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Sifen L, Van Steyn P, Romash MM. Clinical Outcome of Kissing Mosaicplasty for Treatment of Asymmetric Medial Tibiotalar Osteoarthritis: A Case Report. JBJS Case Connect 2021; 11:01709767-202109000-00109. [PMID: 34478410 DOI: 10.2106/jbjs.cc.21.00085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We report a case of asymmetric medial ankle arthritis that was treated by medial malleolar osteotomy and oblique fibular osteotomy to expose and resurface both the medial talar dome and medial tibial plafond articular surfaces. CONCLUSION This technique permitted a unique application of mosaicplasty in which osteochondral plugs were placed in a "kissing" orientation. The outcome seen here suggests the possibility of mosaicplasty as a viable option for treatment of localized ankle arthritis. In addition, this exposure technique is also applicable to treating isolated lesions of the medial tibial plateau.
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Affiliation(s)
- Lena Sifen
- Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Peter Van Steyn
- Orthopaedic Surgery Program, Madigan Army Medical Center, Tacoma, Washington
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Akoh CC, Dibbern K, Amendola A, Sittapairoj T, Anderson DD, Phisitkul P. Effect of Ankle Position and Noninvasive Distraction on Arthroscopic Accessibility of the Distal Tibial Plafond. Foot Ankle Int 2017; 38:1152-1159. [PMID: 28741435 DOI: 10.1177/1071100717717264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Osteochondral lesions of the tibial plafond (OLTPs) can lead to chronic ankle pain and disability. It is not known how limited ankle motion or joint distraction affects arthroscopic accessibility of these lesions. The purpose of this study was to determine the effects of different fixed flexion angles and distraction on accessibility of the distal tibial articular surface during anterior and posterior arthroscopy. METHODS Fourteen below-knee cadaver specimens underwent anterior and posterior ankle arthroscopy using a 30-degree 2.7-mm arthroscopic camera. Intra-articular working space was measured with a precision of 1 mm using sizing rods. The accessible areas at the plafond were marked under direct visualization at varying fixed ankle flexion positions. Arthroscopic accessibilities were normalized as percent area using a surface laser scan. Statistical analyses were performed to assess the relationship between preoperative ankle range of motion, amount of distraction, arthroscopic approach, and arthroscopic plafond visualization. RESULTS There was significantly greater accessibility during posterior arthroscopy (73.5%) compared with anterior arthroscopy (51.2%) in the neutral ankle position ( P = .007). There was no difference in accessibility for anterior arthroscopy with increasing level of plantarflexion ( P > .05). Increasing dorsiflexion during posterior arthroscopy significantly reduced ankle accessibility ( P = .028). There was a significant increase in accessibility through the anterior and posterior approach with increasing amount of intra-articular working space (parameter estimates ± SE): anterior = 14.2 ± 3.34 ( P < .01) and posterior = 10.6 ± 3.7 ( P < .05). Frequency data showed that the posterior third of the plafond was completely inaccessible in 33% of ankles during anterior arthroscopy. The frequency of inaccessible anterior plafond during posterior arthroscopy was 12%. CONCLUSION Intra-articular working space and arthroscopic accessibility were greater during posterior arthroscopy compared with anterior arthroscopy. Improved accessibility of OLTPs may be achieved from posterior arthroscopy. Arthroscopic accessibility was heavily dependent on the amount of intraoperative joint working space achieved and not on ankle position. CLINICAL RELEVANCE OLTPs are often encountered in tandem with talar lesions, and safely achieving intra-articular working space through noninvasive distraction greatly improved arthroscopic accessibility.
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Affiliation(s)
- Craig C Akoh
- 1 Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Kevin Dibbern
- 1 Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Annuziato Amendola
- 1 Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Tinnart Sittapairoj
- 1 Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Donald D Anderson
- 1 Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Phinit Phisitkul
- 1 Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Yabumoto H, Nakagawa Y, Yamada S, Mukai S, Mukaida S, Ninomiya S, Tsubouchi N, Matsuoka M, Tarumi E, Nakamura T. Osteochondral autograft transfer for post-traumatic osteochondral defects of the anterolateral surface of the distal tibial plafond. Trauma Case Rep 2016; 3:18-25. [PMID: 29942840 PMCID: PMC6011856 DOI: 10.1016/j.tcr.2016.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2016] [Indexed: 11/01/2022] Open
Abstract
Post-traumatic osteochondral defects of the distal tibial plafond may be a more common cause of pain and osteoarthritis than previously recognized. However, the literature on the surgical treatment of osteochondral defects of the distal tibial plafond is significantly limited. This case report presents the operative technique and clinical outcome of osteochondral autograft transfer for an osteochondral defect on the anterolateral surface of the distal tibial plafond. A case of transfer of osteochondral autograft plugs to repair the anterolateral surface of the distal tibial plafond and prevent progression of forward displacement of the talus in a 25-year-old man who presented with pain in his right ankle, following a history of trauma.
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Affiliation(s)
- Hiromitsu Yabumoto
- Department of Orthopaedic Surgery, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
| | - Yasuaki Nakagawa
- Department of Orthopaedic Surgery, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
| | - Shigeru Yamada
- Department of Orthopaedic Surgery, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
| | - Syogo Mukai
- Department of Orthopaedic Surgery, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
| | - Seiji Mukaida
- Department of Orthopaedic Surgery, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
| | - Shuzo Ninomiya
- Department of Orthopaedic Surgery, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
| | - Naoya Tsubouchi
- Department of Orthopaedic Surgery, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
| | - Masayuki Matsuoka
- Department of Orthopaedic Surgery, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
| | - Eri Tarumi
- Department of Orthopaedic Surgery, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
| | - Takashi Nakamura
- Department of Orthopaedic Surgery, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
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