Positioning

Loose bodies localized in the anterior compartment can be approached with a routine setup of anterior ankle arthroscopy.  In case of tight ankle ligaments, joint distraction may be necessary to reach the fragment(s). 

Instruments

Arthroscopic Equipment

A 4.0 mm and 2.7 mm arthroscope with 30° obliquity can be used for ankle arthroscopy. The new small diameter short arthroscopes yield an excellent picture that is difficult to distinguish from a standard 4 mm scope. The small diameter arthroscope sheath, however, cannot deliver the same amount of irrigation fluid per time as the standard sheath. This is an important drawback when motorized instruments are used, as in these cases an adequate amount of irrigation is beneficial. In the author's opinion, for routine arthroscopic procedures such as anterior impingement syndrome, loose body removal, treatment of synovitis and the vast majority of osteochondral defects, it is beneficial to use the 4.0 mm arthroscope. A 2.7 mm arthroscope should be used only for osteochondral defects of the posterior talar dome (less than 8% of all osteochondral defects in the ankle joint), pathology of the articular part of the tibiofibular joint (intrinsic syndesmosis), such as a soft tissue impediment or impremated ossicles or loose bodies, posterior ankle problems that are treated by an anterior approach, and patients without a pre-operative diagnosis. But even in these cases we use the 4.0 mm arthroscope; the scope stays in front, and with the 30 degree angle we can inspect the ankle joint.

Irrigation

Different fluids can be used for arthroscopic irrigation during arthroscopy: normal saline, glycine or Ringer’s lactate. When a 4 mm arthroscope is used, gravity inflow is usually adequate if the fluid is introduced through the arthroscope sheath. When a 2.7 mm arthroscope is used, the gravity inflow should be introduced through a separate cannula. Alternatively an arthroscopic pump can be used. 

Instrumentation

For treatment of loose bodies, a bonecutter shaver, graspers and a  small periosteal elevator can be useful. 

Portals

For removal of loose bodies in the anterior compartment, in most cases the standard anteromedial- and lateral portals can be used. Sometimes additional inferior anteromedial- and lateral portals can be useful. Please click HERE.