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Anastasio AT, Lau B, Adams S. Ankle Osteoarthritis. J Am Acad Orthop Surg 2024:00124635-990000000-01006. [PMID: 38810230 DOI: 10.5435/jaaos-d-23-00743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 04/23/2024] [Indexed: 05/31/2024] Open
Abstract
Ankle osteoarthritis (OA) is less common than knee and hip OA, and 75% to 80% of all presentations are posttraumatic in nature, resulting from either ligamentous or bony injury to the ankle. While the ankle joint cartilage demonstrates capacity for self-restoration, the ankle joint is sensitive to aberrancies in biomechanics and the inflammatory milieu after an injury is thought to contribute to the onset of posttraumatic ankle OA. Conservative care for ankle OA is currently centered on pain reduction, and derivatives that may delay the progression of ankle OA are the subject of ongoing investigation. Surgical management for end-stage ankle OA currently focuses on ankle arthrodesis and total ankle arthroplasty. Specific indication for one procedure over the other is the topic of much debate. While total ankle arthroplasty has become more frequently used with the advent of newer generation systems, ankle arthrodesis may still be favored in younger patients with high-demand occupations.
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Affiliation(s)
- Albert T Anastasio
- From the Duke University Department of Orthopaedic Surgery, Division of Sports Medicine, Durham, North Carolina
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2
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Kim J, Palmar J, Demetracopoulos C, Ellis S, Deland J. Radiographic Analysis of Valgus Ankle Deformity With or Without Medial Longitudinal Arch Collapse. Foot Ankle Int 2024; 45:517-525. [PMID: 38445609 DOI: 10.1177/10711007241231230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
BACKGROUND Establishing a surgical plan for ankle deformities necessitates a comprehensive understanding of the deforming forces involved, and the morphology of the ankle deformity plays an important role as well. Valgus tibiotalar tilt development has mostly been described in patients with a low medial longitudinal arch, as seen in progressive collapsing foot deformity (PCFD). However, some valgus ankles demonstrate no radiographic evidence of a collapsed medial arch. This study aims to investigate whether there are differences in the radiographic morphology of valgus ankle deformities between patients with and without a low medial longitudinal arch to explore if they have different etiologies. METHODS We retrospectively reviewed patients who underwent surgical treatment for asymmetric valgus ankle deformity at our institution between 2017 and 2021. Patients with a valgus tibiotalar tilt (TT) greater than 4 degrees and Meary angle greater than 30 degrees (mean: 38.9) were included in the PCFD group (n = 29). The non-PCFD group (n = 24) with TT greater than 4 degrees and Meary angle less than 4 degrees (mean: 0.3) was also established. In the weightbearing ankle anteroposterior view, the TT and medial distal tibial angle were measured. Additionally, to assess the mediolateral position of the talus, the talar center migration (TCM) and lateral talar dome-plafond distance (LTD-P) ratio in the coronal plane were measured. In weightbearing computed tomography (WBCT), the degree of axial plane talocalcaneal subluxation and the prevalence of sinus tarsi bony impingement were assessed. Intergroup comparison was conducted. RESULTS Both groups demonstrated a similar degree of TT, with a mean of 11.6 degrees in the PCFD group and 13.7 degrees in the non-PCFD group (P = .2330). However, the PCFD group showed a significantly greater TCM and LTD-P ratio compared with those of the non-PCFD group (P < .0001), indicating that PCFD patients have a more medially translated talus in ankle anteroposterior radiographs. WBCT showed that the PCFD group on average had 18 degrees greater axial plane talocalcaneal subluxation (P < .0001) and 52% higher prevalence of sinus tarsi bony impingement (P = .0002) compared with the non-PCFD group. CONCLUSION This study suggests that valgus ankles may exhibit different radiographic morphologies depending on the status of the longitudinal arch. Valgus ankles in PCFD patients tend to have a more medially translated talus. This finding may suggest the presence of different deforming forces between the 2 groups and may indicate the need for different treatment strategies to address talar tilt. LEVEL OF EVIDENCE Level III, case-control.
