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Ishibashi S, Nakasa T, Ikuta Y, Kawabata S, Moriwaki D, Sakurai S, Adachi N. The Hounsfield Unit Values of Talar Subchondral Bone Predict Articular Cartilage Degeneration in Patients With Ankle Osteoarthritis. Foot Ankle Int 2024:10711007241268111. [PMID: 39188102 DOI: 10.1177/10711007241268111] [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: 08/28/2024]
Abstract
BACKGROUND Therapeutic strategies for ankle osteoarthritis (OA) are determined based on OA staging, alignment, and articular cartilage conditions. However, it is difficult to evaluate the degeneration of the remaining cartilage using imaging modalities. Subchondral bone plays a crucial role in maintaining cartilage homeostasis. Measurement of local Hounsfield unit (HU) values allows for the quantitative assessment of small changes in the subchondral bone. This study aimed to evaluate a relationship between the HU values of the subchondral bone and the histologic findings of articular cartilage in ankle OA. METHODS The talar articular surface was harvested from 14 ankles during arthroplasty. The talus was divided into anterior, middle, and posterior parts, and histologic specimens were prepared. Safranin O staining was performed and histologic findings were evaluated using the modified Mankin score. The regions of interest (ROIs) were set in the medial, central, and lateral regions of the specimens and computed tomography (CT) images, and the relationship between the HU values and histologic findings was analyzed. RESULTS As OA progressed, cartilage defects increased. In conjunction with cartilage degeneration, the subchondral bone plate thickened, and the HU values increased. The HU value significantly and positively correlated with the modified Mankin score (r = 0.756), subchondral bone thickness (r = 0.674, P < .01), and trabecular bone area (r = 0.637). The cutoff HU values were 594 (sensitivity, 0.813; specificity, 0.944) for 3 points and 727 (sensitivity, 0.929; specificity, 0.782) for 11 points on the modified Mankin score. CONCLUSION Significant correlations between HU values and cartilage degeneration in ankle OA were noted. Measuring HU values on CT images can be useful for evaluating the joint surface condition, including histologic findings of the remaining cartilage.
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Affiliation(s)
- Saori Ishibashi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tomoyuki Nakasa
- Department of Artificial Joints and Biomaterials, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yasunari Ikuta
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shingo Kawabata
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Dan Moriwaki
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Satoru Sakurai
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Park CH, Park JJ, Woo IH. Joint Preservation Surgery Using Supramalleolar Osteotomy Combined with Posterior Tibial Tendon Release and Lateral Ligament Augmentation in Advanced Varus Ankle Arthritis. J Clin Med 2024; 13:4803. [PMID: 39200945 PMCID: PMC11355857 DOI: 10.3390/jcm13164803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 07/10/2024] [Accepted: 07/27/2024] [Indexed: 09/02/2024] Open
Abstract
Background: Recent studies utilizing weight-bearing computed tomography have identified abnormal internal rotation of the talus in advanced varus ankle arthritis (VAA) with a large talar tilt (TT), influenced by the posterior tibial tendon (PTT). This study aimed to evaluate the clinical and radiographic results of supramalleolar osteotomy (SMO) combined with PTT release and lateral ligament augmentation for VAA with a large TT. Methods: From January 2015 to September 2018, 15 patients with VAA and a large TT (greater than 5°) underwent SMO combined with PTT release. Clinical results, including visual analog scale (VAS) for pain, American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, and ankle osteoarthritis scale (AOS), were assessed. Radiographic results were assessed with various parameters, including medial distal tibial angle (MDTA), anterior distal tibial angle (ADTA), talar tilt (TT), talus center migration (TCM), Meary angle, hindfoot alignment angle (HAA), and hindfoot moment arm (HMA) on foot and ankle weight-bearing radiographs. Clinical and radiographic results were evaluated preoperatively and at the last follow-up. Results: VAS, AOFAS ankle-hindfoot score, and AOS improved significantly from 7.5, 54.4, and 72.6 preoperatively to 3.1, 82.5, and 34.5 postoperatively, respectively. All radiographic parameters exhibited significant changes postoperatively, with the exception of the Meary angle, which demonstrated no significant change. Four patients exhibited improvement in radiographic stage postoperatively; however, average radiographic stage did not significantly improve postoperatively in all patients. One patient progressed to end-stage arthritis postoperatively, necessitating additional ankle arthrodesis. Conclusions: In conclusion, lengthening and lateral ligament augmentation combined with bony realignment procedures may be a reasonable option for treating VAA with a large TT greater that 5°.
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Affiliation(s)
- Chul Hyun Park
- Department of Orthopaedic Surgery, College of Medicine, Yeungnam University, Daegu 42415, Republic of Korea
| | - Jeong-Jin Park
- Korea Armed Forces Athletic Corps, Mungyeong 36931, Republic of Korea;
| | - In-Ha Woo
- ROKA 7th Artillery Brigader, Namyangju 12284, Republic of Korea;
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Gong X, Yang X, Li X, Guan J, Wang X, Zhang B, Wang Y, Li Y, Sun N, Du H, Lai L, Li W, Li H, Wu Y. Analysis of radiologic parameters and clinical outcomes in supramalleolar osteotomy for varus ankle osteoarthritis: A novel method for evaluating ankle alignment. Foot Ankle Surg 2024:S1268-7731(24)00119-X. [PMID: 38853037 DOI: 10.1016/j.fas.2024.05.013] [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: 01/03/2024] [Revised: 04/13/2024] [Accepted: 05/27/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND Solely relying on the tibial ankle surface (TAS) angle for determining the mechanical ankle axis might be insufficient. We introduce a novel method to determine the distance from the center of the talus to the tibial axis (TTD). This study aimed to investigate the association between clinical outcomes and radiological changes before and after supramalleolar osteotomy (SMO), including TAS angle, talar tilt (TT) angle, tibiotalar surface (TTS) angle and TTD. METHODS Seventy patients who received SMO were enrolled. Radiological changes were measured using weight-bearing anteroposterior imaging. The percentage of talar center displacement (TTDP) was calculated as the difference between postoperative and preoperative TTD, divided by talar width (TW). Clinical assessments were performed using the American Orthopedic Foot and Ankle Society ankle-hindfoot (AOFAS) scale. Differences in the aforementioned indicators before and after the operation were analyzed. We defined ΔAOFAS, ΔTAS, ΔTT and ΔTTS as the difference between postoperative and preoperative values. RESULTS ΔTTS correlated with ΔAOFAS (r = 0.40, p = 0.008), as did TTDP (r = 0.32, p = 0.035). No correlation was observed between ΔAOFAS and ΔTAS. In the comparison between groups, patients with a TTDP greater than 26.19 exhibited a significantly greater ΔAOFAS. The high intraclass correlation coefficient indicated good reliability of the novel method. CONCLUSION Solely relying on the TAS angle for tibial correction was insufficient. We found TTD as a novel method to evaluate mechanical ankle joint axis. TTDP and ΔTTS both positively correlated with ΔAOFAS, indicating the usefulness of these radiologic parameters.
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Affiliation(s)
- Xiaofeng Gong
- Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital, Capital Medical University, Peking University Fourth School of Clinical Medicine, 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China
| | - Xiaosong Yang
- Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital, Capital Medical University, Peking University Fourth School of Clinical Medicine, 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China
| | - Xing Li
- Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital, Capital Medical University, Peking University Fourth School of Clinical Medicine, 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China
| | - Jack Guan
- Bay Area Foot and Ankle Medical Clinic, San Jose 3150, CA, USA
| | - Xuewen Wang
- Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital, Capital Medical University, Peking University Fourth School of Clinical Medicine, 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China
| | - Baozhou Zhang
- Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital, Capital Medical University, Peking University Fourth School of Clinical Medicine, 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China
| | - Yan Wang
- Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital, Capital Medical University, Peking University Fourth School of Clinical Medicine, 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China
| | - Ying Li
- Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital, Capital Medical University, Peking University Fourth School of Clinical Medicine, 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China
| | - Ning Sun
- Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital, Capital Medical University, Peking University Fourth School of Clinical Medicine, 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China
| | - Hui Du
- Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital, Capital Medical University, Peking University Fourth School of Clinical Medicine, 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China
| | - Liangpeng Lai
- Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital, Capital Medical University, Peking University Fourth School of Clinical Medicine, 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China
| | - Wenjing Li
- Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital, Capital Medical University, Peking University Fourth School of Clinical Medicine, 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China
| | - Heng Li
- Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital, Capital Medical University, Peking University Fourth School of Clinical Medicine, 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China
| | - Yong Wu
- Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital, Capital Medical University, Peking University Fourth School of Clinical Medicine, 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China.
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Rammelt S, Walther EJ. Joint-Preserving Osteotomy of the Lateral Tibial Plafond for Posttraumatic Osteonecrosis: A Prospective Cohort Study. Foot Ankle Int 2024; 45:328-337. [PMID: 38389195 DOI: 10.1177/10711007241227928] [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: 02/24/2024]
Abstract
BACKGROUND Posttraumatic osteonecrosis (ON) of the lateral distal tibia is a rare but severe complication of malleolar fractures. Treatment options include ankle fusion, arthroplasty, osteotomy, and drilling but clinical data on outcomes are limited to single case reports. The aim of this study was to prospectively evaluate the outcome following joint-preserving reconstruction. METHODS Over a 10-year period, 10 patients (8 females and 2 males, average age 36 years; range, 27-68 years) with posttraumatic ON were treated with intra-articular osteotomy of the distal tibia and bone grafting. All patients initially sustained a closed pronation injury, 7 with initial tibiotalar subluxation. Chronic syndesmotic instability following initial treatment was present in 4 patients and 5 were smokers. All patients were followed for a median of 68 (range, 12-103) months, 7 returned in person for clinical and radiographic follow-up. RESULTS No immediate postoperative complications were seen. Secondary ankle fusion was necessary in 1 case (10%) because of progressive osteoarthritis. At the time of follow-up, anterior ankle arthritis leading to impingement and requiring cheilectomy was noted in 4 cases, partial graft necrosis, and secondary syndesmotic instability requiring revision surgery was seen in 1 case each. Compared with the preoperative values, significant improvement in the Olerud-Molander Ankle Score (P = .012), EuroQuol-5 Score (P = .008), and Foot Function Index (FFI-D pain, P = .028; FFI-D restriction, P = .038) was seen. Average range of motion at the ankle was 45 degrees. CONCLUSION In our limited series of patients with posttraumatic ON of the lateral distal tibia, we found that joint-preserving reconstruction using an intra-articular distal tibial osteotomy with autologous bone grafting usually provided significant functional improvement and pain relief. In our cohort secondary fusions by a median 5.5-year follow-up were rare, but secondary, joint-sparing surgeries were common. LEVEL OF EVIDENCE Level III, prospective study.
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Affiliation(s)
- Stefan Rammelt
- University Center of Orthopaedics, Trauma and Plastic Surgery, Dresden, Germany
- University Hospital Carl Gustav Carus at TU Dresden, Dresden, Germany
| | - Eric Jörg Walther
- University Center of Orthopaedics, Trauma and Plastic Surgery, Dresden, Germany
- University Hospital Carl Gustav Carus at TU Dresden, Dresden, Germany
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Xie Q, Sui L, Sun Y, Li X, Liu S, Wang P. Comparisons of ankle arthrodesis with different internal fixation methods in the treatment of post-traumatic osteoarthritis. J Orthop Sci 2024; 29:621-626. [PMID: 36858837 DOI: 10.1016/j.jos.2023.02.009] [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] [Received: 06/22/2022] [Revised: 01/06/2023] [Accepted: 02/14/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND The aim of this study was to explore the clinical efficacy of ankle arthrodesis with different internal fixation methods in the treatment of post-traumatic osteoarthritis. METHODS We collected 85 patients with post-traumatic osteoarthritis who underwent different ankle arthrodesis between December 2015 and December 2020. The operation performance, complication rate, hindfoot alignment, talus tilt angle, visual analogue scale (VAS), and American Orthopedic Foot and Ankle Society (AOFAS) score were preoperatively and postoperatively evaluated. RESULTS In an anterior approach, the locking plate-fixation exhibited a similarity in operation time, incision length, postoperative drainage, bone fusion, hindfoot alignment, and talus tilt angle with fibula support compression screw-fixation, but it was better in increasing postoperative AOFAS. The locking plate-fixation in the anterior approach had lower operation time, incision length, and postoperative drainage than that in the lateral approach. In addition, the lateral locking plate combined with posterolateral compression screw fixation (LLPPCSF) presented shorter bone fusion time, higher AOFAS score, and lower complication rate than either plate- or screw-fixation alone. CONCLUSION Lateral locking plate fixation was better than fibula support compression screw fixation in relieving postoperative pain. Anterior locking plate fixation was more time-saving and less invasiveness than lateral locking plate fixation, but its application was limited in low degree of ankle deformation. LLPPCSF was the most effective in improving bone fusion and postoperative pain, considering an optimal option for the treatment of post-traumatic osteoarthritis.
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Affiliation(s)
- Qiang Xie
- Department of Hand and Foot Surgery, Affiliated Hospital of Chengde Medical University, Chengde City, Hebei Province, 067000, China
| | - Lei Sui
- Department of Hand and Foot Surgery, Affiliated Hospital of Chengde Medical University, Chengde City, Hebei Province, 067000, China
| | - Yupeng Sun
- Department of Hand and Foot Surgery, Affiliated Hospital of Chengde Medical University, Chengde City, Hebei Province, 067000, China
| | - Xiaodong Li
- Department of Hand and Foot Surgery, Affiliated Hospital of Chengde Medical University, Chengde City, Hebei Province, 067000, China
| | - Shibo Liu
- Department of Hand and Foot Surgery, Affiliated Hospital of Chengde Medical University, Chengde City, Hebei Province, 067000, China
| | - Pei Wang
- Department of Hand and Foot Surgery, Affiliated Hospital of Chengde Medical University, Chengde City, Hebei Province, 067000, China.
