Keyhole (arthroscopic) ankle surgery in Mumbai

What this operation is

Ankle arthroscopy is not one operation. It is a way in — a camera through one small incision, fine instruments through another, and the problem treated while I watch it on a screen. What I actually do once I am inside depends entirely on what is wrong.

That distinction matters more than it sounds, because it changes the question worth asking. Not “does ankle arthroscopy work?” — that question has no single answer, and anyone who gives you one has flattened six different problems into an average. The useful question is: which of them do I have, and is mine one this helps?

Six things bring people to me for it.

• A pinching pain at the front of the ankle.
• Pain deep at the back when you point the foot down.
• A patch of damaged cartilage.
• An inflamed joint lining.
• Loose fragments floating in the joint.
• And an ankle that keeps giving way.

The evidence behind each is different — genuinely strong for one of them, thin for another — so this page takes them one at a time.

I perform around 150 to 200 of these at the front of the ankle each year, and 80 to 100 at the back. Those are figures from my own records, averaged over the last three to five years, not an estimate.

Why this operation is done

An arthroscope is a thin telescope with a camera. Through two small incisions — called portals — it lets me see inside your ankle directly, magnified, and treat what I find in the same sitting.

The reason that matters is that the ankle is a tight joint with very little room. Problems that are obvious once you are inside it can be difficult to be certain about from the outside, and several of them are mechanical: something is physically in the way, or something has come loose, or a surface has broken down. Those are problems you fix by getting to them, not by waiting.

Pinching at the front of the ankle (anterior ankle impingement)

A blocked, pinching pain at the front of the ankle when you squat, walk up a slope, or push off. It is caused either by extra bone at the edge of the joint or by thickened soft tissue getting caught as the ankle bends upward.

That distinction matters more than it sounds, because it changes what will help you. If the problem is bone, no injection is going to melt it. If it is soft tissue, an anti-inflammatory injection may well settle it.

Clearing the impingement arthroscopically improves pain and function, and the published reviews agree on that much.^[12][13] The 2026 review goes further and recommends different treatment for the two subtypes — arthroscopic clearance where the problem is bone, and conservative treatment or a very small-instrument arthroscopy where it is soft tissue.^[12]

I would treat that recommendation carefully rather than as settled. It rests on forty studies of mostly male, mostly athletic patients, and none of those studies compared surgery against treating the problem non-surgically — so the comparison a patient actually wants has not been made. An earlier review reached the more cautious conclusion that the studies varied too much to show how the subtype affects outcome.^[13]

So when I recommend clearing an impingement, I am recommending it on the mechanics — there is something physically in the way, I can see it on your scan and feel it on examination, and removing it typically relieves that. I am not recommending it on the strength of trial evidence, because that comparison has not been done.

Pain at the back of the ankle (posterior impingement and os trigonum)

Pain deep at the back of the ankle when you point your foot down — going up on your toes, or pushing off. Dancers, footballers and cricketers see it most. Often there is a small extra bone at the back of the ankle, called an os trigonum, being compressed.

This is where the evidence for keyhole surgery is strongest on this page, and I want to be precise about what it does and does not say.

Read that carefully: it compares keyhole surgery against open surgery, not against resting and rehabilitation. And because the second score showed no difference, I am not going to tell you that keyhole surgery hurts less. What it does is get you back sooner.

A separate review of 47 surgical reports covering 905 procedures reached a cautiously similar conclusion: return to sport appears quicker after endoscopic approaches, and there is no evidence supporting better long-term results for either technique.^[2]

Faster back, not better off. That is a real benefit, and it is worth having. It is just not the same claim as “better.”

Cartilage damage in the ankle (osteochondral lesions of the talus)

A patch of damaged cartilage, usually on the talus — the bone that sits inside the ankle — often with the bone underneath it affected too. It commonly follows a sprain or a fracture, and it is a frequent reason an ankle stays painful and swollen long after the original injury looks healed.

This one has its own section below, because the decision about how to treat it is the least straightforward thing on this page.

An inflamed joint lining (synovitis)

The lining of the joint thickens and inflames, giving you swelling, warmth and a joint that feels full.