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Affiliation(s)
- Jaeyoung Kim
- Baylor University Medical Center, Dallas, TX, USA
- Hospital for Special Surgery, New York, NY, USA
| | | | | | - Scott Ellis
- Hospital for Special Surgery, New York, NY, USA
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3
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Caravelli S, Puccetti G, Vocale E, Di Ponte M, Pungetti C, Baiardi A, Grassi A, Mosca M. Reconstructive Surgery and Joint-Sparing Surgery in Valgus and Varus Ankle Deformities: A Comprehensive Review. J Clin Med 2022; 11:jcm11185288. [PMID: 36142935 PMCID: PMC9504878 DOI: 10.3390/jcm11185288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 08/22/2022] [Accepted: 09/02/2022] [Indexed: 11/29/2022] Open
Abstract
Osteoarthritis (OA) of the ankle affects about 1% of the world’s adult population, causing an important impact on patient lives and health systems. Most patients with ankle OA can show an asymmetrical wear pattern with a predominant degeneration of the medial or the lateral portion of the joint. To avoid more invasive ankle joint sacrificing procedures, joint realignment surgery has been developed to restore the anatomy of the joints with asymmetric early OA and to improve the joint biomechanics and symptoms of the patients. This narrative, comprehensive, all-embracing review of the literature has the aim to describe the current concepts of joint preserving and reconstructive surgery in the treatment of the valgus and varus ankle early OA, through an original iconography and clear indications and technical notes.
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Affiliation(s)
- Silvio Caravelli
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
- Correspondence:
| | - Giulia Puccetti
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Emanuele Vocale
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Marco Di Ponte
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Camilla Pungetti
- Department Orthopaedics and Traumatology, Ospedale Maggiore “Pizzardi”, 40133 Bologna, Italy
| | - Annalisa Baiardi
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Alberto Grassi
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Massimiliano Mosca
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
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4
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Herrera-Pérez M, Valderrabano V, Godoy-Santos AL, de César Netto C, González-Martín D, Tejero S. Ankle osteoarthritis: comprehensive review and treatment algorithm proposal. EFORT Open Rev 2022; 7:448-459. [PMID: 35900210 PMCID: PMC9297055 DOI: 10.1530/eor-21-0117] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Ankle osteoarthritis (OA) is much less frequent than knee or hip OA, but it can be equally disabling, greatly affecting the quality of life of the patients. Approximately 80% of ankle OA is post-traumatic, mainly secondary to malleolar fractures, being another of the main causes untreated in chronic instability. The average age of the patient affected by ankle OA is around 50 years, being therefore active patients and in working age who seek to maintain mobility and remain active. The authors conducted a comprehensive review of the conservative, medical, and surgical treatment of ankle OA. Initial conservative treatment is effective and should be attempted in any stage of OA. From a pharmacological point of view, non-steroidal anti-inflammatory drugs (NSAIDs) and intra-articular infiltrations can produce temporary relief of symptoms. After the failure of conservative-medical treatment, two large groups of surgical treatment have been described: joint-preserving and joint-sacrificing procedures. In the early stages, only periarticular osteotomies have enough evidence to recommend in ankle OA with malalignment. Both ankle arthrodesis and ankle replacement can produce satisfactory functional results if correctly indicated in the final stages of the disease. Finally, the authors propose a global treatment algorithm that can aid in the decision-making process.
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Affiliation(s)
- Mario Herrera-Pérez
- Foot and Ankle Unit, Orthopaedic Department, Hospital Universitario de Canarias, Tenerife, Spain
- Department of Surgery, Universidad de La Laguna, Tenerife, Spain
| | - Victor Valderrabano
- Foot and Ankle Unit, Orthopaedic Department, Schmerzklinik, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | - César de César Netto
- Director of the UIOWA Orthopedic Functional Imaging Research Laboratory (OFIRL), Iowa, USA
- Department of Orthopedic and Rehabilitation, University of Iowa, Iowa, USA
| | - David González-Martín
- Foot and Ankle Unit, Orthopaedic Department, Hospital Universitario de Canarias, Tenerife, Spain
- Department of Surgery, Universidad de La Laguna, Tenerife, Spain
| | - Sergio Tejero
- Foot and Ankle Unit, Hospital Universitario Virgen del Rocío, Sevilla, Spain
- Department of Surgery, Universidad de Sevilla, Sevilla, Spain
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5
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Correction of the Valgus Ankle with a Joint Sparing Supra-Malleolar Osteotomy: The Modified Wiltse Technique. Foot Ankle Clin 2022; 27:91-113. [PMID: 35219371 DOI: 10.1016/j.fcl.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The valgus ankle is a common cause of pain, deformity, and disability in patients. Addressing these deformities with extraarticular osteotomies is a valuable, joint-sparing treatment option. The modified Wiltse osteotomy provides correction of the mechanical alignment as well as allowing inherent stability. Accurate templating of the Wiltse triangle enables reproducible, accurate intraoperative results.