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Jie K, Liang J, Xu J, Zou Y, Li B, Tan Y, Zhang H, Zhu Y. Changes in clinical outcomes and alignment of the ipsilateral knee and ankle after supramalleolar osteotomy in patients with varus osteoarthritis of the ankle: a short-term follow-up study. Arch Orthop Trauma Surg 2024; 144:161-170. [PMID: 37789151 DOI: 10.1007/s00402-023-05079-3] [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] [Received: 06/25/2023] [Accepted: 09/17/2023] [Indexed: 10/05/2023]
Abstract
PURPOSE The purpose of this study was to investigate the changes in clinical outcomes and alignment of the ipsilateral knee and ankle in patients with varus ankle osteoarthritis after supramalleolar osteotomy (SMO). METHODS We retrospectively reviewed 23 patients (24 ankles) with Takakura II, IIIa and IIIb ankle osteoarthritis treated with SMO between May 2017 and March 2022. The radiologic parameters of ankles contained medial distal tibial angle (TAS), tibiotalar angle (TT), tibial lateral surface (TLS), tibial plafond inclination (TPI) and talar inclination (TI). The radiologic parameters of knees contained medial proximal tibial angle (MPTA), joint line convergence angle (JLCA), the knee joint line orientation relative to ground (G-KJLO) and WBL. Hip-knee-ankle angle (HKA) was also collected. The Takakura system was used for evaluating the ankle osteoarthritis and the Kellgren-Lawrence (KL) system was used for evaluating the knee osteoarthritis. Clinical evaluation of the ankle joints contained American Orthopedic Foot and Ankle Society (AOFAS), range of motion (ROM) and visual analogue scale (VAS). Clinical evaluation of the knee joints contained Japanese Orthopaedic Association Scores (JOA), ROM, VAS. RESULTS The mean follow-up times were 20.3 ± 7.3 months (range 12-38). According to the radiologic evaluation, the TAS increased from preoperative 84.7° ± 2.0° to 91.2° ± 1.8° at the last follow-up (P < 0.001). The TPI and TI decreased from 4.4° ± 4.2° and 11.0° ± 5.2° to 0.1° ± 4.7° and 4.1° ± 4.8° (P < 0.001 for both). The TT angel improved from 9.5° ± 4.1° to 4.9° ± 3.3° (P < 0.001). No significant differences were found regarding MPTA, JLCA, G-KJLO, knee WBL and HKA (P > 0.05 for all). The Takakura stage improved after SMO (P < 0.001) whilst the KL stage maintains the similar lever (P > 0.05). According to the clinical evaluation, the AOFAS significantly increased from 67.5 ± 10.6 to 88.5 ± 9.3 and the VAS of the ankle decreased from 4.7 ± 1.6 to 1.2 ± 1.1, whilst there were no changes on VAS and even the JOA and knee ROM after SMO (P > 0.05 for all). CONCLUSIONS SMO can alleviate the symptoms of varus ankle osteoarthritis and delay the time for ankle replacement or arthrodesis by redistributing the abnormal stress of the ankle and restoring the congruence of the tibiotalar joint. In addition, it did not induce the clinical symptoms of knee without compromising lower limb alignment or knee joint line orientation in the short term. LEVEL OF EVIDENCE Level IV case series.
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Affiliation(s)
- Ke Jie
- Foshan Hospital of Traditional Chinese Medicine, 6 Qinren Road, Foshan, 528000, Guangdong, China
| | - Jinjie Liang
- Foshan Hospital of Traditional Chinese Medicine, 6 Qinren Road, Foshan, 528000, Guangdong, China
| | - Jingcheng Xu
- Foshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Chinese Medicine, 6 Qinren Road, Foshan, 528000, Guangdong, China
| | - Yunxuan Zou
- Foshan Hospital of Traditional Chinese Medicine, 6 Qinren Road, Foshan, 528000, Guangdong, China
| | - Biyi Li
- Foshan Hospital of Traditional Chinese Medicine, 6 Qinren Road, Foshan, 528000, Guangdong, China
| | - Yanqing Tan
- Foshan Hospital of Traditional Chinese Medicine, 6 Qinren Road, Foshan, 528000, Guangdong, China
| | - Hongning Zhang
- Foshan Hospital of Traditional Chinese Medicine, 6 Qinren Road, Foshan, 528000, Guangdong, China
| | - Yongzhan Zhu
- Foshan Hospital of Traditional Chinese Medicine, 6 Qinren Road, Foshan, 528000, Guangdong, China.
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Zhao B, Liu W, Zhao Y, Wahafu P, Wang X, Qi L, Wang C. Efficacy of supramalleolar osteotomy in the treatment of traumatic ankle joint varus deformity in adolescents. J Orthop Surg Res 2023; 18:749. [PMID: 37789419 PMCID: PMC10548641 DOI: 10.1186/s13018-023-04239-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 09/26/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Supramalleolar osteotomy (SMOT) has emerged as a valuable treatment for ankle varus deformity; however, there are fewer reports of treatment outcomes in adolescents. The purpose of this study was to investigate the radiologic and clinical outcomes of SMOT for the treatment of traumatic ankle joint varus deformity (TAVD) in adolescents. METHODS We reviewed 32 adolescent cases who underwent SMOT between February 2017 and February 2022 for TAVD. Radiologic assessment included tibial anterior surface angle (TAS), talar tilt angle (TT), and tibial lateral surface angle (TLS) preoperatively and at 3 months and 12 months postoperatively, and clinical assessment was performed using American Orthopaedic Foot and Ankle Society (AOFAS) scores, Visual Analogue Scale (VAS) scores, and ankle dorsiflexion-plantarflexion ROM including preoperative and 6 months postoperative and 12 months postoperative. RESULTS All 32 patients were followed up completely with a mean follow-up of (20.3 ± 3.2) months. From the radiologic outcomes, the mean preoperative TAS improved from 61.53 ± 3.74 to 88 ± 1.72 at 12 months postoperatively, the mean preoperative TT decreased from 2.25 ± 1.32 to 0.5 ± 0.57 at 12 months postoperatively, the mean preoperative TLS improved from 76.72 ± 0.21 to 79.34 ± 1.52 at 12 months postoperatively, the differences between the above preoperative and 12 months postoperative radiologic outcomes were statistically significant (p < 0.05), the mean preoperative AOFAS score improved from 65.5 ± 9.40 to 92.34 ± 4.00 at 12 months postoperatively, the mean preoperative VAS score decreased from 2.44 ± 1.24 to 0.78 ± 0.75 at 12 months postoperatively, and the mean preoperative range of motion (ROM) of ankle improved from 50.16 ± 7.46 to 55.78 ± 4.77 at 12 months postoperatively. The differences between the above preoperative and 12 months postoperative clinical results were statistically significant (p < 0.05). CONCLUSION Our study demonstrated that SMOT was effective in correcting TAVD and significantly improving ankle function in adolescents, and that it is an efficient and successful method for restoring ankle joint congruence and normal hindfoot alignment.
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Affiliation(s)
- Bo Zhao
- The Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830000, People's Republic of China
| | - Wei Liu
- The Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830000, People's Republic of China
| | - Yaqiong Zhao
- The Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830000, People's Republic of China
| | - Paerhati Wahafu
- The Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830000, People's Republic of China
| | - Xue Wang
- The Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830000, People's Republic of China
| | - Ling Qi
- The Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830000, People's Republic of China
| | - Chengwei Wang
- The Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830000, People's Republic of China.
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Christidis P, Lampridis V, Kalitsis C, Kantas T, Biniaris G, Gougoulias N. Supramalleolar osteotomies for ankle arthritis: a systematic review. Arch Orthop Trauma Surg 2023; 143:5549-5564. [PMID: 37010603 DOI: 10.1007/s00402-023-04867-1] [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] [Received: 11/07/2022] [Accepted: 03/27/2023] [Indexed: 04/04/2023]
Abstract
INTRODUCTION We investigated the mid-term outcomes of supramalleolar osteotomies regarding "survivorship" [before ankle arthrodesis (AA) or total ankle replacement (TAR)], complication rate and adjuvant procedures required. MATERIAL AND METHODS PubMed, Cochrane and Trip Medical Database were searched from January 01, 2000. Studies reporting on SMOs for ankle arthritis, in minimum of 20 patients aged 17 or older, followed for a minimum of two years, were included. Quality assessment was performed with the Modified Coleman Methodology Score (MCMS). A subgroup analysis of varus/valgus ankles was performed. RESULTS Sixteen studies met the inclusion criteria, with 866 SMOs in 851 patients. Mean age of patients was 53.6 (range 17-79) years, and mean follow-up was 49.1 (range 8-168) months. Of the arthritic ankles (646 ankles), 11.1% were classified as Takakura stage I, 24.0% as stage II, 59.9% as stage III and 5.0% as stage IV. The overall MCMS was 55.2 ± 9.6 (fair). Eleven studies (657 SMOs) reported on "survivorship" of SMO, before arthrodesis (2.7%), or total ankle replacement (TAR) (5.8%) was required. Patients required AA after an average of 44.6 (range 7-156) months, and TAR after 36.71 (range 7-152) months. Hardware removal was required in 1.9% and revision in 4.4% of 777 SMOs. Mean AOFAS score was 51.8 preoperatively, improving to 79.1 postoperatively. Mean VAS was 6.5 preoperatively and improved to 2.1 postoperatively. Complications were reported in 5.7% (44 out of 777 SMOs). Soft tissue procedures were performed in 41.0% (310 out of 756 SMOs), whereas concomitant osseous procedures were performed in 59.0% (446 out of 756 SMOs). SMOs performed for valgus ankles failed in 11.1% of patients, vs 5.6% in varus ankles (p < 0.05), with disparity between the different studies. CONCLUSIONS SMOs combined with adjuvant, osseous and soft tissue, procedures, were performed mostly for arthritic ankles of stage II and III, according to the Takakura classification and offered functional improvement with low complication rate. Approximately, 10% of SMOs failed and patients required AA or TAR, after an average of just over 4 years (50.5 months) after the index surgery. It is debatable whether varus and valgus ankles treated with SMO reveal different success rates.
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Affiliation(s)
- Panagiotis Christidis
- Department of Orthopedic Surgery, General Hospital of Katerini, 6th km Katerini-Aronas Rd, 60100, Katerini, Greece
| | - Vasileios Lampridis
- Department of Trauma and Orthopedics, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Christos Kalitsis
- Department of Orthopedic Surgery, General Hospital of Katerini, 6th km Katerini-Aronas Rd, 60100, Katerini, Greece
| | - Theofanis Kantas
- Department of Orthopedic Surgery, General Hospital of Katerini, 6th km Katerini-Aronas Rd, 60100, Katerini, Greece
| | - Georgios Biniaris
- Department of Orthopedic Surgery, General Hospital of Katerini, 6th km Katerini-Aronas Rd, 60100, Katerini, Greece
| | - Nikolaos Gougoulias
- Department of Orthopedic Surgery, General Hospital of Katerini, 6th km Katerini-Aronas Rd, 60100, Katerini, Greece.
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Correction of ankle varus deformity using patient-specific dome-shaped osteotomy guides designed on weight-bearing CT: a pilot study. Arch Orthop Trauma Surg 2023; 143:791-799. [PMID: 34562121 DOI: 10.1007/s00402-021-04164-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 09/01/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Dome-shaped supramalleolar osteotomies are a well-established treatment option for correcting ankle deformity. However, the procedure remains technically demanding and is limited by a two-dimensional (2D) radiographic planning of a three-dimensional (3D) deformity. Therefore, we implemented a weight-bearing CT (WBCT) to plan a 3D deformity correction using patient-specific guides. METHODS A 3D-guided dome-shaped supramalleolar osteotomy was performed to correct ankle varus deformity in a case series of five patients with a mean age of 53.8 years (range 47-58). WBCT images were obtained to generate 3D models, which enabled a deformity correction using patient-specific guides. These technical steps are outlined and associated with a retrospective analysis of the clinical outcome using the EFAS score, Foot and Ankle Outcome Score (FAOS) and visual analog pain scale (VAS). Radiographic assessment was performed using the tibial anterior surface angle (TAS), tibiotalar angle (TTS), talar tilt angle (TTA), hindfoot angle (HA), tibial lateral surface angle (TLS) and tibial rotation angle (TRA). RESULTS The mean follow-up was 40.8 months (range 8-65) and all patients showed improvements in the EFAS score, FAOS and VAS (p < 0.05). A 3-month postoperative WBCT confirmed healing of the osteotomy site and radiographic improvement of the TAS, TTS and HA (p < 0.05), but the TTA and TRA did not change significantly (p > 0.05). CONCLUSION Dome-shaped supramalleolar osteotomies using 3D-printed guides designed on WBCT are a valuable option in correcting ankle varus deformity and have the potential to mitigate the technical drawbacks of free-hand osteotomies. LEVEL OF EVIDENCE Level 5 case series.