Synovitis is not one condition. Infection, inflammatory arthritis and tenosynovial giant cell tumour — the condition once called PVNS — behave differently and are operated on for different reasons. That is why I will not give you a single recovery timeline for it.

Where the disease is localised — a single nodule of tenosynovial giant cell tumour — removing it arthroscopically is a reasonable operation. Where that tumour is diffuse rather than a single nodule, the published review found the evidence too weak to establish whether arthroscopic removal matches open surgery.^[11] Two things about that review matter and I would rather state them than leave them out: it covered this tumour across several joints, not the ankle specifically, and it did not settle the arthroscopic-versus-open question for diffuse disease in the ankle. So for diffuse tenosynovial giant cell tumour I am telling you the evidence is insufficient — not that the two operations are equivalent.

Loose fragments in the joint

Fragments of bone or cartilage floating inside the joint, causing catching, locking, or a sudden giving way. Removing them is one of the more straightforward things this operation does well.

An ankle that keeps giving way (chronic ankle instability)

This is the commonest reason I operate arthroscopically on the ankle — repairing the torn ligaments that let the ankle roll again and again after an original sprain never properly healed.

If your main problem is repeated giving way after a sprain, the question is whether the ligaments are actually loose and whether rehabilitation has restored enough control — and that decision, between repair, reconstruction and rehabilitation, is a page of its own. My ankle ligament surgery page covers who needs which, what raises the risk of it failing, and what the evidence shows — including the open-versus-keyhole comparison, which I summarise in the Keyhole surgery, open surgery, or an injection section below.

Who needs this operation — and who doesn’t

Not every painful ankle needs an operation. When people ask me why I still recommend arthroscopy, I think the question is better put the other way round: the skill is in selecting the patient.

When I examine you, with 15+ years of doing this, I can usually tell which kind of ankle I am looking at. Some patients will recover with physiotherapy and exercises, and they should. Others have a complicated injury, or poor muscle control, or other things working against them, and they are unlikely to recover without help. I decide by putting the clinical findings and the imaging findings side by side — and if surgery is not going to help you, I will say so.

When keyhole surgery is the wrong operation

There are two situations where I will not do this operation at all.

An established infection that has involved bone as well as the joint. Where infection has taken hold in the bone and cartilage, my practice is to deal with it thoroughly through an open approach rather than through portals. I should be clear that this is how I handle it — other surgeons do treat some infected ankles arthroscopically, and a joint infection caught early is a different situation from one that has been there long enough to damage bone.

A complicated fracture involving the major bones of the ankle. These need open reduction and fixation with plates and screws. Arthroscopy is not the operation that fixes them.

Where the operation has limits rather than a prohibition

Established ankle arthritis. Keyhole surgery can clear inflamed tissue, take out loose fragments and release bony impingement. What it cannot do is reverse cartilage that has already been lost, and it does not cure arthritis. If anyone tells you otherwise, be careful.

If the joint has already lost its shape, clearing it out will not give that back — and the more deformity there is, the less there is for this operation to offer. Where arthritis is advanced, the honest conversation is about different operations altogether.

The borderline case. Sometimes the decision genuinely could go either way, and what tips it is not the scan. It is your life.

For that patient, the calculation is about what they stand to gain against a recovery they can afford to take. The shorter leave from work is usually what makes it feasible; getting back to the sport is usually what makes it worth doing. Whether they get both is what we discuss honestly beforehand — I cannot promise either.

How I do this operation

At the front of the ankle — and why I do not use distraction

The ankle is a tight joint. To see and work inside it you need space. Historically that space was made by pulling the joint open — distraction — first with pins fixed into the bone, later with non-invasive straps applied when needed.

I never use distraction. Not routinely, not selectively, not at all.

The reason is that it works against you. When you apply traction, the space at the front of the ankle actually reduces. If instead you bring the foot upward — dorsiflex it — the capsule at the front slackens and the space opens by itself. That gives me room to move instruments inside the joint without pulling on anything.

I am sometimes asked whether particular cases make me change that. They do not. With the right positions of the foot and the right manipulation, I can reach what I need to from the front.