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Abstract
Valgus ankle OA is a complex problem with multiple etiologies that can either be isolated or superimposed on top of other medical or musculoskeletal disorders. Proper medical history, physical, and preoperative radiological examinations are crucial in deciding on surgery and planning the surgical approach. JPS, especially the varisating medial closing-wedge SMOT with solid plate fixation, has been consistently associated with good outcomes for patients with valgus ankle OA. To further improve JPS for valgus ankle OA, further clinical and biomechanical studies are required to address the long-term clinical and functional outcomes and complications.
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Affiliation(s)
- Ahmad Alajlan
- SWISS ORTHO CENTER, Schmerzklinik Basel, Swiss Medical Network, Hirschgässlein 15, Basel 4010, Switzerland; Orthopaedic Department, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Victor Valderrabano
- SWISS ORTHO CENTER, Schmerzklinik Basel, Swiss Medical Network, Hirschgässlein 15, Basel 4010, Switzerland.
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7
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[Arthrodesis vs. prosthesis for end-stage osteoarthritis of the ankle joint : A scientific argument]. Unfallchirurg 2022; 125:205-210. [PMID: 35175404 DOI: 10.1007/s00113-022-01145-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2022] [Indexed: 10/19/2022]
Abstract
The gold standard in operative treatment of end-stage ankle osteoarthritis remains controversial even now. Endoprosthetic treatment, which has undergone significant improvements in recent years competes with arthrodesis, which can achieve excellent results particularly in the arthroscopically assisted technique. Both procedures offer specific advantages and disadvantages so that the decision about indications for treatment should always be made individually, taking specific needs and the individual constellation of findings of the patient into consideration.
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8
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Kim J, Kim JB, Lee WC. Eccentric ankle arthritis in the sagittal plane: a novel description of anterior and posterior ankle arthritis. Foot Ankle Surg 2021; 27:934-941. [PMID: 33413954 DOI: 10.1016/j.fas.2020.12.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 12/21/2020] [Accepted: 12/30/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND To report radiographic characteristics of anterior and posterior ankle arthritis, which demonstrates the eccentric narrowing of either aspect of the tibiotalar joint in the sagittal plane. METHODS Radiographic analysis of 19 ankles with anterior arthritis and 16 ankles with posterior arthritis was performed, which were defined as having both (1) eccentric narrowing of the anterior or posterior tibiotalar joint space on lateral radiographs and (2) talar tilt angle less than 4 degrees on anteroposterior radiographs. Measured radiographic parameters were: Talar tilt angle, medial distal tibial angle (MDTA), talar center migration (TCM), anterior distal tibial angle (ADTA), tibial axis-to-talus ratio (TT ratio), talo-first metatarsal (Meary) angle, hindfoot alignment angle (HAA), hindfoot moment arm, and mechanical axis deviation (MAD). An Intergroup comparison analysis, including a normal control group, was also performed. RESULTS The TT ratio was significantly different between each group, indicating a distinct talus position in the sagittal plane. The anterior group had a significantly larger TCM than the control group and lower ADTA compared to other groups, indicating medial translation of the talus and anterior opening of the tibial plafond. The posterior group demonstrated a significantly higher Meary angle and lower HAA compared to other groups and lower MDTA compared to the control group, indicating lower medial longitudinal arch, valgus heel alignment, and varus tibial plafond. The MAD was significantly higher in both the anterior and posterior groups than the control group, indicating varus lower limb alignment. CONCLUSION Anterior ankle arthritis demonstrated anteromedial translation of the talus and anterior opening of the tibial plafond. Posterior ankle arthritis was associated with the lower medial longitudinal arch and hindfoot valgus, indicating an association with flatfoot deformity. Both anterior and posterior ankle arthritis were associated with varus lower limb alignment.
