Ankle arthroscopy using the Smith and Nephew Guhl non-invasive ankle distractor
Subscribe to get full access to this operation and the extensive Foot Surgery Atlas.
Watch the overview
Learn the Ankle arthroscopy using the Smith and Nephew Guhl non-invasive ankle distractor surgical technique with step by step instructions on OrthOracle. Our e-learning platform contains high resolution images and a certified CME of the Ankle arthroscopy using the Smith and Nephew Guhl non-invasive ankle distractor surgical procedure.
Modern ankle arthroscopy was popularised by amongst others James Guhl in the United States in the eighties and is now a common place intervention in most Foot and Ankle surgeons repertoires.
Many of the pathologies which cause symptoms in the ankle are soft tissue in origin and poorly imaged by MRI. A normal scan should definitely not be a reason not to intervene in a joint that has failed to recover and which has well localised and congruent symptoms. Ankle arthroscopy has a significant role in the treatment of the post traumatic joint (after fracture or severe sprain) as well as early ankle arthritis from any cause.
There are a variety of portals described for ankle arthroscopy but the vast majority of pathology in almost every intra-articular location in my experience can be dealt with through the basic antero-lateral and antero-medial portals described in this technique. The keys are having appropriate portal placement and a wide enough range of appropriately sized (and angled) instruments. Posterior ankle arthroscopy is a different beast for different indications and demonstrated by Nick Cullen from Stanmore elsewhere on OrthOracle at Posterior Ankle decompression-Arthroscopic technique . A comprehensive review of the range of other portals is to be found in the paper by Ferkel & Scranton (Current concepts review:Arthroscopy of the Foot & Ankle. J Bone Joint Surg.1993. 75-A:1233-1242. R.D.Ferkel , P.E.Scranton) or any of James Guhls instructional works.
Instantaneous recovery never occurs after an ankle arthroscopy despite instantaneous removal of the causative pathologies. The joint linings need to heal just as any operated soft tissues and this may take 6-12 weeks, condition dependent. Full recovery after microfracture of osteochondral defects is longer again in most cases by another couple of months.
The set up and detailed technique described here is basically the one taught to me by Paul Cooke during my fellowship in Oxford fifteen years ago. My guess is he worked most of the tricks out himself, but some may just originate from elsewhere.
Watch the full instructional video for this technique by subscribing.
Author:Mark Herron FRCS.
Institution: The Wellington Hospital, London, UK.
- Each operation and the questions associated become a named course in the CPD section
- The operative technique itself is read as a lesson as is any company implant information if this is being assessed.
- You’ll need to tick the box to confirm this has been done and can do this immediately if you have already read the op tech.
- The vast majority of operations have a 10-15 MCQ quiz covering all aspects of the decision making and the technique
- There are four possible answers of which one is correct (or on occasion more correct) than the others.
- There are additional quiz modules on the surgical steps, the implants and problem cases being added continually
- The course is completed once all the lessons are read and quizzes submitted and passed.
- On successful completion of each quiz you will receive validated CPD points that add to the certificate in your CPD folder.
- Your dashboard also will contain a record of the time you have spent logged onto and using the site.
- The timer suspends after 5 minutes though if there is no activity.
- When you restart you will resume at the same point in the module.
- Once you have completed each quiz you will need to feedback on the module first then click “submit” and your paper will be marked.
The pass mark is 75%.
- If you fall below this level you will be directed back to re-read the slides where you’ve tripped up.
- Once these have been read you can re-do just the questions you failed on.
- Once you have passed the quiz you can return at a future stage & resit .
- Operation Quiz – 1 CPD point
- Surgical steps Quiz – 1/4 CPD point
- Implants Quiz – 1/4 CPD point
- Problem case Quiz – 1/2 CPD point
One CPD point equates to one hour of academic activity
Welcome to the Professional Development question section. The objective of taking these tests is to demonstrate that you have understood all aspects of the assessment and management of patients requiring surgical intevention. On successful completion you will receive a certificate accredited by both the Royal College of Surgeons of both England and Edinburgh as well as the British Orthopaedic Association.
Our content is designed for both Surgeons in independent practice and Surgeons in training.