Left ankle arthroscopy

PREOPERATIVE DIAGNOSIS:  Left ankle gout, possible ankle impingement synovitis.

POSTOPERATIVE DIAGNOSES:

1.  Ankle impingement mild.

2.  Osteochondrotic lesion lateral aspect of talus with associated synovitis.

3.  Mild arthritis.

OPERATION PERFORMED:  Left ankle arthroscopy with

1.  Debridement of OCD lesion.

2.  Major synovectomy.

3.  Injection of ankle with Marcaine postoperatively.

BLOOD LOSS:  Minimal.

FLUIDS:  Crystalloid.

COMPLICATIONS:  None.

INDICATION FOR SURGERY:  The patient is a gentleman with left ankle pain and swelling.  Risks, benefits, and alternatives were discussed with the patient.  He wished to proceed with surgery.

PROCEDURE IN DETAIL:  The patient was identified, brought to the operating room, and placed in supine position on the table.  After induction of general anesthesia, the left ankle was sterilely prepped and draped.  Ankle inflated with saline.  Portal sites established.  We exsanguinated the leg and inflated tourniquet to 300 mmHg.  The medial and lateral portals were established carefully.  Blunt dissection to the capsule.  We protected the superficial peroneal nerve branches.  On inspection of the ankle joint, noted to have some arthritis on the distal talus as well as along the medial malleolus and lateral malleolus.  There was evidence of hypertrophic impingement lesion and synovitis diffuse throughout the ankle.  There was no evidence of an obvious loose body.  We went ahead and using a full-radius resector, debrided the synovitis throughout.  There was a chondral lesion along the lateral talar dome and this was resected, and smoothed using combination of the ArthroCare type device as well as the shaver.  ArthroCare was used for hemostasis.  All instruments removed from the ankle after we inspected both medial and lateral aspects completely.  Of note, the posterior talar dome was grossly intact.  At this time, portal sites were closed with simple nylon sutures, injected with Marcaine as well as the ankle following closure.  The patient tolerated the procedure well.  Tourniquet was deflated approximately 30 minutes.  Please note my assistant was essential during this case.