Nano Arthroscopy Benefits for Treating Foot and Ankle Injuries

Arianna L. Gianakos, DO, shares why she is excited about offering Nano arthroscopy to her patients.

Arianna L. Gianakos, DO (New Haven, CT), is a foot and ankle surgeon and assistant professor of orthopedics and rehabilitation at the Yale School of Medicine. Here, she shares her experience with Nano arthroscopy, why she incorporates it into her practice, and how it benefits her patients.

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As surgeons, we always want to improve our current treatment strategies. Part of that is incorporating new technologies that allow patients to return to work and sport in a safe but more efficient manner.

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Designed to support positive patient outcomes and recovery, Nano arthroscopy (also referred to as needle arthroscopy) is moving the needle in the arthroscopic field.

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Nano arthroscopy uses needle-sized Nano tools, including a crystal-clear camera and other arthroscopic instrumentation, to allow your doctor to look inside your joint to see and, in some cases, treat what's wrong—all in the same visit.

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In addition, this technology allows surgeons to perform certain procedures bedside and within their offices and procedure rooms.

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What excites you the most about Nano arthroscopy?

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Nano arthroscopy allows me to use smaller instrumentation to perform the same procedures that once required larger incisions and longer recovery periods. The tiny, specialized camera at the end of the Nano device features “chip-on-tip technology,” which means it can capture clear images that provide me with better visualization during surgery.

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How has the NanoNeedle Scope changed arthroscopic surgery?

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With the NanoNeedle Scope, which is extremely minimally invasive instrumentation used in many Nano arthroscopy procedures, I have the ability to both diagnose and treat a patient’s condition or injury at the same time.

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Procedures that once required general anesthesia or spinal anesthesia now have the potential to be done under local anesthesia (where the area is numbed and the patient stays awake during treatment) with minimal potential for complications. And since they are so portable, the NanoNeedle Scope and other Nano instrumentation can move from the operating room to bedside treatment and even into the office setting.

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How does Nano arthroscopy help you treat your patients better?

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Nano arthroscopy requires just a tiny incision and is designed to reduce the risk of harm to soft tissue and the possibility of iatrogenic injury—damage from the medical treatment process rather than the injury itself—to articular joint surfaces. The semirigid camera also offers enough flexibility to be able to reach areas within the joint that otherwise would not be accessible using a larger, traditional arthroscope.

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What joint injuries and ailments do you treat most often?

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I use Nano arthroscopy for a variety of foot and ankle conditions, including:

Ankle cartilage injuries: also called a lesion or an osteochondral defect, these injuries can occur from trauma (such as a fall) or deterioration due to osteoarthritis
Ankle impingement: this often-painful condition occurs when soft tissue or scar tissue becomes pinched between the ankle bones
Loose bodies within the ankle joint: pieces of cartilage or bone break off during normal ankle motion; these may sometimes require removal if they cause pain or impede movement
Tendonoscopy for the Achilles and peroneal tendons (the tendons located at the back and sides of your ankle, respectively)
Arthroscopic-assisted fracture reduction: commonly known as “setting” a fracture, I perform this procedure for talar fractures (the bone located between your foot and ankle bones), calcaneal fractures (heel bone), and syndesmotic injuries (also known as a high ankle sprain)

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Learn more about how Nano arthroscopy is used in the foot and ankle

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How do you explain Nano arthroscopy to your patients?

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I tell them we now have the ability to use a 1.9 mm camera to not only assess their injury but, in many cases, treat it at the same time. In addition, we do not need to make incisions but rather use small poke holes that do not require sutures. The smaller size of this instrumentation allows us to do more surgically, and the tools are designed to reduce the risk of injury to surrounding soft-tissue structures and the cartilage within the joint.

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How does Nano arthroscopy impact your patients’ experience and recovery timeline?

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Studies have demonstrated a quick return to work and sport following Nano arthroscopy for certain injuries.¹In addition, my patients tell me they don’t feel like they are true “patients” who have to undergo a lengthy operating room day in a gown and hospital bed. Instead, many procedures can be performed without general anesthesia in an office room or procedure room and patients may be able to more quickly get back into motion following the procedure. This helps patients feel mentally prepared to get back to their day-to-day activities more quickly. Since patients are awake in many cases, they understand their care better.

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How does Nano arthroscopy differ from other emerging surgical technologies, such as artificial intelligence (AI) or robotic surgery?

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Nano arthroscopy is used for the same procedures that we are already doing but through smaller incisions with less nerve damage.² In addition, we can now perform many of those same procedures that required general anesthesia under local anesthesia. This allows us to bring the procedures from a hospital setting into a doctor’s office, making the actual procedure day easier and faster for the patient. Studies have also demonstrated high rates of return to work and sport¹ and reduced complications.³

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What is your favorite part about using the NanoNeedle Scope?

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The NanoNeedle Scope is an easy-to-use camera that affords me great visualization. I really like the flexibility of the device as I can see areas within the ankle (or other small joints and tendons) that I would not be able to see using a standard arthroscope. In addition, it is designed to minimize damage to the cartilage within the ankle. Patients have also commented they like to know they are being treated with the newest and most minimally invasive technology on the market, giving them more confidence in their surgical decision.

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Explore the Nano Experience

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Surgeon is a paid consultant for Arthrex, Inc.

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References

Colasanti CA, Mercer NP, Garcia JV, Kerkhoffs GMMJ, Kennedy JG. In-office needle arthroscopy for the treatment of anterior ankle impingement yields high patient satisfaction with high rates of return to work and sport. Arthroscopy. 2022;38(4):1302-1311. doi:10.1016/j.arthro.2021.09.016
Stornebrink T, Altink JN, Appelt D, Wijdicks CA, Stufkens SAS, Kerkhoffs GMMJ. Two-millimetre diameter operative arthroscopy of the ankle is safe and effective. Knee Surg Sports Traumatol Arthrosc. 2020;28(10):3080-3086. doi:10.1007/s00167-020-05889-7
McMillan S, Chhabra A, Hassebrock JD, Ford E, Amin NH. Risks and complications associated with intra-articular arthroscopy of the knee and shoulder in an office setting. Orthop J Sports Med. 2019;7(9):2325967119869846. doi:10.1177/2325967119869846