I should be clear that this is my preference and my technique, not a verdict on anyone else’s. Distraction is used safely by a great many surgeons, and the large series quoted below for its low complication rate used a non-invasive strap intermittently when it was needed.

This is not an idiosyncratic view. The large Amsterdam series most often quoted for its low complication rate works the same way, and its authors put it plainly: working without distraction gives better access to the front of the ankle, precisely because it creates an anterior working space.^[5] They still reached for a non-invasive strap occasionally, for lesions sitting well back inside the joint. I have not found that I need to.

At the back of the ankle — staying in the safe zone

This is where patients get nervous, and they are right to ask. The tibial nerve and the main blood vessels to your foot run behind the ankle. When someone says to me, doctor, there are nerves and blood vessels right where you are operating, this is what I tell them.

The technique for hindfoot endoscopy is very clearly worked out, and there are anatomical structures that guide you away from the nerves and vessels. When you look at the back of the ankle from behind, the first structure you meet is the tendon that moves your big toe.

That tendon is the flexor hallucis longus. Almost all the work described in this operation happens lateral to it, and as long as you practise the technique that way, the chance of injuring a nerve or a vessel is minimal.

That is not a rule of thumb of mine. The two-portal posterior approach I use was first described by van Dijk and colleagues.^[16] Staying lateral to that tendon is my own operative rule rather than something I am attributing to that original paper — and in my hands it is what separates a controlled operation from a risky one.

Something patients find surprising: in that 1,305-procedure series, the complication rate for hindfoot endoscopy on its own was 2.3%, against 3.5% across the whole series — and there were 311 posterior procedures in it.^[5] The back of the ankle sounds like the more dangerous place to be. Practised the way it is described, with that tendon as the boundary, it is not — though no technique makes a nerve injury impossible, and I would not tell you otherwise.

Cartilage damage: when the simple treatment is enough

If the damaged patch is small, I can treat it through the arthroscope. I clear away the loose cartilage, stimulate the bone underneath to heal — microfracture, or bone marrow stimulation — and smooth the damaged surface. Exactly which technique I use depends on what the lesion looks like when I get to it, and I will go through that with you beforehand rather than leave it open.

If the patch is large, or cystic, or has already failed one operation, it usually needs a graft.

Where is the line? Honestly, it has moved, and no two sources put it in the same place.

Five sources, five answers, and the line has drifted downward across fifteen years.

I am not going to give you one number as though the profession agreed on one. What I can tell you is that those sources converge at roughly one square centimetre, and how I make the decision myself.

My own threshold is around 125 mm² — 125 square millimetres of surface area. I want to be clear that this is my threshold. Size matters, but where a surgeon draws the line depends on their own experience, and mine is where it is because that is what I have found works.

What recovery looks like if cartilage was treated

Two things change, and it is worth separating them.

Early weight-bearing is delayed. How long depends on what was done, and I will tell you at the time rather than guess here.

Full recovery is later, at around three to four months. In the early weeks you will be behind the timelines further down this page; you then close the gap. That is the whole of the difference — the end point is the same, it arrives later.

Size is also not the whole decision, and I weigh three other things. The location matters a great deal: a lesion on the shoulder of the talus has a worse outlook than one in the centre. Whether the defect is contained or uncontained changes what will hold. And what you need from the ankle changes the calculation entirely — a sedentary worker and an active young sportsman are not the same problem even with the same scan.

What this treatment actually achieves

This is the question patients are really asking, and it is the one I can least well answer from published work.

There is a recent systematic review of return to sport after surgery for these lesions.^[7] I have taken its figures off this page, and I would rather tell you why than quietly leave them out. The rule on this page is that a number only appears if you can see the condition it applies to, what was measured, how long people were followed, and how many patients it came from. That last part — how many studies and how many patients the figures were pooled from — could not be confirmed, so the figures do not appear here.

What I can give you instead is the distinction worth holding on to: getting back to sport and getting back to the same level of sport are not the same outcome, and they are worth asking about separately. Ask me about your own ankle, your own lesion and your own sport rather than a published average.

If you have diabetes, or you are over sixty

Two things change for you, and neither is a reason not to have the operation.

