Surgical Procedure
We start the procedure with the scope in the lateral- and the shaver in the medial portal. With the opening of the shaver onto the medial talus, scar tissue is removed.
The talar component comes into view.
More proximal the inlay is now visible.
The ankle capsule is removed.
Medially the soft tissue between medial malleolus and talus is removed.
A reflection of the scope is visible in the talar component of the ankle prothesis.
Soft tissue in the posteromedial area is removed.
On plantar- and dorsiflexion excess soft tissue is visible.
Scar tissue medial to the tibia component is removed using a punch.
Scar tissue and excess bone is removed medial from the talar component.
Make sure that the opening of the shaver is not pointing at the prosthesis in order to prevent damage to metal or inlay.
Reflection of scope onto the talar component of the ankle prothesis.
Now the shaver is placed below the medial malleolus to remove bony impingement.
Reflection of the arthroscope can make orientation very challenging.
With the ankle in plantarflexion and some distraction it is possible to look to posterior.
With plantar- and dorsiflexion it is again psossible to see if sufficient impinging bone or tissue is removed.
The medial malleolus needs to be reduced to prevent recurrent complaints of impingement. The opening of the shaver is aiming at the bone.
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The tip of the medial malleolus is reduced.
The ankle is moved to see if there is remaining impingement.
A remaining osteofyte is removed.
End- result.
Bonus image: reflection of the arthroscope.