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Affiliation(s)
- Jaeyoung Kim
- Hospital for Special Surgery, New York, NY 10021, USA
| | - Ji-Beom Kim
- Seoul Foot and Ankle Center, Dubalo Orthopaedic Clinic, Seoul, Republic of Korea
| | - Woo-Chun Lee
- Seoul Foot and Ankle Center, Dubalo Orthopaedic Clinic, Seoul, Republic of Korea.
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9
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Shibuya N, McAlister JE, Prissel MA, Piraino JA, Joseph RM, Theodoulou MH, Jupiter DC. Consensus Statement of the American College of Foot and Ankle Surgeons: Diagnosis and Treatment of Ankle Arthritis. J Foot Ankle Surg 2021; 59:1019-1031. [PMID: 32778440 DOI: 10.1053/j.jfas.2019.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 10/20/2019] [Indexed: 02/03/2023]
Affiliation(s)
- Naohiro Shibuya
- Professor, College of Medicine, Texas A&M University, Temple, TX.
| | | | - Mark A Prissel
- Faculty, Advanced Foot and Ankle Reconstruction Fellowship Program, Orthopedic Foot and Ankle Center, Worthington, OH
| | - Jason A Piraino
- Associate Professor, Department of Orthopaedic Surgery and Rehabilitation, University of Florida Health, Gainesville, FL
| | - Robert M Joseph
- Chairman, Department of Podiatric Medicine & Radiology, Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University, North Chicago, IL
| | - Michael H Theodoulou
- Chief, Division of Podiatric Surgery, Cambridge Health Alliance, Instructor of Surgery, Harvard Medical School, Cambridge, MA
| | - Daniel C Jupiter
- Associate Professor, Department of Preventive Medicine and Community, Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, TX
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10
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Sarpong NO, Levitsky M, Held M, Coury J, Greisberg J, Vosseller JT. Isolated fibular stress fractures: Radiographic parameters. Foot Ankle Surg 2020; 26:935-938. [PMID: 31937428 DOI: 10.1016/j.fas.2019.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 12/06/2019] [Accepted: 12/30/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Fibular stress fractures are uncommon injuries with an incompletely understood pathogenesis and predisposing characteristics. This study investigated the demographic and radiographic risk factors for fibular stress fractures. METHODS A retrospective chart review from 2010 to 2018 revealed thirteen patients with isolated fibular stress fractures. Demographics, history of fracture, fracture location, bone quality, and heel alignment were collected. RESULTS The cohort consisted of six men and seven women with a mean age of 41.8 years. The average BMI was 28.5kg/m2. Three patients used tobacco. 69.2% of fractures were in the distal third, 23.1% proximal third, and 7.7% middle third. No patients had evidence of osteopenia. Distal fibula stress fractures were more common in women (66.7%) and associated with hindfoot valgus. CONCLUSION Distal third fibula stress fractures were most common and associated with hindfoot valgus. This could be due to a greater amount of axial force through fibula in this alignment. LEVEL OF EVIDENCE Level IV, Retrospective Case Series.
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Affiliation(s)
- Nana O Sarpong
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA.
| | - Matthew Levitsky
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Michael Held
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Josephine Coury
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Justin Greisberg
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - J Turner Vosseller
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
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Plaass C, Louwerens JW, Claassen L, Ettinger S, Yao D, Lerch M, Stukenborg-Colsman C, Donken C. Treatment concepts for pes valgoplanus with concomitant changes of the ankle joint : Tibiotalocalcaneal arthrodesis, total ankle replacement and joint-preserving surgery. DER ORTHOPADE 2020; 49:991-999. [PMID: 33104862 DOI: 10.1007/s00132-020-03996-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Concomitant valgus deformities of the ankle joint are found in approximately 3% of patients with symptomatic flat foot deformities. Conservative treatment is mostly successful only in the short term or in low-demand patients. The operative treatment of flat foot deformities follows the standard algorithm for flat foot treatment. The ankle joint can be treated while retaining mobility or by arthrodesis depending on the degree and rigidity of the deformity, degenerative changes, patient factors and expectations. Achieving an orthograde hindfoot and midfoot is obligatory for successful treatment as well as in ankle reconstructive or arthrodesis procedures.
