AANA Fellowship Education - Ankle Arthroscopy, Ankle Instability, Talar OCDs, Achilles Ruptures: What Every Sports Physician Should Know-Ankle Arthroscopy, Ankle Instability, Talar OCDs, Achilles Ruptures: What Every Sports Physician Should Know

Video Transcription

Video Summary

The webinar on ankle arthroscopy and sports-related ankle conditions featured leading foot and ankle orthopedic surgeons discussing key aspects of diagnosis and treatment. Dr. Holly Johnson provided an overview of ankle and subtalar arthroscopy, emphasizing broad indications such as impingement, osteochondral lesions, fractures, arthrodesis, and instability. She detailed patient positioning, portal placement, careful tissue handling, and use of minimal distraction during procedures while warning about potential nerve and cartilage injury risks. Diagnostic arthroscopy is critical for visualizing cartilage and soft tissue impingements.<br /><br />Dr. Michalis Hogan focused on osteochondral lesions of the talus, highlighting their distinct cartilage characteristics and the importance of advanced imaging like MRI and CT. Conservative treatment has limited success (~50%), and bone marrow stimulation techniques such as microfracture remain first-line for small lesions (<10-15 mm). Biologic augmentation with bone marrow aspirate concentrate (BMAC) can improve healing and outcomes, though long-term durability of fibrocartilage repair remains a concern.<br /><br />Dr. Eric Giza reviewed lateral ankle instability, stressing understanding ligament anatomy and dynamic stabilizers like the peroneal tendons. After initial conservative management with RICE and bracing, persistent mechanical or functional instability may warrant surgical repair. Modified Brostrom repair, often augmented with internal brace or peroneal tendon tissue, is the standard, with arthroscopic approaches suitable for less severe cases. Addressing concomitant impingement and subtalar joint pathology is important.<br /><br />Dr. Robert Anderson discussed acute Achilles tendon ruptures in athletes, advocating minimally invasive mini-open repair techniques (e.g., PARS system) to restore tendon tension, reduce complications, and enable early rehab. Open repairs carry higher complication risks. Post-op protocols involve staged weight bearing and controlled ankle motion to prevent elongation and optimize return to sport.<br /><br />Case discussions reviewed management of complex intra-articular loose bodies, multi-ligament ankle instability with osteochondral lesions, and chronic non-insertional Achilles tendinopathy requiring reconstruction and possible allograft augmentation.<br /><br />Overall, the webinar underscored that tailored arthroscopic and minimally invasive surgical approaches, combined with biologic augmentation and careful rehab, optimize outcomes in sports-related ankle pathology. Comprehensive assessment, including subtalar joint evaluation, and individualized treatment plans are essential for successful management.

Keywords

ankle arthroscopy

sports-related ankle conditions

osteochondral lesions

ankle instability

Achilles tendon rupture

minimally invasive repair

biologic augmentation

microfracture technique

subtalar joint pathology

arthroscopic surgical approaches