The first is preparation. At the hospitals where I operate, a fit younger patient has routine blood tests and the standard pre-anaesthetic workup. If you are older, or you have diabetes, a heart condition or high blood pressure, you will need additional tests and a fitness-for-surgery clearance from your physician before I will operate. Exactly which tests are asked for is set by the hospital and the anaesthetist, not by me. That is not a formality — it is how we avoid problems that have nothing to do with your ankle.

The second is what to expect from biological treatments. My own view, from what I see in clinic rather than from published trials, is that these injections do more for younger patients with less severe problems, and less for older patients with diabetes. I will tell you which of those I think you are, plainly, rather than let you spend money on a low chance. Treat that as my clinical judgement, because that is what it is — the published evidence does not settle it.

There is also a general point about age. In the 1,305-procedure series discussed later on this page, age was a significant risk factor for a complication occurring.^[5] That is a reason to prepare properly. It is not a reason to avoid the operation.

Keyhole surgery, open surgery, or an injection

Three tools, and they solve different problems. Being clear about which is which saves a lot of disappointment.

Keyhole versus open surgery

For an os trigonum in an athlete, the randomised evidence shows an earlier return to training and to sport after keyhole surgery. A separate review found no evidence supporting superior long-term results for either technique. For ligament repair, pooled data found no significant difference in the main measured outcomes, with weight-bearing beginning about 1.3 weeks earlier after arthroscopic repair.

So the evidence supports a faster early milestone in selected situations; it does not prove that the techniques are equivalent or that keyhole surgery is superior overall.

The word I would avoid is “better.” And I am not going to tell you the two are equal either — that has not been shown, and an absence of detected difference is not the same finding.

There are also things open surgery does better, and I have listed them above: established infection, and complicated fractures of the major bones.

Injections — PRP, stem cells and cortisone

More patients now come to me having read that a regenerative injection might let them avoid surgery altogether. I do offer these, and I think the honest way to discuss them is in terms of probability rather than promise.

Biologics help where healing is lagging behind its normal pace. When I offer them, I give you a rational estimate of how likely they are to work for your particular condition. If you are young and the problem is not severe, that estimate is genuinely encouraging and I will say so. If you are elderly and diabetic and the chances are poor, I will be open with you about that too. The decision is yours — I am offering an option, not making a recommendation dressed up as one.

Where an injection is reasonable, and where it stops being reasonable. In early disease, an injection is a real option and may be all you need. In advanced disease the probability of it working falls away, and at that point I think it stops being a reasonable use of your money and your time.

For impingement specifically, my position is more particular:

• If the impingement is bony, no injection will remove the problem. The hard bone will not be melted by any injection. A local cortisone injection can still give you temporary relief from the pain — so it can be worth having — but it is buying time, not treating the cause.
• If it is soft-tissue impingement, an anti-inflammatory injection can treat it.
• PRP is rarely indicated in impingement. Where I do use an injection for it, it is more often a corticosteroid.

One more thing that needs saying plainly, because it is marketed hard: a regenerative injection does not restore mechanical stability to a torn ligament. That is a mechanical problem, and the evidence for injections solving it is not there.

Step by step: what actually happens

Before

Once we have agreed on surgery, you are given the costs and the hospital options — chosen for whichever is most convenient for you and for where your insurance works best for a cashless claim. You tell us your preferred date, we match it against the operating calendar and confirm it. My office books the operating theatre. You choose your room category and complete the insurance formalities.

Investigations are as above: routine tests for a fit younger patient, additional tests and physician clearance if you are older or have other conditions.

If you take blood thinners, tell me at the consultation, and tell me which one. Do not stop them on your own and do not work from a timeline you have read anywhere, including here. Different blood thinners are handled completely differently — some are stopped well in advance, some are stopped briefly, some are continued, and some patients need a substitute in the gap. It depends on the drug, on why you are taking it, and on your kidney function.

What happens is that I speak to the doctor who prescribed it and to the anaesthetist, and the three of us plan it for you specifically — including when you restart.

If you are diabetic, your sugar control in the weeks before matters more than most people expect. It helps you recover faster and it lowers the risk of infection. That is the single most useful thing you can do for yourself before the operation.