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Affiliation(s)
- Christian Plaass
- Department for Foot and Ankle surgery, DIAKOVERE Annastift, Orthopedic Clinic of the Hannover Medical School, Anna-von-Borries Straße 1-7, 30627, Hannover, Germany.
| | - Jan Willem Louwerens
- Foot and Ankle Reconstruction Unit of the Orthopaedic Department, St. Maartenskliniek, Hengstdal 3, 6574, Ubbergen, NA, The Netherlands
| | - Leif Claassen
- Department for Foot and Ankle surgery, DIAKOVERE Annastift, Orthopedic Clinic of the Hannover Medical School, Anna-von-Borries Straße 1-7, 30627, Hannover, Germany
| | - Sarah Ettinger
- Department for Foot and Ankle surgery, DIAKOVERE Annastift, Orthopedic Clinic of the Hannover Medical School, Anna-von-Borries Straße 1-7, 30627, Hannover, Germany
| | - Daiwei Yao
- Department for Foot and Ankle surgery, DIAKOVERE Annastift, Orthopedic Clinic of the Hannover Medical School, Anna-von-Borries Straße 1-7, 30627, Hannover, Germany
| | - Matthias Lerch
- Department for Foot and Ankle surgery, DIAKOVERE Annastift, Orthopedic Clinic of the Hannover Medical School, Anna-von-Borries Straße 1-7, 30627, Hannover, Germany
| | - Christina Stukenborg-Colsman
- Department for Foot and Ankle surgery, DIAKOVERE Annastift, Orthopedic Clinic of the Hannover Medical School, Anna-von-Borries Straße 1-7, 30627, Hannover, Germany
| | - Christian Donken
- Foot and Ankle Reconstruction Unit of the Orthopaedic Department, St. Maartenskliniek, Hengstdal 3, 6574, Ubbergen, NA, The Netherlands
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12
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[Supramalleolar osteotomy in asymmetric ankle osteoarthritis : Short-term clinical and radiographic results]. DER ORTHOPADE 2018; 46:761-775. [PMID: 28405708 DOI: 10.1007/s00132-017-3416-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The main indication for the supramalleolar osteotomy is asymmetric ankle osteoarthritis with concomitant supramalleolar valgus or varus deformity. The aim of this prospective study was to analyze short-term clinical and radiographic outcomes in patients with asymmetric ankle osteoarthritis. METHODS A total of 16 patients with asymmetric ankle osteoarthritis and concomitant supramalleolar deformity - 7 patients with valgus deformity, 9 patients with varus deformity - were treated. Intraoperative and postoperative complications were recorded and analyzed. The clinical and radiographic outcomes were assessed after a mean follow-up of 3.6 ± 1.1 years. RESULTS In 10 of 16 patients, removal of hardware was performed. The AOFAS hindfoot score increased significantly after surgery. All categories of the SF-36 score showed significant improvement. The average range of motion also increased significantly. Radiographic assessment showed neutral hindfoot alignment at the latest follow-up. The postoperative clinical outcomes were comparable in both patient groups. The time until complete osseous union was significantly longer in patients with opening wedge osteotomy. CONCLUSION This prospective study demonstrated encouraging short-term results in patients with asymmetric ankle osteoarthritis who underwent supramalleolar osteotomy. In progressive ankle osteoarthritis, joint-nonpreserving treatment options including total ankle replacement or ankle arthrodesis should be discussed.