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Supramalleolar osteotomy for the treatment of ankle osteoarthritis leads to favourable outcomes and low complication rates at mid-term follow-up: a systematic review. Knee Surg Sports Traumatol Arthrosc 2023; 31:701-715. [PMID: 36151410 DOI: 10.1007/s00167-022-07144-7] [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: 05/18/2022] [Accepted: 08/26/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE The purpose of this systematic review was to evaluate both the clinical and radiographic outcomes following supramalleolar osteotomy (SMO) in patients with ankle osteoarthritis, and to analyse the level of evidence (LOE) and quality of evidence (QOE) of the included studies. METHODS A systematic review of the MEDLINE, EMBASE, and Cochrane Library databases was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies reporting clinical data following SMO for the treatment of ankle osteoarthritis were included and assessed. The level and quality of evidence of the included studies were also evaluated. RESULTS Twenty-four studies with 1160 patients (1182 ankles) were included. Overall, 78.8% patients presented with post-traumatic ankle osteoarthritis. The weighted mean AOFAS score improved from 52.6 ± 9.7 (range 33.8-78.4) preoperatively to 78.1 ± 5.7 postoperatively at weighted mean follow-up of 50.4 ± 18.6 months (range 24.5-99.0). The most frequently utilised radiographic parameter was the tibial anterior surface angle, which improved from a preoperative weighted mean of 86.3° ± 5.6° (range 76.0°-102.0°) to a postoperative weighted mean of 89.9° ± 3.7° (range 84.9°-99.6°). The complication rate was 5.1% with non-union as the most commonly reported complication (1.6%). Secondary procedures were carried out in 28.2% of patients, the most common of which was implant and hardware removal (17.6%). The failure rate was 6.8%. Two studies were LOE II, 3 studies were LOE III, and 19 studies were LOE IV. The mean Modified Coleman Methodology Score was 59.3 ± 6.6 and the mean MINORS criteria score of all the included studies was 9.5 ± 3.7. CONCLUSION This systematic review demonstrates good clinical and radiological outcomes, together with a low failure rate at mid-term follow-up following supramalleolar osteotomy in patients with ankle osteoarthritis. However, a moderate reoperation rate (28.2%) was reported. A low failure rate (6.8%) was reported, which must be interpreted in light of the shortcomings of the design of the included studies and a relatively short follow-up period. In addition, there is a low level and quality of evidence in the current literature with inconsistent reporting of data which underscores the need for further higher quality research to be conducted. Our review highlights that SMO may be an effective and safe procedure in the setting of early-to-intermediate-stage ankle osteoarthritis. LEVEL OF EVIDENCE IV.
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Beijk I, Burgerhof J, de Vries AJ, van Raaij TM. Is there an optimal degree of correction for ankle varus deformity after supramalleolar osteotomy? A systematic review. Foot Ankle Surg 2022; 28:1139-1149. [PMID: 35738984 DOI: 10.1016/j.fas.2022.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/26/2022] [Accepted: 06/06/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND There is no consensus on the angle targeted for in varus ankle deformity after supramalleolar osteotomy (SMOT). The aim of this study was to investigate which obtained correction has the best clinical outcome after valgus SMOT. METHODS A systematic review according PRISMA guidelines was conducted with studies being eligible for inclusion when published in English, German or Dutch, patients older than 18 years at study entrance, primary or posttraumatic varus ankle osteoarthritis, using any valgus SMOT technique, describing radiological alignment and clinical outcome at baseline and after at least 12 months follow-up. Risk of bias was assessed using the McMaster University Occupational Therapy Evidence-Based Practice Research Group quality assessment tool. The electronical databases PubMed, EMBASE and Cinahl were used as data sources. Included cohorts were categorized according to the mean obtained medial distal tibia angle (MDTA; ranged between 87° and 100°). A linear mixed effect model was used for individual patient data to assess the association between the MDTA and the (difference in) clinical outcome. RESULTS Thirty studies including 33 patient cohorts with 922 ankles were identified. At a mean follow-up of 4 years no differences in clinical outcome between correction categories were found. Individual data of 34 ankles showed no relationship between obtained MDTA and clinical outcome either. CONCLUSION This review could not demonstrate an optimal degree of correction after valgus SMOT. Results were hampered by biased low quality studies and the widespread use of unreliable 2D alignment measures such as the MDTA.
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Affiliation(s)
- Iris Beijk
- Department of Orthopedic Surgery, Martini Hospital Groningen, Van Swietenplein 1, 9728 NT Groningen, the Netherlands
| | - Johannes Burgerhof
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands
| | - Astrid J de Vries
- Department of Orthopedic Surgery, Martini Hospital Groningen, Van Swietenplein 1, 9728 NT Groningen, the Netherlands
| | - Tom M van Raaij
- Department of Orthopedic Surgery, Martini Hospital Groningen, Van Swietenplein 1, 9728 NT Groningen, the Netherlands.
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Ahn J, Son HS, Jeong BO. Clinical Outcomes of Supramalleolar Osteotomy in Intermediate Stage of Varus Ankle Osteoarthritis in Joint Preservation. J Foot Ankle Surg 2022; 61:1280-1286. [PMID: 35585001 DOI: 10.1053/j.jfas.2022.04.002] [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: 10/12/2020] [Revised: 04/01/2022] [Accepted: 04/02/2022] [Indexed: 02/03/2023]
Abstract
Supramalleolar osteotomy (SMO) is an effective treatment for intermediate-stage varus ankle osteoarthritis (OA). This study aimed to investigate how clinical outcomes were associated with radiological changes and cartilage regeneration shown on arthroscopy before and after SMO in patients with intermediate-stage varus ankle OA. Twenty-six cases with intermediate-stage varus ankle OA underwent SMO with at least 1 year of postoperative follow-up. Clinical assessment was performed preoperatively and postoperatively using the visual analog scale (VAS), American Orthopedic Foot and Ankle Society ankle-hindfoot (AOFAS) scores, and their associations with postoperative changes in tibial ankle surface angle (TAS), talar tilt, tibial lateral surface angle, and heel alignment ratio. The degrees of cartilage regeneration in the tibia plafond and talar dome were observed via second-look arthroscopy. Afterward, their associations with the corresponding clinical outcomes were analyzed. There were significant changes in the TAS, talar tilt, and heel alignment ratio (p < .001, for all). However, there were no significant changes in the tibial lateral surface angle (p = .864) at the final follow-up compared to its preoperative value. Postoperative changes in TAS (p = .013) and the degree of cartilage regeneration (p = .028) in the talar dome significantly influenced the final follow-up AOFAS score. Changes in the TAS angle and the degree of cartilage regeneration after SMO were predictors of clinical outcomes after SMO. In particular, greater changes in the TAS angle corresponded to better clinical outcomes.
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Affiliation(s)
- Jungtae Ahn
- Department of Orthopedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Hyuck Sung Son
- Department of Orthopedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Bi O Jeong
- Department of Orthopedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea.
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Lai L, Wang Y, Wu Y, Sun N, Li Y, Du H, Gong X. Outcomes of intermediate stage varus ankle arthritis treated by supramalleolar osteotomy. J Orthop Surg (Hong Kong) 2022; 30:10225536221132769. [PMID: 36197148 DOI: 10.1177/10225536221132769] [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: 02/07/2023] Open
Abstract
OBJECTIVE To evaluate the outcomes of intermediate stage varus ankle arthritis treated by supramalleolar osteotomy. METHODS Clinical data of 57 patients with varus arthritis who underwent supramalleolar osteotomy at our hospital between March 2018 and December 2019 were retrospectively analyzed. The patients were grouped according to the Takakura classification, and assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score and the Visual Analogue Score (VAS). Tibial anterior surface (TAS) angle and talar tilt (TT) angle were measured at the weight-bearing anteroposterior view. Tibial lateral surface (TLS) angle was measured at the weight-bearing lateral view. The differences in the above indicators of patients with different stages of varus ankle arthritis before and after treatment were analyzed. RESULTS The patients were followed up for an average of 31.9 ± 5.8 months. Upon the last follow-up, the AOFAS score was 84.1 ± 9.7, the VAS score 2.2 ± 1.3, the TAS angle 92.4 ± 5.5°, the TLS angle 79.3 ± 5.3°, and the TT angle 3.7±3.4°, which were significantly different from the preoperative levels (64.2 ± 14.6, 4.5 ± 1.8, 80.5 ± 6.7°, 74.9 ± 4.6°, and 5.2 ± 64.1°, respectively) (p < .05). There were significant differences in AOFAS and VAS scores before surgery and upon the last follow-up in each group (p < .05). The postoperative TT angle was significantly different from the preoperative level in stage IIIb patients (p = .003). CONCLUSIONS Supramalleolar osteotomy achieved good short-to mid-term clinical outcomes for intermediate stage varus ankle arthritis. This procedure could significantly improve the TAS and TLS angles of the patients at any stage and the TT angle of stage IIIb patients.
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Affiliation(s)
- Liangpeng Lai
- Department of Foot and Ankle Surgery, 66526Beijing Jishuitan Hospital(Fourth Clinical Medical School of Peking University), China
| | - Yan Wang
- Department of Foot and Ankle Surgery, 66526Beijing Jishuitan Hospital(Fourth Clinical Medical School of Peking University), China
| | - Yong Wu
- Department of Foot and Ankle Surgery, 66526Beijing Jishuitan Hospital(Fourth Clinical Medical School of Peking University), China
| | - Ning Sun
- Department of Foot and Ankle Surgery, 66526Beijing Jishuitan Hospital(Fourth Clinical Medical School of Peking University), China
| | - Ying Li
- Department of Foot and Ankle Surgery, 66526Beijing Jishuitan Hospital(Fourth Clinical Medical School of Peking University), China
| | - Hui Du
- Department of Foot and Ankle Surgery, 66526Beijing Jishuitan Hospital(Fourth Clinical Medical School of Peking University), China
| | - Xiaofeng Gong
- Department of Foot and Ankle Surgery, 66526Beijing Jishuitan Hospital(Fourth Clinical Medical School of Peking University), China
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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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Burssens A, Susdorf R, Krähenbühl N, Peterhans U, Ruiz R, Barg A, Hintermann B. Supramalleolar Osteotomy for Ankle Varus Deformity Alters Subtalar Joint Alignment. Foot Ankle Int 2022; 43:1194-1203. [PMID: 35786021 DOI: 10.1177/10711007221108097] [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: 02/01/2023]
Abstract
BACKGROUND Although correction of ankle and hindfoot deformity after supramalleolar osteotomy has been investigated extensively, the specific effect on the subtalar joint alignment remains elusive. This can be attributed to the limitations of 2-dimensional measurements, which impede an exact quantification of the 3-dimensional subtalar joint alignment. Therefore, we determined both the ankle, hindfoot, and subtalar joint alignment before and after supramalleolar osteotomy using autogenerated 3-dimensional measurements based on weightbearing CT imaging. METHODS Twenty-nine patients with a mean age of 50.4±10.6 years were retrospectively analyzed in a pre-post study design using weightbearing CT. Inclusion criteria were correction of ankle varus deformity by an opening wedge (n = 22) or dome osteotomy (n = 7). Exclusion criteria consisted of an additional inframalleolar arthrodesis or osteotomy. Corresponding 3-dimensional bone models were reconstructed to compute following autogenerated measurements of the ankle- and hindfoot alignment: tibial anterior surface (TAS), tibiotalar surface (TTS), talar tilt (TT) angle, hindfoot angle (HA). In addition, the talocalcaneal angle (TCA) in the axial (TCAax), sagittal (TCAsag), and coronal (TCAcor) plane were measured to assess the subtalar joint alignment. RESULTS The preoperative radiographic parameters of the ankle joint alignment (TAS=88±4 degrees, TTS=82±7 degrees, TT=5.8±4.9 degrees) improved significantly relative to their postoperative equivalents (TAS = 93±5 degrees, TTS = 88±7 degrees, TT=4.2±4.5 degrees; P < .05). The following radiographic parameters of the hindfoot and subtalar joint alignment improved significantly from preoperatively (8.7±8.9 degrees, TCAax = 41±10 degrees, TCAsag = 48±10 degrees) to postoperatively (HA=4.5±8.6 degrees, TCAax = 38±9 degrees, TCAsag = 44±11 degrees; P < .05). No significant differences could be detected in the coronal plane alignment of the subtalar joint (TCAcor) pre- compared to postoperatively (P > .05). CONCLUSION This study quantified the 3-dimensional ankle, hindfoot, and subtalar joint alignment after a solitary supramalleolar osteotomy. We found alterations in the subtalar joint alignment, which occurred by 2 to 3 degrees in each anatomic plane. However, before recommendations can be given related to inframalleolar procedures in conjunction to supramalleolar osteotomies, further studies on the variation of subtalar joint alignment change are needed.