Fasting. Strict fasting for six hours before surgery. The hospital and the anaesthetist will confirm the timing for your admission on the day, and if their instruction differs from this, follow theirs.

Anaesthesia

The anaesthetist decides this, not me, and they decide it after examining you. Whatever is the safest form for you is the one we use.

If you are young and fit with no other risk factors, it can genuinely be your choice. Under regional anaesthesia only the leg is made numb and you stay awake — and if you would like to, you can watch your own operation on the screen while I do it. Some patients find that fascinating. If you would rather sleep through it, we use a general anaesthetic instead.

Neither is better. It is a question of what is safe for you and, where both are safe, what you would prefer.

The operation

Two small incisions at the front, or two at the back, depending on where the problem is. The camera goes through one, the instruments through the other. I work with the foot positioned to open the space I need rather than pulling the joint apart. What happens next depends entirely on what we agreed beforehand — clearing impingement, removing loose fragments, treating cartilage, repairing ligaments.

One point that matters for your bill as well as your recovery: I come into theatre with the plan already made. Because we have gone through the examination and the imaging together, it is uncommon for me to find something I was not expecting.

How long it takes. A straightforward clearance at the front of the ankle takes me around twenty to thirty minutes. A ligament repair is about forty-five minutes. If I am doing a ligament repair and cartilage work together, fifty to sixty. Most of my arthroscopic procedures are finished inside an hour.

You will see “45 to 90 minutes” quoted on other websites. I have no idea where that came from — it is not attached to any surgeon. These are my own times, and they will not be another surgeon’s.

Closing and going home

The incisions are small enough to need very few stitches. You will have a bandage, and you will be given adequate pain relief.

Most patients stay one night. Two things decide it: I like to see you comfortable the next morning before you go home, and in my experience many policies expect an overnight stay for a claim to go through. Check that against your own policy rather than assuming.

How this field has changed

I have watched this change substantially over my career, and the driver has been the technology rather than any single idea. Suture anchors got better, and a great deal moved towards minimally invasive surgery.

I now rarely do open ligament surgery — I do them all arthroscopically. I rarely do open tendo-achilles surgery either, because that can be done through posterior hindfoot endoscopy. Complex ligament work involving both the deltoid on the inner side and the lateral ligaments on the outer side became possible entirely arthroscopically in the last five years, and I do those regularly now.

What drove the change, more than anything else, was regularly analysing our own results. As you do more of these operations you start to see things you believe you could extend a little further.

What the evidence shows — and what it doesn’t

You will find websites telling you this operation has an eighty or ninety per cent success rate. I am not going to give you one, and this section is why.

One thing that last sentence does and does not say. It is a finding about what those 29 reviews contained — not a statement that no such trial exists. For one of the operations on this page, ligament repair, a randomised comparison against supervised rehabilitation was published in 2024, and it is discussed on my ligament page. It does not change the picture for the rest of what this page covers.

The underlying point is worth sitting with. Improvement after an operation is not proof that the operation caused the improvement. Without a comparison group, you cannot separate the effect of surgery from natural healing, from the rehabilitation that came with it, or from the simple fact that patients chosen for surgery were chosen for a reason.

What this does not mean. It does not mean this operation does not work. The review did not show that and did not set out to. It assessed how certain the evidence is, not whether the operation helps.

It is worth being precise about how far it reaches, in both directions. The review names impingement and synovitis explicitly among the conditions for which it found no evidence establishing efficacy — so it does reach much of what I have described on this page. What it does not cover at all is the os trigonum, and that happens to be where the strongest evidence on this page sits: a randomised trial with five years of follow-up.

What I would add to it

The finding stands and I am not going to argue with it. The evidence for this operation is not as solid as the way it usually gets presented, and saying so plainly is the point of this section.

What I would add is about what that review does and does not measure. It assessed how well the published reviews were conducted — their methods, not their results. So it tells you how much confidence the profession should place in the existing literature. It does not measure whether this operation helps a particular patient, and it does not measure any individual surgeon’s results. Those are three different questions, and only the first has been examined properly.