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Bae JY, Won HJ, Seo DK. Valgus Ankle Degenerative Arthritis with an Isolated Deltoid Insufficiency and Tibial Varus: A Case Report. J Foot Ankle Surg 2018. [PMID: 28633795 DOI: 10.1053/j.jfas.2017.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We report a case of valgus ankle degenerative arthritis due to chronic isolated deltoid insufficiency combined with tibial varus that was treated successfully with ankle joint preserving surgery. A 63-year-old male complained of right lateral ankle pain with 10 minutes of maximal pain-free walking time. The assessed American Orthopaedic Foot and Ankle ankle-hindfoot scale score was 33 points. The ankle joint showed 18° of valgus deformity with 6° of tibia varus. Medial displacement calcaneal osteotomy, supramalleolar open wedge osteotomy, and deltoid ligament imbrication were performed. At the 2-year follow-up examination, the ankle joint showed 10° of valgus and the tibial plafond showed flattening. The hindfoot showed 7° of valgus. He could run for 2 hours on the treadmill without pain. The American Orthopaedic Foot and Ankle ankle-hindfoot scale score was 90 points. In conclusion, valgus ankle degenerative arthritis with isolated deltoid insufficiency and tibial varus could be treated successfully with realignment using a double osteotomy and additional deltoid imbrication.
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Affiliation(s)
- Joo-Yul Bae
- Department of Orthopaedic Surgery, GangNeung Asan Hospital, University of Ulsan, College of Medicine, Gangneung, South Korea
| | - Hee-Jae Won
- Orthopedist, Department of Orthopaedic Surgery, GangNeung Asan Hospital, University of Ulsan, College of Medicine, Gangneung, South Korea
| | - Dong-Kyo Seo
- Department of Orthopaedic Surgery, GangNeung Asan Hospital, University of Ulsan, College of Medicine, Gangneung, South Korea.
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Krähenbühl N, Zwicky L, Bolliger L, Schädelin S, Hintermann B, Knupp M. Mid- to Long-term Results of Supramalleolar Osteotomy. Foot Ankle Int 2017; 38:124-132. [PMID: 27765869 DOI: 10.1177/1071100716673416] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Good clinical and radiographic short-term results have been reported for patients who underwent realignment surgery of the hindfoot for treatment of early- and mid-stage ankle osteoarthrosis (OA). However, no mid- to long-term results have been reported. The aim of this study was to gain a better insight into the indications and contraindications for realignment surgery. METHODS Two hundred ninety-four patients (298 ankles) underwent realignment surgery between December 1999 and June 2013. Kaplan-Meier survival analysis was performed with total ankle replacement and arthrodesis of the ankle joint as endpoints. A Cox proportional hazards model was performed to identify risk factors for failure. The mean time to follow-up was 5.0 ± 3.7 years. RESULTS The overall 5-year survival rate was 88%. Thirty-eight patients (12.9%) underwent either secondary total ankle replacement or ankle arthrodesis (30 total ankle replacements, 8 ankle arthrodesis). Risk factors for failure following realignment surgery were age at the time of surgery and a Takakura score of 3b preoperatively. CONCLUSION Realignment surgery of the hindfoot was an excellent treatment option for young and physically active patients with early to mid-stage ankle OA. LEVEL OF EVIDENCE Level IV, prospective observational study.
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Affiliation(s)
- Nicola Krähenbühl
- 1 Clinic for Orthopaedic and Trauma Surgery, Kantonsspital Baselland, Liestal, Switzerland
| | - Lukas Zwicky
- 1 Clinic for Orthopaedic and Trauma Surgery, Kantonsspital Baselland, Liestal, Switzerland
| | - Lilianna Bolliger
- 1 Clinic for Orthopaedic and Trauma Surgery, Kantonsspital Baselland, Liestal, Switzerland
| | - Sabine Schädelin
- 2 Clinical Trial Unit, University Hospital Basel, Basel, Switzerland
| | - Beat Hintermann
- 1 Clinic for Orthopaedic and Trauma Surgery, Kantonsspital Baselland, Liestal, Switzerland
| | - Markus Knupp
- 1 Clinic for Orthopaedic and Trauma Surgery, Kantonsspital Baselland, Liestal, Switzerland
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15
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The Use of Tibial Osteotomy (Ankle Plafondplasty) for Joint Preservation of Ankle Deformity and Early Arthritis. Foot Ankle Clin 2016; 21:15-26. [PMID: 26915775 DOI: 10.1016/j.fcl.2015.09.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Asymmetric ankle osteoarthritis (OA) is an increasingly recognized condition. It is imperative to differentiate between extraarticular and intraarticular deformity and to address these appropriately. Any associated instability and multilevel deformity must be recognized and addressed. Patients with intraarticular varus or valgus asymmetric OA have poorer outcomes and higher rates of recurrence when treated with standard techniques targeted at correction with traditional supramalleolar or inframalleolar techniques. Plafondplasty aims to correct the deformity at its center of rotation and angulation and is associated with low rates of recurrence, substantial postoperative pain relief, functional improvement, and a possible slowing of the degenerative process.
