In-office needle arthroscopy for ankle impingement may lead to high patient satisfaction
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Published results showed in-office needle arthroscopy for treatment of anterior ankle impingement may reduce pain and yield low complication rates and excellent patient-reported outcomes.
“The ability of [in-office needle arthroscopy] to visualize ankle pathology has been enhanced with the ability to perform certain procedures with small-scaled instruments,” John G. Kennedy, MD, MCh, MMSc, FFSEM, FRCS (Orth), of NYU Langone Health, told Healio. “We can remove scar and bone for anterior impingement. We can implant a cartilage scaffold with stem cells all in the office for small chondral injuries. We can also perform ligament repairs in office that allow accelerated return to sport of professional and recreational athletes. This has implications for tendon injuries, as well as ligament and intra-articular injuries.”
Positive clinical outcomes
Kennedy and colleagues evaluated clinical outcomes among 31 patients undergoing in-office needle arthroscopy for treatment of anterior ankle impingement between January 2019 and January 2021 using the Foot and Ankle Outcome Scores (FAOS) and Patient-Reported Outcomes Measurement Information System (PROMIS) pain interference and pain intensity domains preoperatively and at final follow-up. Researchers also evaluated a five-point Likert scale regarding patient satisfaction with their in-office needle arthroscopy procedure at final follow-up. Researchers compared preoperative and postoperative outcome scores using the Wilcoxon signed-rank test.
At final follow-up, results showed patients had mean postoperative FAOS-reported symptoms of approximately 79.4, pain of approximately 82.9, daily activities of approximately 83.5, sports activities of approximately 71.9 and quality of life of approximately 64.3. Researchers found 84%, 77%, 75%, 74%, 65%, 61% and 42% of patients achieved the minimal clinically important difference for FAOS pain, FAOS symptoms, FAOS quality of life, FAOS sports, PROMIS pain interference, FAOS activities of daily living and PROMIS pain intensity, respectively.
Return to activity
Researchers noted 94% of patients expressed willingness to undergo the same procedure again. Among 20 patients who worked before the in-office needle arthroscopy, 100% reported return to work after the procedure at a median of 1.98 days, according to results. Researchers also found 96% of the 27 patients who participated in sports activity before the in-office needle arthroscopy returned to their sports activity at a mean of 3.9 weeks. Results showed three complications were reported after in-office needle arthroscopy.
“Many procedures can be performed using [in-office needle arthroscopy] and as the optics improve in tandem with instrumentation, it is likely that this portfolio of procedures will increase greatly,” Kennedy said. “Larger procedures will still require a formal operating room, but for many patients, visiting their ortho surgeon will be like visiting the dentist. Small procedures can be done on-site, allowing the patient to walk home and accelerate recovery times, while minimizing stress and health care costs.”
Perspective
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The future of foot and ankle surgery is minimally invasive procedures, and in-office nano-arthroscopy is a perfect example of where we are headed. In a cohort of 31 patients, the present study not only showed that ankle arthroscopy and anterior debridement was possible from a logistical standpoint in an office setting, but also successful at achieving excellent outcome scores, high patient satisfaction and minimal complications. Typically, ankle arthroscopy and debridement in the OR requires a regional nerve block for pain control, IV sedation, muscle relaxation and possibly general anesthesia depending on the institution. The ability to circumvent all these requirements using local anesthesia with a 1.9-mm nano-arthroscope and a 2-mm shaver and/or 3-mm burr and have patients awake the entire time and walk out of the procedure is nothing short of game changing.
As OR costs increase and surgical reimbursements decrease, the need for in-office procedures is higher than ever across all surgical fields. Nano-arthroscopy is already being used for second-look cartilage evaluations, small-joint procedures and tendoscopy of the foot and ankle at the present time, and now we can add anterior ankle impingement to its expanding list of uses. It is inevitable and incredibly exciting that we will continue to see a growing number of procedures and indications for nano-arthroscopy in the future as this minimally invasive technology is here to stay.
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