That is not a reason to dismiss it. It is the reason I would rather give you transparency than certainty: my patient-selection reasoning above, a clear statement of what I am recommending on mechanics rather than on trial evidence, and my own complication figures — which are being prepared properly rather than quoted loosely, and will appear here when they can be stated with their denominator and follow-up attached.

I am telling you all of this because you will find the optimistic version everywhere else, and because a surgeon who only shows you the flattering half of the record is not someone you can calibrate. The same instinct applies to my own results.

Recovery

Everything below is the guidance I actually give in clinic. It is not a guarantee, and what applies to you depends on what was done inside the joint.

The first week

Three different things get called “walking”, and confusing them is how people get hurt. On this page:

• Putting weight on the foot — standing and stepping on the operated leg, usually with crutches still in hand
• Walking with crutches — moving about, taking some weight through the ankle
• Walking normally — unaided, without crutches. (A light ankle brace is worn for a period after this; it is not the same thing as needing crutches)

I do not give people a fixed date for the first two of those, because they are not really about dates.

Putting weight on the foot happens as soon as the pain has settled enough that the ankle will take it. For most straightforward clearances that is within a few days. I would rather you were guided by what the ankle tolerates than by a number on a page.

The crutches go once your balance and your confidence have come back. Those two travel together, and they come back at different speeds in different people.

Walking normally, unaided, is usually around two to three weeks.

If I have repaired a ligament in the same operation, add a week or two to all of it. Cartilage work is different and moves things further — early weight-bearing is delayed, and full recovery is around three to four months; the cartilage section above sets that out.

Pain is real for the first two or three days, and you will be covered with adequate pain relief. After that, most patients are comfortable.

Keeping the wound dry

The dressing needs to stay dry, and it stays on until your two-week appointment.

You do need to cover the operated area before showering — a plastic wrap or a proper cast cover both work. The easiest method, and the one I usually suggest, is cling film: the kitchen wrap you already have for covering vegetables, wound around the operated area.

If the dressing does get wet or dirty, do not wait for the two-week appointment. Come in and we will change it.

The dressing stays on until two weeks. That is deliberate. I do not encourage repeated opening of the wound in between, because every time it is opened the infection risk goes up. The first change is done at your two-week appointment, by me, in my clinic.

Who I give a longer timeline to

Some patients I tell at the outset that theirs will take longer than the numbers below, and it is better to hear that before than to worry about it after.

• Diabetes — healing is slower and the infection risk is higher
• Smoking or any nicotine use — this one is under your control, and stopping before surgery genuinely changes your recovery
• Osteoporosis or osteopenia — weaker bone means anything anchored into it takes longer to hold
• A high body mass index — more load through a healing ankle, and recovery is generally slower

If one or more of these applies to you, I will not give you the standard timeline. I will give you yours.

The milestones

The way I put it to patients: one day in hospital, two weeks on crutches.

A word about the word “recovery” — it depends on how you define it. Walking unaided is around two to three weeks. Being ready for competitive sport is a different question with a different answer.

One caveat on that whole table. In my own practice I judge progress on what you can actually do rather than on what week it is. Treat the dates above as the shape of a normal recovery rather than a schedule you have to hit.

Getting back to what you actually do

Time is only half the picture. The other half is how far the ankle bends, and this is the target I work towards when I plan and perform a clearance at the front of the ankle.

These are the targets I work towards when I plan and perform a clearance — they are not published thresholds, and they are not a pass mark. People manage stairs and driving on less. I aim for these because getting the range back is what makes the ankle feel like yours again rather than merely painless. If you end up with slightly less, it does not mean the operation failed.

Driving is worth separating out. Movement is only part of it — being able to brake hard and safely also depends on which ankle was operated on, whether the car is manual, what pain medication you are taking, and your own confidence. That is a conversation, not a measurement.

And here is the same thing in weeks, for a straightforward clearance at the front of the ankle. These are the ranges I give in clinic:

Two things about that table. It assumes a straightforward clearance — if I have repaired a ligament or treated cartilage, everything shifts, and the section below sets out how. And it assumes none of the factors in the previous section applies to you.

If I have repaired a ligament in the same operation, add a week or two to these. If I have treated cartilage, use the cartilage timeline above instead — it is longer.