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16
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Galli MM, Scott RT. Supramalleolar Osteotomies: An Algorithm for the Deformed Ankle. Clin Podiatr Med Surg 2015; 32:435-44. [PMID: 26117577 DOI: 10.1016/j.cpm.2015.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Supramalleolar osteotomies are powerful osteotomies that realign the tibiotalar and optimize hindfoot position in the presence of varus, valgus, procurvatum, recurvatum, as well as internal and external rotation of the tibia. Although used in the pediatric and hemophilic population earlier, supramalleolar osteotomy is a relatively new reconstructive surgical technique that was introduced in 1995. Conducted primarily in cancellous bone, supramalleolar osteotomies offer rapid, reliable bony consolidation compared with dome osteotomies and complex arthrodesis.
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Affiliation(s)
- Melissa M Galli
- Department of Orthopedics, The CORE Institute, 18444 North 25th Avenue, Suite 210, Phoenix, AZ 85023-1264, USA
| | - Ryan T Scott
- Department of Orthopedics, The CORE Institute, 18444 North 25th Avenue, Suite 320, Phoenix, AZ 85023, USA.
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17
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Holzer N, Salvo D, Marijnissen ACA, Vincken KL, Ahmad AC, Serra E, Hoffmeyer P, Stern R, Lübbeke A, Assal M. Radiographic evaluation of posttraumatic osteoarthritis of the ankle: the Kellgren-Lawrence scale is reliable and correlates with clinical symptoms. Osteoarthritis Cartilage 2015; 23:363-9. [PMID: 25463444 DOI: 10.1016/j.joca.2014.11.010] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Revised: 10/27/2014] [Accepted: 11/07/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess reliability and construct validity of the Kellgren-Lawrence (K&L) scale in posttraumatic ankle osteoarthritis (OA); additionally evaluate the validity of including tibiotalar tilting in the scale. METHOD One-hundred and fifty ankle radiographs (75 patients, unilateral malleolar fractures) evaluated at average of 18 years after surgery. American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot (HF) score and pain (visual analog scale) were recorded. Grading of OA according to K&L criteria and identification of OA features was performed on standardized radiographs by four physicians. Minimal joint space width, sclerosis, and talar tilt angle were quantified by digital measurements. A modified K&L scale including talar tilting is presented. Validity of original and modified scale was evaluated and expressed as ability to (1) Identify those with clinical symptoms of ankle OA; and (2) Distinguish between different degrees of fracture severity. RESULTS Inter- and intra-observer reliability of OA assessment according to K&L were good (ICC 0.61 and 0.75). Original and modified K&L grades significantly increased with decreasing AOFAS ankle-HF scores and greater pain. A talar-tilt angle > 2° compared with ≤ 2° in grade 3 was associated with significantly higher pain levels (VAS pain 4.2 vs 1.4, respectively; mean difference 2.8, 95% CI 0.5-5.1). More severe fracture patterns at time of surgery were more often in patients with the highest K&L grades. CONCLUSIONS The K&L scale is a valid and reliable radiographic grading system for assessment of ankle OA. Inclusion of the talar tilt angle might allow for better differentiation with respect to clinical outcomes.
