ARTHROSCOPIC TREATMENT OF ANKLE DISORDERS WITH LASER - INDICATIONS, TECHNIQUE AND FIRST RESULTS

As in the knee joint, lasers can be used during ankle arthroscopy for their resective and ablative properties. Reports on arthroscopic treat ment of degenerative and post-traumatic disorder of the ankle by conve ntional techniques are encouraging. We have used laser in ankle arthro scopy in three main situations: (1) When exuberant scar tissue from pr evious capsule-ligamentous damage (e.g. after ankle sprain) symptomati cally restricts range of motion and causes pain (ankle impingement). L aser is used in this case at middle energy, as a resector. (2) In the presence of cartilaginous lesions, as in osteoarthritis, flake fractur es or osteochondrosis dissecans. Here laser is used at lower energy to reshape the cartilaginous surface without resective effect (''welding ''). (3) When impaired range of motion is due to osteophytic rims, mai nly at the anterior tibia, resulting from previous capsular lesions. L aser is then used at high energy to cut excessive bone. A series of 16 patients underwent ankle arthroscopy at our clinic, mainly for post-t raumatic disorders, including impingement, osteochondrosis dissecans a nd osteoarthritis. The most frequently encountered intraarticular find ings were impingement by post-traumatic synovitis and scar tissue of t he antero-lateral and postero-lateral compartments, with or without an osteophytic rim of the distal anterior tibial border. Scar tissue, sy novitis and osteophytes were debrided in half of the patients purely m echanically (with arthroscopic scissors or shaver) and in the other ha lf with the holmium laser. The results are encouraging; 50% of patient s had no symptoms at all at follow-up (9.5 months on average), and ano ther 38% were satisfied with a significant improvement. In two cases, no improvement at all occurred: one patient complained of persistent p ain with lack of objective findings and is believed to have developed ''insurance neurosis.'' The other had severe postinfectious osteoarthr itis that was operated too late in the course to influence pain positi vely. Concerning the clinical, functional and subjective follow-up res ults there was no relevant difference between the two groups. We recom mend ankle arthroscopy to treat post-traumatic impingement syndromes o f the antero-lateral, antero-medial and postero-lateral compartments o f the ankle joint; the use of lasers seems to have a slightly better a nalgetic effect, allows an easier approach than is the case with shave rs or other bulky arthroscopic resectors, and allows shaping of convex resection surfaces, which cannot be performed with a shaver.