The risks, honestly

Every operation carries risk. For this one, the characteristic risk is not dramatic — it is numbness.

The nerves that supply sensation to the top of your foot run close to where the portals are made.

Now the part of that paper that matters most to you, and it is not in the summary. In this series, with a minimum follow-up of 24 months, 17 of the 25 patients who had a neurological complication — 68% — still reported symptoms at follow-up. The symptom was cutaneous hypoesthesia: reduced feeling over an area of skin on the foot. None of those patients had a functional limitation from it. Five were symptom-free; one was lost to follow-up and two could not be assessed because of unrelated neurological conditions.

So the honest version is this: nerve trouble is the commonest complication of this operation, and if you get it, it is more likely than not to leave you with a patch of lasting reduced feeling on the foot — still present at follow-up, which was at least two years. It should not stop you doing anything. But “it usually settles” would be the wrong thing for me to tell you, and I am not going to tell you that.

The most serious complication in that series was a single blood clot on the lung, in a 32-year-old woman a week after surgery. The authors are specific about the circumstances: she had open ligament surgery under the same anaesthetic, six weeks in a cast afterwards, was taking the contraceptive pill, smoked a pack a day, and was not given blood-thinning medication. That combination is what they think caused it. It is rare, and this is the one case in 1,305 procedures — but you asked what the worst thing on the list is, and that is the worst thing on the list.

My own complication figures

I audit my own complications, and I would rather give you mine than a published average from another surgeon’s practice.

Here is where that stands. The audit covers approximately 800 to 1,000 patients operated between 2014 and 2026 — a twelve-year window. The shortest follow-up is nine months and the longest is eight years. Between 10 and 12% of those patients were lost to follow-up. I count as a complication any undesired effect that stops a patient getting the result they came for, and complications treated at another hospital are not in my figures.

What I have not yet separated out is the breakdown by operation — how many of those patients had a keyhole clearance specifically, and what the rate was for that group on its own. That is part of what is still being compiled, and it is one of the reasons there is no percentage on this page yet.

I have deliberately not put a percentage here yet. The rule I have set for this page is that a rate needs its event counts published alongside it to mean anything, and those are still being compiled properly. When they are, the number will appear here with all of the above attached to it. A complication rate quoted without its working is reassurance rather than information, and you should be sceptical of one wherever you find it — including here.

It is worth seeing how much of this risk depends on technique rather than being inherent to the operation.

In an early series from the 1990s, from a period when distraction — holding the joint open with pins fixed into bone — was among the techniques in use, every nerve injury that occurred was caused by direct trauma: from a portal, or from a distractor pin, rather than from anything intrinsic to looking inside the joint.^[6]

I am deliberately not setting that era’s complication rate beside today’s. It would read as a clean before-and-after and it is not one: the two series come from different centres and counted complications differently, and the older one does not report how long its patients were followed — so a percentage from it cannot carry its own meaning. What does travel is the mechanism. Those injuries came from where the instruments went in and from what was holding the joint open. That is why the way I position the foot instead of pulling the joint open, and the way I stay lateral to that tendon at the back, are not technical footnotes.

The three things patients ask me about most are infection, nerve injury, and a repair failing to heal. All three are real, all three are uncommon, and I will not tell you any of them cannot happen.

What patients are actually frightened of

Most people are terrified by the word surgery itself. That is the first thing I deal with, and usually the easiest — once I explain that this is a small keyhole procedure, people settle, and then they tell me what they are really worried about.

It is almost never what you would expect. It is very rarely the anaesthetic, and it is very rarely the pain.

What patients actually ask me is whether it will work. If they came in with a stiff ankle, will the stiffness improve — and improve enough that their life is better, not just their scan? If they came in with an ankle that gives way, will it become an ankle they can trust on a crowded platform?

Those are the right questions, and they are the ones I try to answer honestly at the consultation rather than optimistically. Some patients also ask about the bigger complications — infection, nerve injury, a repair that fails to heal. I would rather you asked. All three are real, all three are uncommon, and none of them are things I will tell you cannot happen.

The one fear I will push back on is the fear of being off work for months. For most of the operations on this page that is not what happens, and the earlier sections set out what does.