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Affiliation(s)
- Arne Burssens
- Department of Orthopaedics, Kantonsspital Baselland, Liestal, Switzerland
- Department of Orthopaedics, University Hospital of Ghent, Ghent, OVL, Belgium
| | - Roman Susdorf
- Department of Orthopaedics, Kantonsspital Baselland, Liestal, Switzerland
| | - Nicola Krähenbühl
- Department of Orthopaedics, University Hospital Basel, Basel, Switzerland
| | - Ursina Peterhans
- Department of Orthopaedics, Kantonsspital Baselland, Liestal, Switzerland
| | - Roxa Ruiz
- Department of Orthopaedics, Kantonsspital Baselland, Liestal, Switzerland
| | - Alexej Barg
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Beat Hintermann
- Department of Orthopaedics, Kantonsspital Baselland, Liestal, Switzerland
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16
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Xue W, Chen T, Wahafu P, Li F, Xiahatai A, Wufuer A, Tuo Y, Zhao B, Wang C. Efficacy evaluation and systematic review of supramalleolar osteotomy for treatment of varus-type ankle arthritis. J Orthop Surg (Hong Kong) 2022; 30:10225536221122286. [PMID: 35998358 DOI: 10.1177/10225536221122286] [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: 11/16/2022] Open
Abstract
BACKGROUND The current surgical treatment plan for medium-term varus-type ankle arthritis is primarily supramalleolar osteotomy (SMOT), but the reliability of this procedure still lacks high-quality evidence-based medical studies, such as randomized controlled clinical trials and meta-analyses of comparative studies. OBJECTIVE The current study explored whether significant differences were present in the clinical effect, reoperation rate, complications, and failure rate of this type of surgery. METHOD Two researchers searched the relevant literature in seven databases, including PubMed, Cochrane Library, EMBASE, the China Biomedical Literature Database, the China Academic Journals Full-text Database, the Wanfang database, and the Weipu Chinese Science and Technology Journal Database. The retrieval time spanned the establishment of the specific database up to September 2020, and the literature was screened to determine their final inclusion in the study. RESULTS AND CONCLUSIONS A total of 20 studies were included, including one Chinese and 19 English language studies. The primary indicators included a definitive effect of SMOT on the treatment of medium-term varus-type ankle arthritis. Concerning secondary indicators, although the surgery effect was satisfactory, some patients may require follow-up surgery, which may be unsuccessful with complications. The study results showed that, based on existing literature reports, the effect of SMOT for varus-type ankle arthritis was a satisfactory surgical method with some clinical value for correcting the ankle force line and relieving or even reversing ankle arthritis. However, its risk of complications and failure rate were comparatively high and, accordingly, requires good preoperative planning and close communication with patients. Due to the limited sample size of this study, more data and longer follow-up times involving this type of surgery should be reviewed to confirm this conclusion.
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Affiliation(s)
- Wang Xue
- Department of Orthopedic Surgery, The Sixth Affiliated Hospital of Xinjiang Medical University, China
| | - Tiannan Chen
- Department Burn Surgery, People's Hospital, Yueqing County, Wenzhou, China
| | - Paerhati Wahafu
- Department of Orthopedic Surgery, The Sixth Affiliated Hospital of Xinjiang Medical University, China
| | - Fei Li
- Department of Orthopedic Surgery, The Sixth Affiliated Hospital of Xinjiang Medical University, China
| | - Ayiding Xiahatai
- Department of Orthopedic Surgery, The Sixth Affiliated Hospital of Xinjiang Medical University, China
| | - Aikeremu Wufuer
- Department of Orthopedic Surgery, The Sixth Affiliated Hospital of Xinjiang Medical University, China
| | - Yanan Tuo
- Department of Orthopedic Surgery, The Sixth Affiliated Hospital of Xinjiang Medical University, China
| | - Bo Zhao
- Department of Orthopedic Surgery, The Sixth Affiliated Hospital of Xinjiang Medical University, China
| | - Chengwei Wang
- The Third Affiliated Hospital of Xinjiang Medical University, China
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17
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Suh JW, Park KH, Lee JW, Han SH. Outcomes of oblique supramalleolar osteotomy without fibular osteotomy for congruent- and incongruent-type medial ankle arthritis. Foot Ankle Surg 2022; 28:603-609. [PMID: 34226096 DOI: 10.1016/j.fas.2021.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 06/09/2021] [Accepted: 06/28/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Although high talar tilt and ankle mortise incongruence are risk factors for supramalleolar osteotomy (SMO), no study on lateral talofibular joint congruence exists. We aimed to evaluate the outcomes of oblique SMO without fibular osteotomy for medial ankle arthritis and compare them according to the lateral talofibular joint congruity. METHODS Forty-eight ankles were retrospectively reviewed and divided according to preoperative talofibular joint congruity (congruent, 22 [45.8%] vs. incongruent, 26 [54.2%]). RESULTS The mean VAS score, AOFAS score, and modified Takakura stage were significantly improved. No significant differences were noted in clinical outcomes, but the mean postoperative tibiotalar angle and difference between the upper and lower talofibular gaps were significantly different in both groups (p = 0.004 and p = 0.009, respectively). The mean Takakura stage at 1 and 2 years after surgery was higher in the incongruent group (p = 0.013, p = 0.012). CONCLUSION This procedure was effective against early- to mid-stage medial ankle arthritis. Radiographic arthritic grade changed according to the talofibular joint congruity.
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Affiliation(s)
- Jae Wan Suh
- Department of Orthopaedic Surgery, Dankook University College of Medicine, Cheonan, Republic of Korea; Graduate School of Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kwang Hwan Park
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin Woo Lee
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung Hwan Han
- Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Ma XL, Ma JX, Zhao XW, Du YR, Wang Y, Bai HH, Lu B. Intra-articular opening wedge osteotomy for varus ankle arthritis with computer-assisted planning and patient-specific surgical guides: a retrospective case series. BMC Musculoskelet Disord 2022; 23:483. [PMID: 35597924 PMCID: PMC9123770 DOI: 10.1186/s12891-022-05437-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 05/09/2022] [Indexed: 11/18/2022] Open
Abstract
Background Computer-assisted preoperative planning, combined with PSI has become an effective technique for treating complex limb deformities. The purpose of this study was to evaluate the efficacy and safety of the novel technique in corrective osteotomy for intra-articular varus ankle deformities associated with osteoarthritis and ankle instability. Methods Nineteen patients with intra-articular varus ankle arthritis were reviewed between April 2017 and June 2019, including ten men and nine women with a mean age of 58.3 ± 9.9 years (range, 38 to 76 years). All patients underwent intra-articular opening wedge osteotomy assisted by 3D virtual planning and PSI. Weight-bearing radiographs were used to assess the radiographic results, including TAS angle, TT angle, TMM angle, TC angle, TLS angle, opening-wedge angle, and wedge height. Functional outcomes were assessed by the AOFAS score, VAS score, and ROM of the ankle. Results The average follow-up time was 32.2 ± 9.0 months (range, 22 to 47 months). The average union time was 4.4 ± 0.9 months (range, 3.0 to 6.5 months). The TAS angle significantly changed from 84.1 ± 4.6° preoperatively to 87.7 ± 3.1° at the 1-year follow-up and 86.2 ± 2.6° at the latest follow-up. Similarly, the TT angle, TMM angle and TC angle changed significantly at the 1-year follow-up compared with the preoperative assessment and remained stable until the last follow-up. However, the TLS was not corrected significantly. The postoperative obtained opening-wedge angle, and wedge height showed no significant change with preoperative planning. The overall complication rate was 15.8%. The mean VAS score improved from 5.3 ± 0.6 to 2.7 ± 0.7. The mean AOFAS score improved from 56.2 ± 7.6 to 80.6 ± 4.6. However, the ROM showed no significant change. Conclusions Accurate correction and satisfactory functional recovery were attained with computer-assisted planning and PSI in the corrective osteotomy of intra-articular varus ankle deformities. Supplementary information The online version contains supplementary material available at 10.1186/s12891-022-05437-z.
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Affiliation(s)
- Xin-Long Ma
- Tianjin Hospital, Tianjin, 300211, China. .,Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin Hospital, Tianjin, 300050, China.
| | - Jian-Xiong Ma
- Tianjin Hospital, Tianjin, 300211, China. .,Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin Hospital, Tianjin, 300050, China.
| | - Xing-Wen Zhao
- Tianjin Hospital, Tianjin, 300211, China.,Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin Hospital, Tianjin, 300050, China.,Graduate School of Tianjin Medical University, Tianjin, 300070, China
| | - Yu-Ren Du
- Tianjin Hospital, Tianjin, 300211, China.,Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin Hospital, Tianjin, 300050, China
| | - Ying Wang
- Tianjin Hospital, Tianjin, 300211, China.,Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin Hospital, Tianjin, 300050, China
| | - Hao-Hao Bai
- Tianjin Hospital, Tianjin, 300211, China.,Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin Hospital, Tianjin, 300050, China
| | - Bin Lu
- Tianjin Hospital, Tianjin, 300211, China.,Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin Hospital, Tianjin, 300050, China
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19
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Hintermann B, Ruiz R. Joint Preservation Strategies for Managing Varus Ankle Deformities. Foot Ankle Clin 2022; 27:37-56. [PMID: 35219368 DOI: 10.1016/j.fcl.2021.11.002] [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
Joint preserving strategies have evolved to a successful treatment option in early and midstage medial ankle OA caused by varus deformity. Though talar tilt can often not be fully corrected, it provides substantial postoperative pain relief, functional improvement, and slowing of the degenerative process. Osseous balancing with osteotomies is the main step for restoration of ankle mechanics and normalization of joint load. Overall, the key for success is to understand the underlying causes that have contributed to the varus OA in each case, and to use all treatment modalities necessary to restore appropriate alignment of the hindfoot complex.
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Affiliation(s)
- Beat Hintermann
- Center of Excellence for Foot and Ankle Surgery, Clinic of Orthopaedics and Traumatology, Kantonsspital Baselland, Rheinstrasse 26, Liestal CH-4410, Switzerland.
| | - Roxa Ruiz
- Center of Excellence for Foot and Ankle Surgery, Clinic of Orthopaedics and Traumatology, Kantonsspital Baselland, Rheinstrasse 26, Liestal CH-4410, Switzerland
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Stukenborg-Colsman C, Ettinger S, Claassen L, Daiwei Y, Plaass C. [Conversion osteotomy for arthrosis of the ankle joint (supramalleolar and inframalleolar)-What can be expected? : Critical review of the literature]. Unfallchirurg 2022; 125:189-195. [PMID: 35147709 DOI: 10.1007/s00113-022-01142-7] [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: 01/11/2022] [Indexed: 11/29/2022]
Abstract
The aim of supramalleolar conversion osteotomy is to reduce the pain of the patient and stop or at least slow down joint degeneration. The indication for supramalleolar osteotomy is asymmetric osteoarthritis of the ankle joint with varus or valgus deformity. Good clinical results for arthritis can be achieved in the early or middle stages. Besides closing and opening wedge osteotomies dome osteotomy is sometimes indicated, especially for larger deformities. The preoperative preparation of individual patient-specific section blocks facilitates the intraoperative implementation and seems to increase the precision. Further studies are necessary to support this. The indications for additional procedures, such as fibular osteotomy are still being discussed. Inframalleolar osteotomy and soft tissue interventions are frequently necessary for balancing the foot.
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Affiliation(s)
- Christina Stukenborg-Colsman
- Department Fuß- und Sprunggelenkchirurgie, Orthopädische Klinik, DIAKOVERE Annastift, Medizinische Hochschule Hannover, Anna-von-Borries-Str. 1-7, 30625, Hannover, Deutschland.
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Matsubara S, Onodera T, Iwasaki K, Hishimura R, Matsuoka M, Kondo E, Iwasaki N. Discrepancy in the Distribution Patterns of Subchondral Bone Density Across the Ankle Joint After Medial Opening-Wedge and Lateral Closing-Wedge High Tibial Osteotomy. Am J Sports Med 2022; 50:478-485. [PMID: 34913761 DOI: 10.1177/03635465211062235] [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: 01/31/2023]
Abstract
BACKGROUND High tibial osteotomy (HTO) changes the alignment and dynamics of the ankle joint; however, differences in the stress distribution of the ankle joint after opening-wedge HTO (OWHTO) and closing-wedge HTO (CWHTO) are not understood. It is believed that subchondral bone density of the articular surface reflects the pattern of cumulative stress distribution across the joint surface. PURPOSE To clarify the effects of OWHTO and CWHTO on the distribution patterns of subchondral bone density across the ankle joint using computed tomography (CT)-osteoabsorptiometry. STUDY DESIGN Cohort study; Level of evidence, 4. METHODS Radiographic and CT data of 18 cases who underwent OWHTO (OW group), 12 cases who underwent CWHTO (CW group), and 11 cases with unilateral anterior cruciate ligament injury serving as controls were retrospectively reviewed. The subchondral bone density of the distal tibia was assessed in the 3 groups using CT-osteoabsorptiometry. The distal tibial surface of the ankle joint was divided into 4 parts in the coronal direction, and the percentage of the high-density area (%HDA) to each subregion was compared before and after HTO. RESULTS Preoperatively, comparing %HDA among the 3 groups, there were no significant differences in any regions. In the OW group, postoperative %HDA in the most medial region was significantly increased compared with preoperative %HDA (49.3% to 53.0%; P = .011), and postoperative %HDA in the most lateral region was significantly decreased (21.4% to 17.2%; P = .003). On the other hand, in the CW group, postoperative %HDA in the most medial region was significantly decreased (55.7% to 35.7%; P = .001), and %HDA in the second lateral region was significantly increased (23.6% to 29.2%; P = .002). CONCLUSION The ankle distribution pattern of subchondral bone density shifted significantly medially after OWHTO without fibular osteotomy, whereas the distribution pattern shifted laterally after CWHTO with fibular osteotomy. When the OWHTO is performed for patients with medial ankle osteoarthritis, surgeons should pay attention to potential postoperative progression of ankle osteoarthritis due to medial shift of the stress distribution in the ankle joint.
