Intra-articular Fibrous Tissue Formation Following Ankle Fracture: The Significance of Arthroscopic Debridement of Fibrous Tissue

Purpose: The purposes of this study were to understand the clinical consequences of arthrofibrosis following surgical reduction of ankle fractures and to examine the effectiveness of arthroscopic debridement. Methods: Subjects included 33 patients (26 males, 7 females) aged 14 to 78 years (mean, 40.2 years) who had undergone open reduction and internal fixation of ankle fractures between May 2000 and May 2003. Arthroscopic examination was performed at the time of implant removal after an average of 12.4 months (range, 6 to 43 months), and abnormal fibrous tissue, when present, was removed through arthroscopy. The mean follow-up period after arthroscopy was 43.7 months (range, 22 to 68 months). Clinical outcomes before and after arthroscopy were evaluated with the American Orthopaedic Foot and Ankle Society scale and our own functional evaluation method. Arthroscopic findings, including the degree of articular cartilage damage and the quantity of fibrous tissue, were scored on a 3-point scale. Results: Functional deterioration of the ankle joint was observed in 27% of subjects. Arthroscopy showed articular cartilage damage in 33% of patients and arthrofibrosis in 73%. In patients with functional deterioration, the rate of articular cartilage damage was 78%, and arthrofibrosis was present in all cases. Furthermore, when extensive fibrosis and impingement on the articular surface were present, 88% of patients showed impaired articular function. Arthroscopic debridement of fibrous tissue resulted in improved articular function in 89% of patients with functional deterioration of the ankle joint before arthroscopy. Conclusions: Arthrofibrosis following ankle fracture causes an unfavorable surgical outcome, and arthroscopic debridement of fibrous tissue is an effective means of improving articular function. Level of Evidence: Level IV, therapeutic case series.