Cost and insurance

I am not going to publish a price range. The ranges you will find on the aggregator sites are marketing rather than estimates, and the honest answer is that the cost depends on what is done inside the joint. What I can do is tell you exactly what moves it.

Procedures that need no implant at all — impingement release, removal of the inflamed joint lining. These are the lower end.

Procedures that need implants or specialised equipment — ligament repairs, fixations, cartilage procedures. It is the anchors and specialised consumables that raise the package cost, not extra surgeon time.

Cartilage damage changes the operation itself. Depending on the size and the grade of the damage, different techniques are used, and that changes what the procedure involves.

Combining arthroscopy with ligament reconstruction does not add much, because I do the ligament reconstruction arthroscopically anyway. The estimates come out much the same.

On augmentation. You may have read about ligament repairs being reinforced with an extra strip of tape — sometimes marketed as an internal brace. Where that is done, it adds the cost of the tape itself.

I do not use extra tape, and not because I am against reinforcing a repair. The anchor I use has the tape built into it. The same tape both stitches the ligament back down and reinforces it afterwards, so the repair is augmented without a second implant and without a second consumable on your bill.

If you are using cashless insurance

The commonest misunderstanding about coverage is not the insurer’s fault. It happens when we as doctors do not explain clearly enough what we are going to do.

In my practice, the examination and the imaging mean the plan is settled before we go in. It does not often change during the operation — so the costing does not often change either.

On implants and consumables specifically. In my experience most policies do cover the anchors and consumables — they are essential to the surgery rather than an optional extra. But this varies by policy, and where a patient gets an unexpected bill it is usually something specific excluded in their own fine print. Confirm it on your policy. I cannot tell you what your insurer covers.

What to confirm before admission: that the hospital accepts your insurer, and that your pre-approval has actually been approved, not merely applied for. My office helps patients get this done before surgery rather than after, so the financial side is settled while you are still thinking clearly about it.

Where I operate

Consultations are at Prabhadevi and Kemps Corner. For the operation itself I work at seven hospitals — four in South Mumbai and three in the western suburbs — so there is usually one that suits both where you live and where your insurance is accepted:

• Advanced Orthopedics — my own centre
• Breach Candy Hospital
• HN Reliance Hospital, Girgaon
• Saifee Hospital, Charni Road
• PD Hinduja Hospital, Mahim
• PD Hinduja Hospital, Khar
• Lilavati Hospital, Bandra

We decide which together, and I would rather you choose on convenience and cover than on any idea that one of them is “the” place for this.

Life after the operation

There is one thing this operation cannot do for you, and it is the most common misunderstanding I meet.

Surgery addresses the problem you came in with — the instability, the impingement, the mechanical block. It does not fix weak muscles.

If you are not going to do the rehabilitation, the operation will underdeliver, and no technique or implant I can offer changes that.

One other correction families often need. The incisions are small, but any surgery is surgery, and it should be treated as a major undertaking rather than a minor one.

Why is my ankle still swollen?

This is the question I am asked most often after the operation, and the answer surprises people: swelling is the last thing to go, and that is normal.

Recovery happens in an order. First the pain settles. Then the function comes back — the joint regains its movement and its strength. Only after that does the swelling start to reduce. People expect the reverse, and worry when they don’t get it.

There is a reason it lasts. The foot and ankle are the most dependent parts of the body — when you stand, gravity pulls blood down into them. So swelling in an ankle is both more visible and slower to settle than it would be almost anywhere else.

What I will not promise you is that it disappears completely. With good physiotherapy and proper strength and conditioning work, the two ankles can be made to look almost the same. Almost. I do not promise patients they will be identical, because that is not a promise I can keep.

When to call us

Getting through the Mumbai rains

Three things, every monsoon, and they are the same three whichever ankle operation you have had.

Slippery surfaces are the real hazard — far more so on a walker or crutches, when a slip does the most damage. Be careful.

Keep the dressing dry. There is no cast after this operation, but the waterproof cover sold as a “cast cover” is exactly the right thing — wear it whenever you are walking in the rain.

If it does get dirty, come to us immediately for a dressing change. Do not leave it, and do not try to clean it yourself.

Common questions