04/17/2014 03:26 pm ET Updated Jun 17, 2014

Eli Manning's Ankle Arthroscopy and Prognosis -- A Foot Surgeon's Perspective

As a New York City Foot Surgeon, I want to provide some insight on Eli Manning's "arthroscopic ankle debridement" surgery that was performed. The surgery has sparked concerns that his better days may be behind him. Of course, any surgery on a pro-athlete poses a threat to continue playing at high level. Before anyone can call it quits for Manning, its best to understand the surgery he had performed and what that really means in terms of recovery.

What is Ankle Arthroscopy Debridement?

Eli had a very common orthopedic procedure called an arthroscopy. It involves accessing a joint through very small incisions with the aid of surgical cameras and shavers. In Mannings case, the joint involved was the ankle.

The most common reasons a surgeon performs an ankle arthroscopy is to remove scar tissue -- a procedure called a debridement. Scar tissue forms from a variety of reasons -- most surrounding trauma to the ankle after sprains. Scar tissue can be in the form of thick bands inside the ankle that interfere with motion and cause pain.

Other reasons patients undergo ankle arthroscopy is to treat bone cysts and simple cartilage problems. Bone spurs can also be removed arthroscopically and in some occasions loose ligaments can be tightened.

The main benefit of performing arthroscopic surgery is that it is mildly invasive when compared to procedures where the joint is fully opened up.

What has been released with regard to Manning is that he had a "debridement" but what was not clear if he had scar tissue debridement alone or required bone debridement and/or ligament tightening.

A High Ankle Sprain: The Underlying Cause.

It seems that the underlying injury that prompted the ankle arthroscopy was a high ankle sprain. Its important to know that high ankle sprain is different than a regular (low) ankle sprain.

The ankle is made up three bones -- two leg bones (tibia and fibula) and one foot bone (talus). There are ligaments that hold the ankle stable on the inside and outside. The ligaments on the outside that are more commonly injured with typical "low" ankle sprains. A high ankle sprain has the characteristics of a "low" ankle sprain, but also involve a thick strong band that holds the leg bones together -- which is a more serious injury, also called a syndesmotic injury.

Acute high ankle sprain can vary in severity -- from mild to severe. Mild sprains can be treated with a period of immobilization, whereas severe injuries require more immediate surgery. The surgery for severe syndesmotic injury involves bolting the two leg bones together at the ankle -- something that was not necessary for Eli Manning when he had the injury.

Chronic ankle pain from syndesmotic injuries and ankle sprains is often caused by scar tissue within the ankle joint itself. Some people may develop instability of the ankle syndesmotic ligaments or ankle ligaments proper. Occasionally bone bruises and cysts arise that can be considered precursors to arthritis.

Prognosis After Ankle Arthroscopic Debridement

Depending on the indications for arthroscopic ankle surgery the prognosis varies. Removing scar tissue, the most common reason for ankle arthroscopy, often holds an excellent prognosis. Once the scar tissue is removed and the joint is rehabbed, patients can return to pre-surgery levels. This seems like Mannings situation.

However, if the high ankle sprain resulted in more damage to the strong ligaments between the leg bones then the recovery is less predictable. This is usually the case with severe syndesmotic injuries that require surgery immediately -- again not the case with Manning.

Its unclear if Manning was dealing with any instability issues. If he was, this may have been addressed in his arthroscopy, but severe cases of instability require more advanced procedures.

So, based on the information released, it may be a bit early to call it quits for Manning...

Dr. Neal Blitz
New York City

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