Q. Why am I experiencing ankle pain after two years of arthroscopic surgery?

Answered by
Dr. Akshay Kumar Saxena
and medically reviewed by iCliniq medical review team.
Published on Jan 10, 2017 and last reviewed on: May 27, 2019

Hello doctor,

About two years back, I had an arthroscopic surgery (OCD MTD) for my ankle because of a previous injury. At first, my ankle got better, but now it is starting to get worse. As I am experiencing a lot of pain and difficulty in walking, I got an MRI done. Please see the results. Can you tell me what they mean?

Dr. Akshay Kumar Saxena

Orthopedics And Traumatology Spine Surgery
#

Hi,

Welcome to icliniq.com.

  • As you have only mentioned about the arthroscopic ankle surgery and have not provided the details, it is difficult to comment on your problem. I do not have the details of what surgery was done in your case as in was there an attempt to fill the defect. So, it will be better if you can kindly send me the details of the surgery done like discharge papers, etc.
  • Your current MRI (attachment removed to protect patient identity) shows that the defect is still there, along with that you also have a chronic anterior talofibular ligament (ATFL) injury which also needs attention.
  • I can suggest you better if you can send me following documents, like the recent MRI ankle images, clinical pictures of your affected ankle with the range of movement of the involved joint, the x-ray of the affected ankle in the anteroposterior and lateral view and your previous hospital papers.
  • Once I have all the details, I can then see them and advise you accordingly. Till that time my advice for you will be to have an intensive physical therapy for your ankle along with anti-inflammatory medications which suit you.
  • Have adequate Calcium and Vitamin D to keep bone metabolism healthy. Have a protected weight bearing like the use of pneumatic air walker if walking is painful. 

The Probable causes:

Previous injury.

Investigations to be done:

1. MRI images.
2. X-rays and clinical pictures.

Regarding follow up:

Revert back with the details to an orthopaedician and traumatologist online.---> https://www.icliniq.com/ask-a-doctor-online/orthopaedician-and-traumatologist

Thank you doctor,

As the surgery was over one year ago, I do not have more details regarding it. The doctor did an arthroscopy to restore cartilage. He took out all of the small bone fragments that were floating. I will upload my MRI results before and after the surgery.

Dr. Akshay Kumar Saxena

Orthopedics And Traumatology Spine Surgery
#

Hi,

Welcome back to icliniq.com.

  • I have gone through your images (attachment removed to protect patient identity) and it seems that debridement of the crater, some drilling and some substance like glue has been used for the defect and this is not a natural cartilage. It is hoped that such a surgery will lead to some fibrocartilage formation which will smoothen the defect and make movements easier and painless.
  • Now, it has happened in your case. Although there is a defect visible, I am sure that it is better than the preoperative status.
  • Since you are still having pain, we would like you to undergo protective weight bearing on the affected ankle by using a long leg cast or a long leg pneumatic walker. This regimen has to continue till you become pain-free.
  • Intensive physical therapy needs to be continued to prevent ankle stiffness. Avoid any sporting activities or any high impact exercises till you become pain-free, so as to prevent further damage to the injured and operated area.
  • I would like to see your ESR (erythrocyte sedimentation rate) and CRP (C-reactive protein) levels to rule out any possibility of infection since there is still a considerable edema even one year after surgery.
  • The defect seems to be filled up and is relatively smooth, so if the bone edema subsides your pain should decrease. Alternatively, the pain will persist till adequate fibrocartilage is formed.
  • You can also add chondroprotective agents like Rosehip extract, MSM (Methylsulfonylmethane), glucosamine, etc., although their role is doubtful.
  • Lastly, re-surgery can only be considered if all such conservative measures fail and you still have pain on the affected joint.

For further information consult an orthopaedician and traumatologist online --> https://www.icliniq.com/ask-a-doctor-online/orthopaedician-and-traumatologist

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