When Is Ankle Arthroscopy Indicated in Ankle Instability?

Ankle sprains are among the most common injuries encountered in work and sport, with well over 2 million individuals experiencing ankle ligament trauma each year in the United States. Although most of these respond well to conservative management, acute ankle sprains are frequently associated with pathology resulting in chronic symptoms, including pain and instability, which persist beyond the expected recovery period. Although it is generally accepted that arthroscopy can be very helpful in the diagnosis and treatment of many ankle injuries and joint disorders, there is still some controversy regarding specific indications and effectiveness for its use. Given that these therapeutic and diagnostic indications are still being defined, the purpose of this article was to review the use and indications of arthroscopy or periarticular endoscopy as an adjunct to treating ankle instability at the time of open ligamentous stabilization. Ankle arthroscopy before lateral ligaments reconstruction will aid the surgeon in assessing for additional damage while conferring minimal additional time or morbidity. Surgically amenable lesions (ie, chondral lesions, loose bodies, associated instabilities, synovitis, impingements, ossicles, and peroneal tendon pathologies) can then be addressed, and the patient can be more accurately counseled regarding the condition of his ankle. Although it is likely that preoperative arthroscopy will improve outcomes in surgically stabilized ankles, there is a lack of controlled prospective studies that can truly assess its efficacy.