AANA Lab Course 908-Foot and Ankle Arthroscopy (APEx)-MIS in Ankle Fractures_ When Is Less More

MIS in Ankle Fractures_ When Is Less More_-Peter Mangone, M.D.

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Dr. Peter G. Mangone’s June 2019 AANA Foot & Ankle Scope Course presentation advocates for the use of arthroscopy and minimally invasive surgery (MIS) in the treatment of ankle fractures, emphasizing biological benefits and improved clinical outcomes. Traditional open surgeries involve large incisions and extensive soft tissue disruption, leading to increased pain, swelling, and delayed healing. Arthroscopy allows better visualization of cartilage and ligament injuries (including the posterior malleolus and syndesmosis), which are often underestimated by imaging alone.<br /><br />The presentation highlights that cartilage damage severity largely determines outcomes, with displaced fractures with articular impaction showing worse prognosis. Arthroscopy permits detection and treatment of occult injuries (e.g., talar dome osteochondral defects, syndesmosis instability, deltoid ligament tears), enabling more accurate fracture management and soft tissue repair.<br /><br />Syndesmosis malreduction is a critical issue; arthroscopy provides a more sensitive assessment than x-rays or stress radiographs and can guide precise reduction, reducing malreduction rates. The deltoid ligament’s role is also underlined, suggesting that its acute repair during ORIF may improve stability and reduce chronic pain, a shift from traditional approaches that often left the deltoid unaddressed if medial mortise appeared congruent radiographically.<br /><br />Dr. Mangone presents case studies demonstrating arthroscopy’s role in detecting residual instability and guiding ligament repair, which resulted in symptom resolution and early return to function. He argues for a new paradigm of early range of motion and weightbearing postoperatively after anatomical repair of both bony and ligamentous injuries, paralleling protocols from other joints and equine medicine principles.<br /><br />The talk encourages surgeons to incorporate arthroscopy skills gradually, building experience to enhance diagnosis, fracture reduction accuracy, and soft tissue management. Arthroscopy and MIS techniques are positioned as the future standard for ankle fractures, improving biological healing and functional outcomes while minimizing soft tissue damage.

Keywords

arthroscopy

minimally invasive surgery

ankle fractures

cartilage injuries

syndesmosis instability

deltoid ligament repair

fracture management

soft tissue repair

malreduction

early weightbearing