Arthroscopic foot and ankle surgery

David Redfern

Arthroscopy or keyhole surgery is an essential tool in the treatment of sports injuries and arthritis in joints. We asked David Redfern, an orthopaedic surgeon who specialises in foot and ankle problems, to tell us more.

What exactly is keyhole surgery?

“Keyhole surgery allows surgeons to carry out procedures in a joint without having to make large incisions to gain access and see what is going on. The joint is visualised using a tiny fibre optic camera – less than 0.5cm in diameter – which is inserted through very small incisions called portals. The surgeon can then see inside the joint on a high definition screen in the operating theatre. Miniature instruments are then introduced into the joint through another keyhole or portal. These highly specialised instruments are powered and operated by the surgeon using a foot pedal. A high level of surgical skill is needed to operate in three dimensions guided by a two dimensional image on the screen.”

How long has keyhole surgery been carried out?

“A very basic form of “keyhole” surgery can be traced back to about 1800, but it did not progress very much until the invention of the small light bulb 100 years later. But it was really in the 1980’s with the development of miniaturised technology and more recently, fibre optics, that the door has truly been opened on this highly specialised type of surgery.”

What conditions can be treated with keyhole surgery?

“Keyhole surgery can be performed for a wide variety of problems, from operations on cartilage and inflamed or scarred joint lining to major joint reconstruction and fusion. Even tendons can now be accessed using this technique. Arthroscopy of the ankle is often performed for chronic ankle problems following a sprain or injury.”

What are the benefits of keyhole surgery?

“Because keyhole surgery is less invasive, only a very small area of the body is cut into and needs to heal. This means that patients will recover a lot quicker and will be able to bear weight on the affected foot sooner than they would after open surgery. There are usually less post operative complications and less scarring. Patients do not need to stay so long in hospital – in fact most keyhole procedures can be performed as day cases.”

Are sports injuries treated by keyhole surgery?

“Indeed they are – in fact it’s often better to treat sports injuries using keyhole techniques where possible, as it usually means an earlier recovery and return to sport, as well as fewer and less frequent complications. Magnetic Resonance Imaging (MRI) has become a very useful tool to help diagnose sports injuries and to plan any surgery. After the operation, the patient is usually allowed to walk on the operated foot immediately and is often able to return to training and sports after two weeks depending upon the type of surgery performed.”