National Joint Registry has been capturing data on ankle replacement surgery since April 2010. This currently represents the largest cohort of ankles replacements captured worldwide and is a valuable resource to give us short term outcome of ankle replacement surgery. Methods:. All the ankle replacements on the NJR were linked to the HES database using deterministic methods. The results were then anonymised. We then looked at Hopital admissions after the ankle replacement had taken place. Results:. There were just over 1600 ankles on the NJR and linking to HES gave 2065 records. 1437 of these were relevant to TAR. There were 12 malleolar fractures post-op and 6 DVT/PE which required readmission. there were 49 reoperations other than revision, 12 of which were ankle arthroscopies, and 14 removal of metalwork. Conclusion:. Ankle replacement is a effective procedure but does carry with it the risk of short term reoperation

Ankle lateral ligament complex injury is common. Traditional ‘Brostrum’ repair, performed either open or arthroscopically, still has a protracted post-operative period. The ‘Internal Brace’ provides a scaffold for the ligament repair and acts as a ‘check-rein’ preventing further injury. 16 patients with ankle instability and injury to the Anterior-Talo-Fibular-Ligament (ATFL) confirmed on MRI were identified. All had completed a period of conservative treatment. All had symptoms of pain in the region of the ATFL and described a feeling of instability. Surgery was performed under general anaesthetic and regional popliteal block. Anterior ankle arthroscopy demonstrated a positive ‘drive through’ in all cases. The ATFL was absent and in the majority replaced by incompetent scar. Scar tissue was removed from the anterior aspect of the ankle allowing visualisation of the fibula and lateral talar neck. Using the Internal Brace system (Arthrex), a 3.5mm swivel-lock with fibre-tape was placed into the fibula. With the ankle in plantar flexion, to allow appropriate tensioning, the distal end of the fibre-tape was secured to the talar neck, at a 45 degree angle, with a 4.75mm biotenodesis screw. The patient was placed into a moon-boot for 7–10 days and mobilised fully weight-bearing. Pre-op score, using EDQ-5, MOXFQ, AOFAS and visual analogue scores, with post-op PROMS were performed. All patients reported improvement in their symptoms at 6 week visit. The majority were back to normal activities at 12 weeks. The few that were not, had missed physiotherapy appointments for various reasons. There were no infections and no implant failures. Arthroscopy allows direct visualisation for accurate placement of the Internal Brace. Post-operatively recovery is expedited due to the stability provided by the ‘Brace’, permitting a more aggressive rehabilitation programme. The greatest potential is arguably for the elite athlete, where an accelerated return to full activity has significant occupational implications