Total ankle arthroplasty (TAA) is gaining in popularity, with the main objective to restore a pain-free mobile and stable ankle and is hoped to solve the long-term problems associated with ankle arthrodesis. Residual pain is not uncommon after TAA, and most is located at the medial gutter with bony impingement as the frequent cause. In this Technical Note, the technical details of arthroscopic decompression for medial ankle impingement after total ankle arthroplasty is described. It has the advantage of earlier weightbearing, faster recovery and less risk of periprosthetic infection.
Technique Video Video 1 Arthroscopic decompression for medial ankle impingement after total ankle arthroplasty of left ankle. The patient is in supine position with a triangular supporting frame (Innomed) under the knee to keep the knee flexed. With the anterolateral portal as the viewing portal and the anteromedial portal as the working portal, the fibrous tissue at the medial gutter and around the prosthesis is dissected out with an arthroscopic probe and resected with an arthroscopic shaver. The tip of medial malleolus and the bony prominence of medial talar facet is resected. The medial malleolus facing the total ankle prosthesis is debulked. The fibrous tissue and inflamed synovium around the metallic back plate is resected. The arthroscope is then switched to the anteromedial portal and the remaining part of the prosthesis and lateral ankle gutter is examined.