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Affiliation(s)
- N Holzer
- Division of Orthopedics and Trauma Surgery, Geneva University Hospital, Switzerland.
| | - D Salvo
- Division of Orthopedics and Trauma Surgery, Geneva University Hospital, Switzerland
| | - A C A Marijnissen
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, The Netherlands
| | - K L Vincken
- Imaging Sciences Institute, University Medical Center Utrecht, The Netherlands
| | - A C Ahmad
- Division of Orthopedics and Trauma Surgery, Geneva University Hospital, Switzerland
| | - E Serra
- Division of Orthopedics and Trauma Surgery, Geneva University Hospital, Switzerland
| | - P Hoffmeyer
- Division of Orthopedics and Trauma Surgery, Geneva University Hospital, Switzerland
| | - R Stern
- Division of Orthopedics and Trauma Surgery, Geneva University Hospital, Switzerland
| | - A Lübbeke
- Division of Orthopedics and Trauma Surgery, Geneva University Hospital, Switzerland
| | - M Assal
- Division of Orthopedics and Trauma Surgery, Geneva University Hospital, Switzerland
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18
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Abstract
A variety of surgical procedures are utilized for management of ankle osteoarthritis. The most common etiology in patients with ankle osteoarthritis is post-traumatic often resulting in asymmetric ankle osteoarthritis with concomitant valgus or varus deformity. A substantial part of tibiotalar joint is often preserved, therefore, in appropriate patients, joint-preserving surgery holds the potential to be a superior treatment option than joint-sacrificing procedures including total ankle replacement or ankle arthrodesis. This review is designed to describe indications and contraindications for single-stage supramalleolar realignment surgery. Complications associated with this type of surgery and postoperative outcome are highlighted using recent literature.
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Affiliation(s)
- Alexej Barg
- Head Foot and Ankle Surgery, Department of Orthopedic Surgery, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland,
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19
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Stapleton JJ, Zgonis T. Supramalleolar osteotomy and ankle arthrodiastasis for juvenile posttraumatic ankle arthritis. Clin Podiatr Med Surg 2014; 31:597-601. [PMID: 25281519 DOI: 10.1016/j.cpm.2014.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Numerous techniques have been described for posttraumatic ankle arthritis with or without an associated lower extremity deformity in the adult population. These surgical procedures may include, but are not limited to, ankle exostectomy with joint resurfacing, ankle arthrodiastasis, ankle arthroplasty, and ankle arthrodesis. Associated deformities may also be addressed with supramalleolar osteotomies, tibia or fibular lengthening, and calcaneal osteotomies. In juvenile patients, surgical treatment options for posttraumatic ankle arthritis can be challenging, especially when an associated deformity is present. This article describes a combined supramalleolar osteotomy and ankle arthrodiastasis for a juvenile patient with posttraumatic ankle arthritis and valgus deformity.
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Affiliation(s)
- John J Stapleton
- Foot and Ankle Surgery, VSAS Orthopaedics, Lehigh Valley Hospital, 1250 South Cedar Crest Boulevard, Suite #110, Allentown, PA 18103, USA; Penn State College of Medicine, 500 University Drive, Hershey, PA 17033, USA.
| | - Thomas Zgonis
- Division of Podiatric Medicine and Surgery, Department of Orthopaedic Surgery, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, MSC 7776, San Antonio, TX 78229, USA
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20
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Sabharwal S, Louie KW, Reid JS. What's new in limb-lengthening and deformity correction. J Bone Joint Surg Am 2014; 96:1399-406. [PMID: 25143503 DOI: 10.2106/jbjs.n.00369] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Sanjeev Sabharwal
- Department of Orthopedics, Rutgers-New Jersey Medical School, 90 Bergen Street, Doctor's Office Center, Suite 7300, Newark, NJ 07103. E-mail address for S. Sabharwal:
| | - Kevin W Louie
- Department of Orthopedics, Rutgers-New Jersey Medical School, 90 Bergen Street, Doctor's Office Center, Suite 7300, Newark, NJ 07103. E-mail address for S. Sabharwal:
| | - J Spence Reid
- Department of Orthopedics, Rutgers-New Jersey Medical School, 90 Bergen Street, Doctor's Office Center, Suite 7300, Newark, NJ 07103. E-mail address for S. Sabharwal:
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