High Hopes for Ankle Scopes

Ankle injuries can be difficult to diagnose. The ankle itself is very complex with many bones in a small space. The two lower leg bones form the top of the ankle joint. The large shinbone is called the tibia; the small bone next to it is the fibula. The lower end of these two bones is connected by four ligaments. Together, these four ligaments form a structure doctors refer to as the syndesmosis.

Doctors often use X-rays to look for fractures in the anklebones. Even with two different views of X-rays, it isn’t always clear what’s wrong. Sometimes a bone in the ankle can be broken, but the ligaments that make up the ankle syndesmosis are not damaged. Other times, there can be a bone fracture, and the syndesmosis is also torn. In these cases, the X-rays sometimes show an abnormal separation between the tibia and fibula. Providing the right treatment depends upon the right diagnosis.

Doctors now have a new way to look inside the ankle joint. They can use an arthroscope, a tiny TV camera that can be placed inside the ankle to see the bones and ligaments directly. The arthroscope helps doctors see if any structures are broken or torn.

Doctors wanted to make sure that using an arthroscope to check for syndesmosis problems (compared to just an X-ray) is worth the risk. One group of doctors was able to study 38 people with ankle injuries. Doctors checked the accuracy in diagnosing syndesmosis problems by comparing arthroscopy to two different X-ray angles.

Is it worth the extra expense and risks to use arthroscopic examination for injuries in the ankle syndesmosis? Yes, definitely! The arthroscopic exam was 100 percent accurate in showing both bone fractures and syndesmosis injuries. By comparison, X-rays were accurate less than half the time (48 percent) for one view and only 64 percent for the second view.

Ankle arthroscopy provides a view of the ankle that allows doctors to see if anything is broken. It is also superior to X-rays for showing if an injury has occurred in the ankle syndesmosis. Making the correct diagnosis ensures that patients get the best treatment right away.