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Affiliation(s)
- Shinji Matsubara
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-ku, Sapporo, Japan
| | - Tomohiro Onodera
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-ku, Sapporo, Japan
| | - Koji Iwasaki
- Department of Functional Reconstruction for the Knee Joint, Faculty of Medicine, Hokkaido University, Kita-ku, Sapporo, Japan
| | - Ryosuke Hishimura
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-ku, Sapporo, Japan
| | - Masatake Matsuoka
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-ku, Sapporo, Japan
| | - Eiji Kondo
- Centre for Sports Medicine, Hokkaido University Hospital, Kita-ku, Sapporo, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-ku, Sapporo, Japan
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Park CH, Kim J, Kim JB, Lee WC. Repositional Subtalar Arthrodesis Combined With Supramalleolar Osteotomy for Late-Stage Varus Ankle Arthritis With Hindfoot Valgus. Foot Ankle Int 2022; 43:203-210. [PMID: 34530642 DOI: 10.1177/10711007211036699] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Late-stage varus ankle arthritis is thought to be associated with varus of the tibial plafond and hindfoot. However, some late-stage varus arthritis show hindfoot valgus, which can be explained by subtalar subluxation with opposite directional motion between the talus and calcaneus. We hypothesized that late-stage varus ankle arthritis with hindfoot valgus could improve with repositional subtalar arthrodesis and supramalleolar osteotomy (SMO). The purpose of this study was to investigate the clinical and radiographic results of the repositional subtalar arthrodesis combined with SMO for late-stage varus ankle arthritis with hindfoot valgus. METHODS This study includes 16 consecutive patients (16 ankles) with late-stage varus ankle arthritis of Takakura stage 3-b and hindfoot valgus who were treated using repositional subtalar arthrodesis combined with SMO and followed for a minimum of 2 years. Clinical results were assessed with the visual analog scale (VAS) and the Foot Function Index (FFI). Radiographic results were assessed with standard parameters measured on weightbearing foot and ankle radiographs. Clinical and radiographic results were evaluated preoperatively and at the last follow-up. RESULTS VAS and FFI significantly improved after surgery. Mean talar tilt angle improved from 12.8 ± 2.8 degrees to 3.9 ± 3.1 degrees (P < .001). Talus center migration and Meary angle significantly improved after surgery. Medial distal tibial angle, lateral talocalcaneal angle, hindfoot moment arm, and talonavicular coverage angle significantly changed after surgery. Radiographic stage improved in 15 ankles (93.8%) after surgery. CONCLUSION In this series with minimum 2-year follow-up, we found that late-stage (Takakura stage 3-b) varus ankle arthritis with hindfoot valgus clinically and radiographically improved with repositional subtalar arthrodesis combined with SMO. LEVEL OF EVIDENCE Level IV, prognostic.
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Affiliation(s)
- Chul Hyun Park
- Department of Orthopaedic Surgery, College of Medicine, Yeungnam University, Daegu, Korea
| | - Jaeyoung Kim
- Department of Orthopedics, Foot and Ankle Division, Hospital for Special Surgery, New York, NY, USA
| | - Ji Beom Kim
- Seoul Foot and Ankle Center, Dubalo Orthopaedic Clinic, Seoul, Korea
| | - Woo-Chun Lee
- Seoul Foot and Ankle Center, Dubalo Orthopaedic Clinic, Seoul, Korea
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Rikken QGH, Dahmen J, Reilingh ML, van Bergen CJA, Stufkens SAS, Kerkhoffs GMMJ. Outcomes of Bone Marrow Stimulation for Secondary Osteochondral Lesions of the Talus Equal Outcomes for Primary Lesions. Cartilage 2021; 13:1429S-1437S. [PMID: 34167358 PMCID: PMC8739575 DOI: 10.1177/19476035211025816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To compare clinical, sports, work, and radiological outcomes between primary and secondary osteochondral lesions of the talus (OLTs; <15 mm) treated with arthroscopic bone marrow stimulation (BMS). DESIGN Secondary OLTs were matched to primary OLTs in a 1:2 ratio to assess the primary outcome measure-the Numeric Rating Scale (NRS) during activities. Secondary outcomes included the pre- and 1-year postoperative NRS at rest, American Orthopaedic Foot and Ankle Society score, Foot and Ankle Outcome Score subscales, and the EQ-5D general health questionnaire. The rates and time to return to work and sports were collected. Radiological examinations were performed preoperatively and at final follow-up using computed tomography (CT). RESULTS After matching, 22 and 12 patients with small (<15 mm) OLTs were included in the primary and secondary groups, respectively. The NRS during activities was not different between primary cases (median: 2, interquartile range [IQR]: 1-4.5) and secondary cases (median: 3, IQR: 1-4), P = 0.5. Both groups showed a significant difference between all pre- and postoperative clinical outcome scores, but no significant difference between BMS groups postoperatively. The return to sport rate was 90% for primary cases and 83% for secondary cases (P = 0.6). All patients returned to work. Lesion filling on CT was complete (67% to 100%) in 59% of primary cases and 67% of secondary cases (P = 0.6). CONCLUSION No differences in outcomes were observed between arthroscopic bone marrow stimulation in primary and secondary OLTs at 1-year follow-up. Repeat BMS may therefore be a viable treatment option for failed OLTs in the short term.
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Affiliation(s)
- Quinten G. H. Rikken
- Department of Orthopaedic Surgery,
Amsterdam Movement Sciences, Amsterdam UMC—Location AMC, University of Amsterdam,
Amsterdam, The Netherlands,Academic Center for Evidence Based
Sports Medicine, Amsterdam UMC, Amsterdam, The Netherlands,Amsterdam Collaboration for Health and
Safety in Sports, International Olympic Committee Research Center, Amsterdam UMC,
Amsterdam, The Netherlands
| | - Jari Dahmen
- Department of Orthopaedic Surgery,
Amsterdam Movement Sciences, Amsterdam UMC—Location AMC, University of Amsterdam,
Amsterdam, The Netherlands,Academic Center for Evidence Based
Sports Medicine, Amsterdam UMC, Amsterdam, The Netherlands,Amsterdam Collaboration for Health and
Safety in Sports, International Olympic Committee Research Center, Amsterdam UMC,
Amsterdam, The Netherlands
| | - Mikel L. Reilingh
- Department of Orthopedic Surgery,
Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Christiaan J. A. van Bergen
- Academic Center for Evidence Based
Sports Medicine, Amsterdam UMC, Amsterdam, The Netherlands,Amsterdam Collaboration for Health and
Safety in Sports, International Olympic Committee Research Center, Amsterdam UMC,
Amsterdam, The Netherlands,Department of Orthopedic Surgery,
Amphia Hospital, Breda, The Netherlands
| | - Sjoerd A. S. Stufkens
- Department of Orthopaedic Surgery,
Amsterdam Movement Sciences, Amsterdam UMC—Location AMC, University of Amsterdam,
Amsterdam, The Netherlands,Academic Center for Evidence Based
Sports Medicine, Amsterdam UMC, Amsterdam, The Netherlands,Amsterdam Collaboration for Health and
Safety in Sports, International Olympic Committee Research Center, Amsterdam UMC,
Amsterdam, The Netherlands
| | - Gino M. M. J. Kerkhoffs
- Department of Orthopaedic Surgery,
Amsterdam Movement Sciences, Amsterdam UMC—Location AMC, University of Amsterdam,
Amsterdam, The Netherlands,Academic Center for Evidence Based
Sports Medicine, Amsterdam UMC, Amsterdam, The Netherlands,Amsterdam Collaboration for Health and
Safety in Sports, International Olympic Committee Research Center, Amsterdam UMC,
Amsterdam, The Netherlands,Gino M. M. J. Kerkhoffs, Department of
Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC—Location AMC,
University of Amsterdam, Amsterdam, The Netherlands.
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Park CH, Kim JB, Kim J, Yi Y, Lee WC. Joint Preservation Surgery for Varus Ankle Arthritis with Large Talar Tilt. Foot Ankle Int 2021; 42:1554-1564. [PMID: 34315278 DOI: 10.1177/10711007211027290] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Varus ankle arthritis with large talar tilt (TT) is a challenging condition when considering joint preservation surgery. Three-dimensional deformity of the talus has been demonstrated with weightbearing computed tomography in varus ankle arthritis with large TT. The aim of this study was to investigate the clinical and radiographic results of posterior tibial tendon (PTT) transfer generally combined with bony realignment for varus ankle arthritis with large TT in nonparalytic ankle arthritis and to determine the indications for PTT transfer. METHODS This study includes 23 ankles with varus arthritis and TT larger than 7.5 degrees. Patients were categorized into improved (19 ankles) and unimproved (4 ankles) groups according to the postoperative clinical results at the last follow-up. Clinical and radiographic results were compared between the groups. A cut-off point for preoperative TT that indicated a borderline between improved and unimproved groups was determined to suggest the appropriate indication for joint preservation surgery. RESULTS In the improved group, TT, radiographic stage, Meary angle, and hindfoot alignment significantly improved at 6 months after surgery and were maintained at the last follow-up. In the unimproved group, the radiographic parameters mentioned above did not improve at 6 months after surgery, and TT decreased to 0.8 degrees as radiographic stage had progressed to end-stage arthritis at the last follow-up. In this small series, the cut-off point for predicting failure of surgery was 14.3 degrees of preoperative TT. CONCLUSION PTT transfer often combined with bony realignment procedures may be a reasonable option for treating painful varus ankle arthritis with TT less than 14 degrees and hindfoot varus. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Chul Hyun Park
- Department of Orthopaedic Surgery, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Ji Beom Kim
- Seoul Foot and Ankle Center, Dubalo Orthopaedic Clinic, Seoul, Republic of Korea
| | - Jaeyoung Kim
- Department of Orthopedics, Foot and Ankle Division, Hospital for Special Surgery, New York, NY, USA
| | - Young Yi
- Department of Orthopaedic Surgery, Inje University Seoul Paik Hospital, Seoul, Republic of Korea
| | - Woo-Chun Lee
- Seoul Foot and Ankle Center, Dubalo Orthopaedic Clinic, Seoul, Republic of Korea
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25
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Bouchard M, Ross TD. Bony Procedures for Correction of the Flexible Pediatric Flatfoot Deformity. Foot Ankle Clin 2021; 26:915-939. [PMID: 34752244 DOI: 10.1016/j.fcl.2021.09.001] [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 pediatric flexible flatfoot is a common foot shape that is most often asymptomatic and may be a physiologic variant of normal. Surgery is only indicated when nonoperative interventions have failed to resolve symptoms. The goal of surgery is to alleviate symptoms by improving hindfoot alignment and restoring the medial arch while preserving joint mobility. This article focuses on the common bony techniques for surgical correction of the pediatric flexible flatfoot that has failed nonoperative management, including calcaneal, midfoot, and supramalleolar osteotomies and distal tibial hemiepiphyseodesis.
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Affiliation(s)
- Maryse Bouchard
- Division of Orthopaedic Surgery, The Hospital for Sick Children, Toronto, Canada; Department of Surgery, University of Toronto, Toronto, Canada; Division of Orthopaedic Surgery, The University of Toronto, Toronto, Canada.
