Arthroscopic ankle fusion - operative indications

For iscolated ankle arthritis arthroscopic ankle fusion has few absolute contraindications. The congruent joint surfaces produced allow early protected weight bearing. The minimal soft tissue disruption yields pain which is short lived. Also poor soft tissue areas such as skin graft or flaps (avoiding the pedicle) can be safely operated through.

In terms of the degree of deformity which can be easily dealt with arthroscopically, more relevant is whether the deformity is fixed or not . If passively correctable then no special techniques are required and any degree can be corrected. If dealing with larger fixed deformites (varus or valgus) asymmetric removal of bone is required. In the fixed varus ankle medial malleolar hypertrophy should be recognised and dealt with by clearing the medial gutter adequately. If required the medial malleolar tip or medial talar wall can also be removed through a slightly enlarged medial portal under direct vision with osteotomes.

An equinus deformity is not easily dealt with intra-articularly and an Achilles release is likely to be required. This is different from an open fusion where the amount of bone remove produces often enough soft tissue slack to allow correction or where the flat cuts easily can have some dorsiflexion dialled in.