Complications in ankle arthroscopy

Over the last few decades there has been great progression in the use of
arthroscopic surgery of the ankle joint. It has become an important diagnostic
and therapeutic surgical tool for the detection and management of both acute
and chronic ankle problems. Ankle arthroscopy allows direct visualisation of
the important structures within the ankle joint without wide arthrotomy or
malleolar osteotomy. This results in decreased morbidity and faster
rehabilitation. Contrary tot the belief that ankle arthroscopy is *no problem
surgery*, literature reports an average complication rate of 10%.
To decrease the amount of complications, it is necessay for surgeons to know
what type of complications occur and when they arise, and furthermore, which
complications give permanent complaints. Therefore it is important to find out:
- the percentage of permanent complications after ankle arthroscopy;
- the type of permanent complications after ankle arthroscopy;
- the initial complications after ankle arthroscopy that resolve;
- after which arthroscopic procedures do complications arise.

To asses the percentage of permanent complications after ankle arthroscopy, and
to assess the type of complications and the procedures after which the
complications occur.

From July 1987 to December 2005, 1305 consecutive ankle arthroscopies and
endoscopies were performed at the University Hospital of the University of
Amsterdam. The procedures were performed by 33 orthopaedic surgeons and
residents, at a single surgery centre, using various techniques. Data from
medical charts, including surgery reports, of all patients undergoing ankle
arthroscopy or endoscopy were collected. These were grouped as to diagnosis and
treatment. Forty-five complications in 45 patients were identified. These
patients will be asked, by means of a written invitation, to visit the
outpatient department of the Academic Medical Center for clinical examination.
Patients willing to participate in this study, will sign an informed consent
form before clinical examination takes place. Neurological complications will
be assessed by standardised neurologic physical examination. Other
complications will be assessed dependent on their type. Additionally,
examination of the operated ankle will take place using the AOFAS ankle score
(appendix 1). The AOFAS Score is an outcome measurement endorsed by the
American Orthopedic Foot and Ankle Society. The score is a clinical rating
system designed to look at ankle and hindfoot function in a given patient. The
maximum score is 100, with the higher score indicating better post-surgery
joint function. The measurement is designed to assess pain (40 points),
function including movement (50 points) and alignment of the hindfoot and ankle
(10 points). Arthroscopy end results are not a part of this study and AOFAS
ankle scores will not be compared to scores of patients without a complication.
However, information of the AOFAS ankle score will give an indication of
overall ankle function in patients with a complication after arthroscopy.

The extent of the burden for the participant is estimated to be low: he or she
will once shortly visit the outpatient department for physical examination. No
invasive examination like X-rays or other will take place.