| | - Tayler Declan Ross
- Division of Orthopaedic Surgery, The University of Toronto, 500 University Avenue #602, Toronto, Ontario M5G 1V7, Canada
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Kim J, Kim JB, Lee WC. Outcomes of Joint Preservation Surgery in Valgus Ankle Arthritis Without Deltoid Ligament Insufficiency. Foot Ankle Int 2021; 42:1419-1430. [PMID: 34109853 DOI: 10.1177/10711007211016001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND To date, information about the role of proximal alignment correction in treating nontraumatic valgus ankle arthritis is limited. This study aimed to report outcomes of realignment surgery, including supramalleolar correction in valgus arthritic ankles without evidence of deltoid ligament insufficiency. METHODS Thirteen patients (13 ankles) who underwent joint preservation surgery for valgus ankle arthritis without evidence of deltoid ligament insufficiency were reviewed. Medial opening wedge supramalleolar osteotomy (n = 11) and varization supramalleolar dome osteotomy (n = 2) were performed to realign the hip-knee-ankle-hindfoot axis. Concomitant hindfoot correction was accompanied with either medial displacement calcaneal osteotomy (n = 8) or subtalar arthrodesis (n = 5). Pain, functional outcome (Foot Function Index [FFI]), radiographic arthritis grade (grades 0-4), 9 plain radiographic parameters, and 2 weightbearing computed tomography parameters were evaluated pre- and postoperatively. All patients completed a minimum 2-year follow-up. RESULTS Preoperatively, 10 ankles (77%) demonstrated a varus tibial plafond, and 3 ankles (23%) demonstrated a valgus or neutral tibial plafond. Postoperatively, radiographic arthritis grade improved in all except 1 patient, and the mean talar tilt angle improved from 5.5 to 1.7 degrees. The mean pain score (visual analog scale) decreased significantly from 7.3 to 2.5 (P < .05), and the mean FFI improved significantly from 57.7 to 18.6 (P < .001). None of the patients underwent conversion to joint-sacrificing procedures at the latest follow-up. CONCLUSION This study demonstrated a possible relationship between lower limb malalignment and valgus ankle arthritis. Realignment surgery, including supramalleolar osteotomies, which straightens the mechanical axis and decreases the slope of the tibial plafond, may be a reasonable approach in joint preservation of valgus ankle arthritis without deltoid ligament insufficiency. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Jaeyoung Kim
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Ji-Beom Kim
- Seoul Foot and Ankle Center, Dubalo Orthopaedic Clinic, Seochogu, Seoul, Republic of Korea
| | - Woo-Chun Lee
- Seoul Foot and Ankle Center, Dubalo Orthopaedic Clinic, Seochogu, Seoul, Republic of Korea
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Lim JW, Eom JS, Kang SJ, Lee DO, Kang HJ, Jung HG. The Effect of Supramalleolar Osteotomy without Marrow Stimulation for Medial Ankle Osteoarthritis: Second-Look Arthroscopic Evaluation of 29 Ankles. J Bone Joint Surg Am 2021; 103:1844-1851. [PMID: 34138774 DOI: 10.2106/jbjs.20.00502] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The effect of supramalleolar osteotomy without a bone marrow-stimulating procedure for articular cartilage regeneration in the ankle joint remains unknown. We investigated whether supramalleolar osteotomy yielded favorable clinical and radiographic outcomes. We also evaluated the joint tissue appearance after supramalleolar osteotomy without a bone marrow-stimulating procedure with use of second-look arthroscopy and its correlation with the outcome. METHODS Twenty-nine ankles were retrospectively reviewed at a mean of 2.9 years after supramalleolar osteotomy without a bone marrow-stimulating procedure. All 29 ankles had had second-look arthroscopy to evaluate tibiotalar joint tissue regeneration at a minimum of 1 year postoperatively. A visual analog scale (VAS) pain score, the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, and patient satisfaction were used for functional evaluations. Ankle osteoarthritis was classified with the Takakura staging system, and the tibial anterior surface (TAS) angle and tibial lateral surface (TLS) angle were measured on radiographs. RESULTS The mean VAS and AOFAS scores improved from 6.2 (95% confidence interval [CI], 5.7 to 6.8) preoperatively to 1.5 (95% CI, 0.9 to 2.1) postoperatively and from 60.5 (95% CI, 54.9 to 66.1) preoperatively to 88.3 (95% CI, 84.3 to 92.3) postoperatively, respectively. Patient satisfaction with the outcome of the procedure was classified as very satisfied or satisfied for 27 ankles (93.1%). Sixteen of 21 ankles that were classified as Takakura stage-IIIa and 2 of 3 ankles that were classified as stage-IIIb preoperatively improved to stage II postoperatively. The mean TAS and TLS angles significantly improved from 83.5° (95% CI, 82.2° to 84.7°) and 77.0° (95% CI, 75.4° to 78.7°) preoperatively to 94.2° (95% CI, 92.7° to 95.7°) and 80.4° (95% CI, 78.3° to 82.5°) postoperatively, respectively. On second-look arthroscopy, 26 ankles (89.7%) showed tissue regeneration of the medial compartment of the ankle joint and no patient showed cartilage deterioration. CONCLUSIONS Medial tibiotalar tissue regeneration was identified in most patients with medial compartment ankle osteoarthritis following supramalleolar osteotomy without a bone marrow-stimulating procedure. The procedure results in satisfactory clinical and radiographic outcomes with high patient satisfaction. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Jung-Won Lim
- Department of Orthopedic Surgery, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Joon-Sang Eom
- Department of Orthopedic Surgery, Chaeum Orthopedic Clinic, Suwon, Republic of Korea
| | - Sung Jin Kang
- Department of Orthopedic Surgery, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Dong-Oh Lee
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hwa Jun Kang
- Department of Orthopedic Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Republic of Korea
| | - Hong-Geun Jung
- Department of Orthopedic Surgery, Konkuk University Medical Center, Seoul, Republic of Korea
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Kim J, Kim JB, Lee WC. Clinical and Radiographic Results of Ankle Joint Preservation Surgery in Posterior Ankle Arthritis. Foot Ankle Int 2021; 42:1260-1269. [PMID: 34092125 DOI: 10.1177/10711007211011182] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Little information is available about how to manage ankles with eccentric arthritis in the sagittal plane. This study aimed to report clinical and radiographic outcomes following joint preservation surgery for ankles with eccentric arthritis at the posterior tibiotalar joint and a plantarflexed talus in the sagittal plane, which we named posterior ankle arthritis. METHODS Ten ankles with posterior ankle arthritis were treated with realignment surgery between 2017 and 2018. Posterior ankle arthritis was defined as having both (1) eccentric narrowing of the joint space at the posterior aspect of the tibiotalar joint on weightbearing lateral radiographs and (2) coronal talar tilt angle less than 4 degrees on weightbearing anteroposterior radiographs. Flatfoot reconstruction with a hindfoot arthrodesis procedure was performed in all patients (subtalar arthrodesis, n = 9; triple arthrodesis, n = 1), and a supramalleolar osteotomy was added in patients with varus distal tibial alignment (n = 6). Pain, functional outcome (foot function index [FFI]), radiographic arthritis stage (stage I to IV), and 9 radiographic parameters, including lateral talar center migration (LTCM), were evaluated on pre- and postoperative weightbearing radiographs. All patients completed a minimum 2-year follow-up. RESULTS Preoperative radiographic evaluation demonstrated that ankles with posterior arthritis had a lower medial longitudinal arch, forefoot abduction, and valgus hindfoot alignment. Postoperatively, sagittal tibiotalar alignment was restored, as evidenced by an improved median LTCM from -3.3 to -0.3 mm (P < .001). The radiographic arthritis stage improved in 7 (70%) patients, whereas 3 (30%) remain unchanged in the same stage. The median score for pain (visual analog scale) decreased significantly from 8 to 2, and the median FFI improved significantly from 67.8 to 23.4 (P < .001). None of the patients underwent conversion to joint-sacrificing procedures at the latest follow-up. CONCLUSION The study results suggest a possible relationship between posterior ankle arthritis and the plantarflexion of the talus, which can be seen in the setting of a flatfoot deformity. Reconstruction of the flatfoot deformity using subtalar arthrodesis restored the tibiotalar relationship in the sagittal plane and resulted in clinical improvements at an average 2.3-year follow-up in this 10-ankle case series. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
| | - Ji-Beom Kim
- Seoul Foot and Ankle Center, Dubalo Orthopaedic Clinic, Dongjak Daero, Seoul, Republic of Korea
| | - Woo-Chun Lee
- Seoul Foot and Ankle Center, Dubalo Orthopaedic Clinic, Dongjak Daero, Seoul, Republic of Korea
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Kim JB, Park CH, Ahn JY, Kim J, Lee WC. Characteristics of medial gutter arthritis on weightbearing CT and plain radiograph. Skeletal Radiol 2021; 50:1575-1583. [PMID: 33410964 DOI: 10.1007/s00256-020-03688-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/14/2020] [Accepted: 11/29/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE An ankle arthritis with medial gutter obliteration is known to have good results after joint preservation surgery. However, the diagnosis is often missed on radiographs. The aims of this study were to investigate sensitivity of radiographs in the identification of medial gutter arthritis, incidence and direction of the talar tilt on weightbearing CT (WBCT), and to assess radiographic alignment of the medial gutter arthritis. MATERIALS AND METHODS Radiographic data was retrospectively evaluated in 102 ankles which were diagnosed medial gutter arthritis by using the WBCT at our clinic between January 2017 and June 2019. Among the 102 ankles, proportion of ankles which showed medial gutter arthritis on plain radiograph was obtained. The presence and direction of talar tilt were assessed on three coronal WBCT images at the anterior, middle, and posterior aspect of the ankle. Plain radiographic parameters were compared between the 102 ankles and control group. RESULTS Plain radiograph showed medial gutter arthritis only in 63 ankles (62%) among the 102 ankles. Most of the ankles with medial gutter arthritis showed talar tilt on WBCT, and about half of all ankles showed valgus talar tilt at the anterior aspect of ankle on WBCT. In ankles with medial gutter arthritis, the mechanical axis of the lower extremity and the tibial plafond were varus angulated and the talus was medially translated compared to the control group. CONCLUSION Radiographs were less sensitive than WBCT in demonstrating medial gutter arthritis. Anterior aspect of ankles with medial gutter arthritis often showed valgus direction of talar tilt. Varus mechanical axis deviation and varus tibial plafond are commonly associated with the medial gutter arthritis.
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Affiliation(s)
- Ji-Beom Kim
- Seoul Foot and Ankle Center, Dubalo Orthopaedic Clinic, 212, Seocho-gu, Dongjak Daero, Seoul, Republic of Korea
| | - Chul Hyun Park
- Department of Orthopedic Surgery, Yeungnam University Medical Center, Hyeonchungno 170, Namgu, Daegu, 42415, Republic of Korea
| | - Ji-Yong Ahn
- Department of Orthopaedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University, Uijeongbu-si, Republic of Korea
| | - Jaeyoung Kim
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Woo-Chun Lee
- Seoul Foot and Ankle Center, Dubalo Orthopaedic Clinic, 212, Seocho-gu, Dongjak Daero, Seoul, Republic of Korea.
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Hu M, Xu XY. Osteotomy combined with lateral ligament reconstruction in treating osteochondral lesion in patients with talar injury and varus ankle. Medicine (Baltimore) 2021; 100:e24330. [PMID: 33761633 PMCID: PMC9282085 DOI: 10.1097/md.0000000000024330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 12/19/2020] [Indexed: 01/05/2023] Open
Abstract
This study aimed to investigate the therapeutic effects of osteotomy combined with lateral ligament reconstruction on the osteochondral lesion of patients with talar injuries and varus ankles.Seventy five patients with talar injuries and varus ankles who received osteotomy combined with lateral ligament reconstruction for the osteochondral lesions from June 2008 to December 2014 were retrospectively reviewed. Patients were followed up for 32.4 ± 15.3 months after surgeries, and the AOFAS-AH score, VAS score and SF36 score were determined preoperatively and postoperatively. The iconographic data were compared preoperatively and postoperatively, including tibial anterior surface angle (TAS), TTS, TT, and tibial lateral surface angle (TLS) angles.After surgeries, the AOFAS-AF score increased from 43.2 ± 8.1 to 82.1 ± 5.6, the VAS score decreased from 6.9 ± 2.3 to 1.8 ± 1.5, and the SF36 score increased from 48.7 ± 9.4 to 83.5 ± 6.2. TAS increased from 83.3 ± 5.1 to 90.3 ± 6.1, TTS increased from 70.3 ± 6.1 to 82.5 ± 5.4, TT decreased from 12.9 ± 6.1 to 6.9 ± 5.7, and TLS increased from 76.5 ± 4.1 to 81.2 ± 3.3 (P < .05).Osteotomy combined with lateral ligament reconstruction is effective for the treatment of talar osteochondral lesion with varus ankle, which could relieve the arthritic symptoms induced by cartilage lesions. By correcting the force line on lower limbs and metapedes with osteotomy completely, the treatments on talar osteochondral lesion and lateral ligament reconstruction are the critical factors with better results.
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Affiliation(s)
- Mu Hu
- Department of Orthopedics, Shanghai Ruijin Hospital North, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiang-Yang Xu
- Department of Orthopedics, Shanghai Ruijin Hospital North, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Rikken QGH, Kerkhoffs GMMJ. Osteochondral Lesions of the Talus: An Individualized Treatment Paradigm from the Amsterdam Perspective. Foot Ankle Clin 2021; 26:121-136. [PMID: 33487235 DOI: 10.1016/j.fcl.2020.10.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Osteochondral lesions of the talus (OLTs) are characterized by damage to the articular cartilage of the talus and its underlying subchondral bone. Up to 75% of OLTs are caused by trauma, such as an ankle sprain or fracture. Physical examination and imaging are crucial for diagnosis and characterization of an OLT. No superior treatment for OLTs exists. It is paramount that an evidence-based personalized treatment approach is applied to patients with OLTs because lesion and patient characteristics guide treatment. This current concepts review covers clinical and preclinical evidence on OLT etiology, presentation, diagnosis, and treatment, all based on the Amsterdam perspective.
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Affiliation(s)
- Quinten G H Rikken
- Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands; Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherland; Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands; Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherland; Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands.
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Kvarda P, Heisler L, Krähenbühl N, Steiner CS, Ruiz R, Susdorf R, Sripanich Y, Barg A, Hintermann B. 3D Assessment in Posttraumatic Ankle Osteoarthritis. Foot Ankle Int 2021; 42:200-214. [PMID: 33073607 DOI: 10.1177/1071100720961315] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Auto-generated 3-dimensional (3D) measurements based on weightbearing cone-beam computed tomography (CT) scan technology may allow for a more accurate hind- and midfoot assessment. The current study evaluated the reliability and clinical relevance of such measurements in patients with posttraumatic end-stage ankle osteoarthritis. METHODS Seventy-two patients treated at our institution for posttraumatic end-stage ankle osteoarthritis, with available weightbearing conventional radiographs and a cone-beam CT scan, were analyzed. Twenty healthy individuals aged between 40 and 70 years served as controls. Seven variables were measured on weightbearing conventional radiographs (2D) and compared to 3D measurements that were based on reconstructions from weightbearing cone-beam CT scans. The reliability of each measurement was calculated and subgroups formed according to commonly observed deformities. RESULTS Inter- and intraobserver reliability was superior for 3D compared to 2D measurements. The accuracy of 3D measurements performed on osteoarthritic ankles was similar to 3D measurements performed on healthy individuals. Thirty-three of the 72 included patients (46%) evidenced an inframalleolar compensation of a supramalleolar/intra-articular ankle deformity (78% = varus compensation; 22% = valgus compensation), whereas 24 of those 72 patients (33%) showed no compensation or a further increase of a supramalleolar/intra-articular ankle deformity (67% = varus deformity; 33% = valgus deformity). CONCLUSION Auto-generated 3D measurements of the hind- and midfoot were found to be reliable in both healthy individuals and patients with posttraumatic end-stage ankle osteoarthritis. Such measurements may be crucial for a detailed understanding of the location and extent of hindfoot deformities, possibly impacting decision making in the treatment of end-stage ankle osteoarthritis. LEVEL OF EVIDENCE Level III, comparative study.
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Affiliation(s)
- Peter Kvarda
- Department of Orthopaedics, Kantonsspital Baselland, Liestal, Switzerland
| | - Lukas Heisler
- Department of Orthopaedics, Kantonsspital Baselland, Liestal, Switzerland
| | - Nicola Krähenbühl
- Department of Orthopaedics, Kantonsspital Baselland, Liestal, Switzerland
| | | | - Roxa Ruiz
- Department of Orthopaedics, Kantonsspital Baselland, Liestal, Switzerland
| | - Roman Susdorf
- Department of Orthopaedics, Kantonsspital Baselland, Liestal, Switzerland
| | - Yantarat Sripanich
- Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Alexej Barg
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Beat Hintermann
- Department of Orthopaedics, Kantonsspital Baselland, Liestal, Switzerland
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Xu Y, Li XC, Guo CJ, Xu XY. Intra-articular opening osteotomy combined with lateral ligament reconstruction for varus ankle arthritis. J Orthop Surg Res 2021; 16:7. [PMID: 33407660 PMCID: PMC7786926 DOI: 10.1186/s13018-020-02143-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 12/01/2020] [Indexed: 02/08/2023] Open
Abstract
Background Takakura 3B ankle arthritis is featured as obliteration of ankle space with subchondral bone contact. Among these patients, some have medial distal tibial platform erosion. It is hard to treat this kind of patients. The purpose of this study was to evaluate the therapeutic outcomes of intra-articular opening osteotomy combined with lateral ligament reconstruction for Takakura 3B ankle arthritis with medial distal tibial platform erosion. Methods From September 2009 to May 2016, 17 patients with Takakura 3B ankle arthritis were reviewed, including 3 male and 14 female patients. All underwent the operation of intra-articular opening osteotomy combined with lateral ligament reconstruction. All patients were available for analysis. The main outcome measurements included TT angle, AOFAS score, VAS score, SF-36 scale, and AOS scale. Results All patients were followed for a mean follow-up of 87.2 months (range, 49 to 129 months). The VAS scale improved from 5.5 ± 1.6 to 2.3 ± 1.9. The mean AOFAS score improved from 47.7 ± 15.7 to 75.8 ± 12.0. The SF-36 scale improved from 41.6 ± 14.0 to 67.7 ± 14.6. The AOS improved from 60.9 ± 13.9 to 28.2 ± 17.7. The TT angle improved from 14.3 ± 5.0° to 5.3 ± 4.0°. The TAS and TLS changed from 83.4 ± 2.6° and 77.5 ± 2.3° to 90.7 ± 2.3° and 78.6 ± 2.2°. However, the LTAS was not corrected significantly. Conclusion Intra-articular opening osteotomy combined with lateral ligament reconstruction is an effective method to treat varus ankle arthritis with medial distal tibial platform erosion.
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Affiliation(s)
- Yang Xu
- Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xing-Chen Li
- Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chang-Jun Guo
- Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiang-Yang Xu
- Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. .,Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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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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Abstract
Malunion of ankle and pilon fractures has significant detrimental effect on function and development of post-trauma osteoarthritis. Unfortunately, the incidence of malunion has been reported to be increasing. It is important to assess the ankle for congruency, because this determines the level where correction will occur. A plethora of techniques are available, with low-level evidence supporting each, and therefore it is important that the treating surgeon is fully prepared and comfortable in the techniques they are to use. Supplementary procedures are common and should be expected. This article provides a review of current methods of treatment and their outcomes.
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Krähenbühl N, Susdorf R, Barg A, Hintermann B. Supramalleolar osteotomy in post-traumatic valgus ankle osteoarthritis. INTERNATIONAL ORTHOPAEDICS 2020; 44:535-543. [PMID: 31925464 DOI: 10.1007/s00264-019-04476-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 12/23/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE To assess how the level of the deformity, the stage of the osteoarthritic process, and the role of additional surgeries impact radiographic and clinical outcomes following an extra-articular medial closing supramalleolar osteotomy for treatment of post-traumatic valgus ankle osteoarthritis. METHODS About 56 consecutive patients who underwent an extra-articular medial closing wedge osteotomy for post-traumatic valgus ankle osteoarthritis were retrospectively analyzed. Subgroups were formed according to the pre-operative level of deformity and preoperative stage of ankle osteoarthritis. Additional surgical steps required to achieve a properly balanced hindfoot were also noted. Radiographic and clinical outcomes of each subgroup were compared with each other, and the role of additional surgical steps required to achieve a balanced hindfoot was investigated. RESULTS Radiographic and clinical outcomes improved significantly between pre-operative assessment and the last follow-up. Patients with a pre-operative supramalleolar deformity showed superior radiographic outcomes compared to patients with an intra-articular deformity. Clinical outcomes did not differ significantly between these two subgroups. The pre-operative stage of ankle osteoarthritis significantly impacted radiographic outcomes but did not influence clinical outcome measures. An additional fibula or calcaneus osteotomy was necessary for 55% and 23% of all patients, respectively. CONCLUSION Extra-articular medial closing supramalleolar osteotomies show satisfactory mid- to long-term radiographic and clinical outcomes in patients with post-traumatic valgus ankle osteoarthritis.
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Affiliation(s)
- Nicola Krähenbühl
- Department of Orthopaedics, Kantonsspital Baselland, Rheinstrasse 26, 4410, Liestal, Switzerland.
| | - Roman Susdorf
- Department of Orthopaedics, Kantonsspital Baselland, Rheinstrasse 26, 4410, Liestal, Switzerland
| | - Alexej Barg
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Beat Hintermann
- Department of Orthopaedics, Kantonsspital Baselland, Rheinstrasse 26, 4410, Liestal, Switzerland
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37
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Adukia V, Mangwani J, Issac R, Hussain S, Parker L. Current concepts in the management of ankle arthritis. J Clin Orthop Trauma 2020; 11:388-398. [PMID: 32405197 PMCID: PMC7211821 DOI: 10.1016/j.jcot.2020.03.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 03/30/2020] [Indexed: 01/15/2023] Open
Abstract
Ankle arthritis is a common condition. It causes a significant socioeconomic burden, and is associated with significant morbidity. Patients with ankle arthritis are either elderly with significant co-morbidities, or young adults who have previously suffered with ankle injuries, resulting in post-traumatic arthritis. There is a wide variation in the management of these patients with ankle arthritis. We therefore present an overview of the current evidence based management of patients with symptomatic ankle arthritis.
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Affiliation(s)
- V. Adukia
- Academic Team of Musculoskeletal Surgery, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, United Kingdom,Corresponding author.
| | - J. Mangwani
- Academic Team of Musculoskeletal Surgery, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, United Kingdom
| | - R. Issac
- Academic Team of Musculoskeletal Surgery, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, United Kingdom
| | - S. Hussain
- Barts Health NHS Trust, The Royal London Hospital, Whitechapel, London, E1 1BB, United Kingdom
| | - L. Parker
- Barts Health NHS Trust, The Royal London Hospital, Whitechapel, London, E1 1BB, United Kingdom
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38
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39
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Krähenbühl N, Akkaya M, Deforth M, Zwicky L, Barg A, Hintermann B. Extraarticular Supramalleolar Osteotomy in Asymmetric Varus Ankle Osteoarthritis. Foot Ankle Int 2019; 40:936-947. [PMID: 31023078 DOI: 10.1177/1071100719845928] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND In recent years, supramalleolar osteotomy has become a valuable alternative for treatment of ankle osteoarthritis. The aim of this study was to investigate whether the preoperative stage of ankle osteoarthritis or tilt of the talus in the ankle mortise impacts radiologic and clinical outcomes following a supramalleolar osteotomy. METHODS Forty-four patients who underwent a supramalleolar osteotomy for posttraumatic asymmetric varus ankle osteoarthritis were included. Subgroups were formed according to the preoperative stage of ankle osteoarthritis and the tilt of the talus in the ankle mortise. The radiographic and clinical outcomes of each subgroup were compared, and survival rates calculated. RESULTS Ankles with a preoperative Takakura stage of 2 and 3a showed a significant higher survival rate at 5 years (88% [95% CI, 67-100] and 93% [95% CI, 80-100]) compared with ankles with a preoperative Takakura stage of 3b (47% [95% CI, 26-86]; P = .044). The 5-year survival rate for patients with a preoperative tilt of the talus in the ankle mortise of 4-10 degrees was 85% (95% CI, 68-100), while patients with a preoperative tilt of >10 degrees showed a 5-year survival rate of 65% (95% CI, 46-93; P = .117). CONCLUSION Supramalleolar osteotomy was a valuable treatment option for early to mid-stage posttraumatic asymmetric varus ankle osteoarthritis. LEVEL OF EVIDENCE Level IV, retrospective cohort study.
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Affiliation(s)
- Nicola Krähenbühl
- 1 Department of Orthopaedics, Kantonsspital Baselland, Liestal, Switzerland
| | - Mahmut Akkaya
- 1 Department of Orthopaedics, Kantonsspital Baselland, Liestal, Switzerland
| | - Manja Deforth
- 1 Department of Orthopaedics, Kantonsspital Baselland, Liestal, Switzerland
| | - Lukas Zwicky
- 1 Department of Orthopaedics, Kantonsspital Baselland, Liestal, Switzerland
| | - Alexej Barg
- 2 Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Beat Hintermann
- 1 Department of Orthopaedics, Kantonsspital Baselland, Liestal, Switzerland
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Medial Open-Wedge Supramalleolar Osteotomy for Patients with Takakura 3B Ankle Osteoarthritis: A Mid- to Long-Term Study. BIOMED RESEARCH INTERNATIONAL 2019; 2019:7630868. [PMID: 31317038 PMCID: PMC6601490 DOI: 10.1155/2019/7630868] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 04/17/2019] [Accepted: 05/26/2019] [Indexed: 11/17/2022]
Abstract
It is controversial whether supramalleolar osteotomy is suitable for Takakura Stage 3B osteoarthritis or not. The aim of this study was to evaluate the outcomes of supramalleolar osteotomy in patients with Takakura 3B osteoarthritis. From February 2008 to August 2013, supramalleolar osteotomy was performed in 21 patients matching the inclusion criteria. The mean patient age at operation was 53.7±5.8 years (range: 39 to 61 years). The mean duration of follow-up was 87.7±19.5 months (range: 61 to 125 months). The radiologic evaluation included the tibial articular surface (TAS) angle, tibial lateral surface (TLS) angle, and talar tilt (TT) angle. Functional assessment was performed with use of the AOFAS, VAS, SF-36, and AOS. All patients were followed. TAS angle improved from 82.8±2.4 to 90.3±2.3. TLS angle changed from 77.5±2.8 to 79.4±2.7. The preoperative TT angle and postoperative TT angle were 13.4±3.6 to 4.8±3.6, respectively. For functional evaluation, the preoperative VAS and AOFAS-AH scores were 5.7±1.3 and 48.0±15.8, while the postoperative VAS and AOFAS-AH scores were 2.5±1.9 and 74.8±11.5. The mean SF-36 scale improved from 41.2±13.1 to 66.7±14.9. The AOS score improved from 61.4±12.5 to 27.5±17.8. 1 patient underwent total ankle replacement 3 years postoperatively. 4 patients remained stage 3B including the TAR one. 4 improved to stage 3A, 11 improved to stage 2, and 2 improved to stage 1. Supramalleolar osteotomy combined with auxiliary procedures can restore the malalignment of ankle joint and modify the abnormal stress distribution so as to achieve functional improvement and improve radiographic stages.
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Scheidegger P, Horn Lang T, Schweizer C, Zwicky L, Hintermann B. A flexion osteotomy for correction of a distal tibial recurvatum deformity. Bone Joint J 2019; 101-B:682-690. [DOI: 10.1302/0301-620x.101b6.bjj-2018-0932.r2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Aims There is little information about how to manage patients with a recurvatum deformity of the distal tibia and osteoarthritis (OA) of the ankle. The aim of this study was to evaluate the functional and radiological outcome of addressing this deformity using a flexion osteotomy and to assess the progression of OA after this procedure. Patients and Methods A total of 39 patients (12 women, 27 men; mean age 47 years (28 to 72)) with a distal tibial recurvatum deformity were treated with a flexion osteotomy, between 2010 and 2015. Nine patients (23%) subsequently required conversion to either a total ankle arthroplasty (seven) or an arthrodesis (two) after a mean of 21 months (9 to 36). A total of 30 patients (77%), with a mean follow-up of 30 months (24 to 76), remained for further evaluation. Functional outcome, sagittal ankle joint OA using a modified Kellgren and Lawrence Score, tibial lateral surface (TLS) angle, and talar offset ratio (TOR) were evaluated on pre- and postoperative weight-bearing radiographs. Results Postoperatively, the mean score for pain, using a visual analogue scale, decreased significantly from 4.3 to 2.5 points and the mean American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score improved significantly from 59 to 75 points (both p < 0.001). The mean TLS angle increased significantly by 6.6°; the mean TOR decreased significantly by 0.24 (p < 0.001). Radiological evaluation showed an improvement or no progression of sagittal ankle joint OA in 32 ankles (82%), while seven ankles (18%) showed further progression. Conclusion A flexion osteotomy effectively improved the congruency of the ankle joint. In 30 patients (77%), the joint could be saved, whereas in nine patients (23%), the treatment delayed a joint-sacrificing procedure. Cite this article: Bone Joint J 2019;101-B:682–690.
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Affiliation(s)
- P. Scheidegger
- Clinic of Orthopaedic Surgery, Kantonsspital Baselland, Liestal, Switzerland
| | - T. Horn Lang
- Clinic of Orthopaedic Surgery, Kantonsspital Baselland, Liestal, Switzerland
| | - C. Schweizer
- Clinic of Orthopaedic Surgery, Kantonsspital Baselland, Liestal, Switzerland
| | - L. Zwicky
- Clinic of Orthopaedic Surgery, Kantonsspital Baselland, Liestal, Switzerland
| | - B. Hintermann
- Clinic of Orthopaedic Surgery, Kantonsspital Baselland, Liestal, Switzerland
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42
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Barg A, Saltzman CL. Joint-Preserving Procedures in Patients with Varus Deformity: Role of Supramalleolar Osteotomies. Foot Ankle Clin 2019; 24:239-264. [PMID: 31036267 DOI: 10.1016/j.fcl.2019.02.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The most common cause for end-stage ankle osteoarthritis is posttraumatic, sometimes resulting from concomitant supramalleolar deformity. Aims of the supramalleolar osteotomy include restoring the lower-leg axis to improve intraarticular load distribution and retarding degeneration of the tibiotalar joint. Preoperative planning is based on conventional weight-bearing radiographs. Often advanced imaging, including computed tomography and/or MRI, is needed for a better understanding of the underlying problem. Postoperative complications are not uncommon, including progression of tibiotalar osteoarthritis in up to 25% within 5 years of all patients who have supramalleolar osteotomies.
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Affiliation(s)
- Alexej Barg
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA.
| | - Charles L Saltzman
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA.
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43
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Krähenbühl N, Siegler L, Deforth M, Zwicky L, Hintermann B, Knupp M. Subtalar joint alignment in ankle osteoarthritis. Foot Ankle Surg 2019; 25:143-149. [PMID: 29409290 DOI: 10.1016/j.fas.2017.10.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 09/07/2017] [Accepted: 10/02/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Although it has been proposed that in mid-stage ankle osteoarthritis, the subtalar joint can compensate for deformities above the ankle joint, the evidence is weak. We thus investigated subtalar joint alignment in different stages of ankle osteoarthritis using weightbearing computed tomography (CT) scans. METHODS The subtalar joint of 88 patients with osteoarthritis of the ankle joint and a control group of 27 healthy volunteers were assessed. Subgroups were performed according to the ankle deformity (varus and valgus) and stage of ankle joint osteoarthritis. Subtalar joint alignment was assessed on weightbearing CT scans. RESULTS A more valgus subtalar joint alignment was found in patients with varus ankle osteoarthritis. No significant difference of the subtalar joint alignment was evident when comparing different stages of ankle osteoarthritis. CONCLUSIONS Varus ankles compensate in the subtalar joint for deformities above the ankle joint. Compensation does not correlate with the stage of ankle osteoarthritis.
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Affiliation(s)
- Nicola Krähenbühl
- Department of Orthopaedic Surgery, Kantonsspital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland.
| | - Lena Siegler
- Department of Orthopaedic Surgery, Kantonsspital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Manja Deforth
- Department of Orthopaedic Surgery, Kantonsspital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Lukas Zwicky
- Department of Orthopaedic Surgery, Kantonsspital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Beat Hintermann
- Department of Orthopaedic Surgery, Kantonsspital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Markus Knupp
- Mein Fuss Zentrum AG, Eichenstrasse 41, 4054 Basel, Switzerland
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44
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Chatterton BD, Bing A. A novel technique for supramalleolar osteotomy of the tibia using a circular frame. Ann R Coll Surg Engl 2019; 101:373-374. [PMID: 30855977 DOI: 10.1308/rcsann.2019.0014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- B D Chatterton
- Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust , UK
| | - Ajf Bing
- Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust , UK
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Ettinger S, Schwarze M, Yao D, Ettinger M, Claassen L, Stukenborg-Colsman C, Thermann H, Plaass C. Stability of supramalleolar osteotomies using different implants in a sawbone model. Arch Orthop Trauma Surg 2018; 138:1359-1363. [PMID: 29934820 DOI: 10.1007/s00402-018-2981-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND With ankle arthritis often affecting young patients, joint-sparing treatments instead of total joint replacement should be considered. Only a few implants were specially developed for supramalleolar osteotomies (SMOT). This study was performed to analyse the stability of different implants and their appropriateness for SMOT. METHODS Twenty-five bone models (Sawbone Europe, Malmö, Sweden) were used for biomechanical testing. SMOT were performed as a uniplanar osteotomy, leaving 5 mm of lateral bone intact with a standardized gap of 8 mm. Five different plates commonly used for SMOT were assessed. For axial stability, the constructs were tested during 100 cycles for each load (150N and 800N) at a rate of 0.5 Hz. For rotational stability, each construct was subject to 100 cycles of 5 Nm torque at a rate of 0.25 Hz, performing three runs with an axial preload of 0N, 150N, or 800N. Ultimate axial load was performed for one-half and ultimate rotational load was performed for the other half of the constructs. In addition, the stiffness of the different constructs after failure was tested. RESULTS All constructs showed high stability and could be tested until maximum cyclic load. There was no significant difference between the five plates, neither for stiffness (axial or rotational) nor for failure load (axial or rotational). One plate indicated superiority in axial failure testing without any significant difference. CONCLUSION All implants could be tested until maximum load. The intact hinge apparently provides enough support to compensate for lower moment of inertia of some plates. LEVEL OF EVIDENCE Not applicable.
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Affiliation(s)
- Sarah Ettinger
- Department of Foot and Ankle Surgery, Orthopaedic Clinic at DIAKOVERE Annastift, Hannover Medical School, Anna-von-Borries-Straße 1-7, 30625, Hannover, Germany
| | - Michael Schwarze
- Biomechanical Laboratory, Orthopaedic Clinic, Hannover Medical School, Hannover, Germany
| | - Daiwei Yao
- Department of Foot and Ankle Surgery, Orthopaedic Clinic at DIAKOVERE Annastift, Hannover Medical School, Anna-von-Borries-Straße 1-7, 30625, Hannover, Germany
| | - Max Ettinger
- Department of Foot and Ankle Surgery, Orthopaedic Clinic at DIAKOVERE Annastift, Hannover Medical School, Anna-von-Borries-Straße 1-7, 30625, Hannover, Germany
| | - Leif Claassen
- Department of Foot and Ankle Surgery, Orthopaedic Clinic at DIAKOVERE Annastift, Hannover Medical School, Anna-von-Borries-Straße 1-7, 30625, Hannover, Germany
| | - Christina Stukenborg-Colsman
- Department of Foot and Ankle Surgery, Orthopaedic Clinic at DIAKOVERE Annastift, Hannover Medical School, Anna-von-Borries-Straße 1-7, 30625, Hannover, Germany
| | | | - Christian Plaass
- Department of Foot and Ankle Surgery, Orthopaedic Clinic at DIAKOVERE Annastift, Hannover Medical School, Anna-von-Borries-Straße 1-7, 30625, Hannover, Germany.
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46
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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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Weigelt L, Fürnstahl P, Hirsiger S, Vlachopoulos L, Espinosa N, Wirth SH. Three-Dimensional Correction of Complex Ankle Deformities With Computer-Assisted Planning and Patient-Specific Surgical Guides. J Foot Ankle Surg 2018; 56:1158-1164. [PMID: 28668219 DOI: 10.1053/j.jfas.2017.05.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Indexed: 02/03/2023]
Abstract
Three-dimensional computer-assisted preoperative planning, combined with patient-specific surgical guides, has become an effective technique for treating complex extra- and intraarticular bone malunions by corrective osteotomy. The feasibility and accuracy of such a technique has not yet been evaluated for ankle deformities. Four surgical cases of varying complexity and location were selected for evaluation. Three-dimensional bone models of the affected and contralateral healthy lower limb were generated from computed tomography scans. The preoperative planning software permitted quantification of the deformity in 3 dimensions and subsequent simulation of reduction, yielding a precise surgical plan. Patient-specific surgical guides were designed, manufactured, and finally applied during surgery to reproduce the preoperative plan. Evaluation of the postoperative computed tomography scans indicated adequate reduction accuracy with residual translational and rotational errors of <3 mm and <6°, respectively. Two patients required revision surgery owing to anterior osseous impingement or delayed union of the osteotomy. All patients were satisfied with the postoperative course and were pain free at a mean follow-up period of 2.5 (range 1 to 4) years. These promising results require confirmation in a clinical study with a larger sample size.
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Affiliation(s)
- Lizzy Weigelt
- Orthopedic Department, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
| | - Philipp Fürnstahl
- Computer Assisted Research and Development Group, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Stefanie Hirsiger
- Orthopedic Department, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Lazaros Vlachopoulos
- Computer Assisted Research and Development Group, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Norman Espinosa
- Orthopedic Department, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Stephan H Wirth
- Orthopedic Department, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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48
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Walcher MG, Fraissler L, Konrads C, Plumhoff P, Hoberg M, Rudert M. [Osteotomies of the distal tibia]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2018; 30:253-275. [PMID: 29934783 DOI: 10.1007/s00064-018-0555-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 12/07/2017] [Accepted: 01/05/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Restoration of physiological alignment of the distal tibia and thereby restoration of physiological loading of the ankle joint; joint preservation in asymmetric degenerative arthritis of the ankle. INDICATIONS Congenital deformities of the distal tibia; acquired deformities of the distal tibia; asymmetric degenerative arthritis with partially preserved cartilage. CONTRAINDICATIONS Absolute contraindications comprise severe nicotine abuse, Charcot arthropathy, peripheral polyneuropathy, relevant peripheral arterial vessel disease, poor local soft tissue condition, acute infection and extensive cartilage damage grade 3-4 in the Outerbridge classification in the complete joint. SURGICAL TECHNIQUE Medial and lateral open and closed wedge osteotomies and dome osteotomies of the distal tibia are used, and shortening, lengthening and derotating osteotomies of the fibula. POSTOPERATIVE MANAGEMENT For 6 weeks, 15-20 kg partial weight-bearing in a below knee cast or a walker orthosis; full weight-bearing depending on osseous healing after 9-12 weeks postoperatively. RESULTS Between July 2012 and May 2017, 15 patients (10 men, 5 women) underwent a supramalleor osteotomy. Average age was 41.8 years (range 17-63 years) and the retrospective average follow-up was 28.7 months (range 3-47 months). Mean preoperative AOFAS (American Orthopaedic Foot and Ankle Society) hindfoot score was 54.3 (range 26-86) and postoperatively a mean of 74.2 (44-100). Preoperatively, 9 patients had varus malalignment and 6 patients valgus malalignment; overall, 4 patients developed complications requiring surgical intervention (26.7%). Osteosynthetic material was removed in 60% of the patients.
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Affiliation(s)
- M G Walcher
- OCW Orthopädie Chirurgie Würzburg, Oeggstr. 3, 97070, Würzburg, Deutschland. .,Orthopädische Klinik König-Ludwig-Haus, Brettreichstr. 11, 97074, Würzburg, Deutschland.
| | - L Fraissler
- Orthopädische Klinik König-Ludwig-Haus, Brettreichstr. 11, 97074, Würzburg, Deutschland
| | - C Konrads
- Orthopädische Klinik König-Ludwig-Haus, Brettreichstr. 11, 97074, Würzburg, Deutschland
| | - P Plumhoff
- Orthopädische Klinik König-Ludwig-Haus, Brettreichstr. 11, 97074, Würzburg, Deutschland
| | - M Hoberg
- Orthopädische Klinik König-Ludwig-Haus, Brettreichstr. 11, 97074, Würzburg, Deutschland
| | - M Rudert
- Orthopädische Klinik König-Ludwig-Haus, Brettreichstr. 11, 97074, Würzburg, Deutschland
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49
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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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Hintermann B, Zwicky L, Schweizer C, Ruiz R, Barg A. The Use of Supramalleolar Osteotomies in Posttraumatic Deformity and Arthritis of the Ankle. JBJS Essent Surg Tech 2017; 7:e29. [PMID: 30233964 DOI: 10.2106/jbjs.st.16.00081] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Osteoarthritis of the ankle is a debilitating musculoskeletal disease that affects approximately 1% of adults worldwide. The most common etiology of ankle osteoarthritis is trauma. In general, patients with ankle osteoarthritis are 12 to 15 years younger than patients with hip or knee osteoarthritis. More than 50% of all patients with ankle osteoarthritis exhibit a substantial concomitant hindfoot deformity on the supramalleolar and/or inframalleolar level. Different treatment options for ankle osteoarthritis, including joint-preserving and non-joint-preserving surgical procedures, have been described in the current literature. Supramalleolar osteotomy is a joint-preserving option that can be considered in patients who have asymmetric ankle osteoarthritis, a partially preserved ankle joint, and a concomitant supramalleolar deformity. The primary goal of the supramalleolar osteotomy is to realign the hindfoot and, specifically, the spatial relationship between the talus and the tibia in order to restore normal ankle biomechanics and normalize load distribution within the ankle joint. Different surgical techniques of supramalleolar osteotomy that are based on the underlying deformity, e.g., varus versus valgus, are described. The major steps of the procedure, which are demonstrated in this video article, include (1) exposure of the distal end of the tibia, (2) determination of the osteotomy site, (3) performance of the supramalleolar osteotomy, (4) mobilization of the osteotomized distal end of the tibia, (5) internal fixation of the osteotomy site, (6) additional balancing, and (7) step-by-step wound closure. In some instances, additional procedures are required to balance the ankle joint, e.g., inframalleolar osteotomies, arthrodeses, ligament reconstructions, and tendon transfers. The postoperative rehabilitation requires non-weight-bearing activity for 6 to 8 weeks postoperatively. Intraoperative, perioperative, and postoperative complications can occur and are discussed in this article.
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Affiliation(s)
| | | | | | - Roxa Ruiz
- Kantonsspital Baselland, Liestal, Switzerland
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