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Cao ZL, Wang CH, Ding XH, Wang ZD, Dong QY. Outcomes of ankle arthrodesis in adult patients with ankle osteoarthritis in Kashin-Beck disease. Int Orthop 2024:10.1007/s00264-024-06195-4. [PMID: 38679689 DOI: 10.1007/s00264-024-06195-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/16/2024] [Indexed: 05/01/2024]
Abstract
PURPOSE We retrospectively evaluated the characteristics of these patients and the effectiveness of ankle arthrodesis in the treatment of ankle arthritis caused by Kashin-Beck disease (KBD). METHODS A retrospective study of KBD patients with ankle osteoarthritis who underwent ankle arthrodesis between December 2012 and January 2022 was performed. A total of 46 patients were included. The general characteristics, clinical manifestations and imaging features of the patients were recorded and summarized. measured using the VAS score, and ankle function was assessed by the AOFAS ankle-hindfoot score. RESULTS Multiple subchondral cystic changes were found in 42(91.3%) patients. The VAS scores for both resting and weight-bearing conditions were 6.28 ± 1.30 vs. 2.09 ± 1.12 (P < .001) and 6.87 ± 1.01 vs. 2.17 ± 0.98 (P < .001), respectively. The AOFAS scores were 59.17 ± 5.50 and 88.39 ± 1.42, respectively (P < .001). CONCLUSIONS The subchondral multiple cystic transformation of the ankle KBD has a certain suggestive role.Arthrodesis is an effective method to reduce ankle pain and improve ankle function in KBD patients with ankle osteoarthritis.
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Affiliation(s)
- Zhen Lu Cao
- Department of Hand, Foot and Microsurgery, the Affiliated Hospital of Qingdao University, No. 59, Haier Road, Qingdao City, 266000, Shandong Province, China
| | - Chen Han Wang
- Department of Hand, Foot and Microsurgery, the Affiliated Hospital of Qingdao University, No. 59, Haier Road, Qingdao City, 266000, Shandong Province, China
| | - Xiao Heng Ding
- Department of Hand, Foot and Microsurgery, the Affiliated Hospital of Qingdao University, No. 59, Haier Road, Qingdao City, 266000, Shandong Province, China
| | - Zheng Dan Wang
- Department of Hand, Foot and Microsurgery, the Affiliated Hospital of Qingdao University, No. 59, Haier Road, Qingdao City, 266000, Shandong Province, China
| | - Quan Yu Dong
- Department of Hand, Foot and Microsurgery, the Affiliated Hospital of Qingdao University, No. 59, Haier Road, Qingdao City, 266000, Shandong Province, China.
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El-Adly W, Adam FF, Kamel MS, Osman AE. Functional and radiographic assessments of post-traumatic asymmetrical ankle osteoarthritis treatment using supramalleolar osteotomies. Eur J Orthop Surg Traumatol 2024; 34:1095-1101. [PMID: 37943337 PMCID: PMC10857950 DOI: 10.1007/s00590-023-03773-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 10/23/2023] [Indexed: 11/10/2023]
Abstract
PURPOSE This study's objective is to assess the effectiveness of supramalleolar osteotomies (SMOT) in the treatment of asymmetrical ankle osteoarthritis in terms of the improvement in alignment assessed radiographically and its impact on symptoms measured by the American Orthopedic Foot and Ankle Society ankle-hindfoot score (AOFAS ankle-hindfoot score). METHODS Twelve patients participated in this prospective observational case series study. Standing anteroposterior, true lateral, and mortise views radiographs were taken. For preoperative planning, the lateral distal tibial angle (LDTA), talar tilt (TT), talocrural angle (TCA), and anterior distal tibial angle (ADTA) were all measured. A medial opening wedge osteotomy mainly was used to treat the varus arthritis ankle. A further oblique fibular osteotomy is frequently necessary. RESULTS The male-to-female ratio was 3:1, and the mean age of the patients was 26.25 ± 13.032 years. There were highly statistically significant differences between pre-and post-operative AOFAS ankle-hindfoot score (p < 0.001). Statistically significant differences concerning ankle range of motion (p = 0.002, < 0.001) of dorsiflexion and planter flexion were detected. Comparison between pre-and post-operative patients' radiology characteristics shows statistically significant differences concerning TT (p = 0.016) and LDTA (p = 0.046). CONCLUSION SMOT is very effective in the treatment of post-traumatic ankle osteoarthritis and postpones ankle fusion or total ankle replacements. This surgery significantly improves functional and radiological outcomes as well as the range of motion in the ankle. Meticulous preoperative planning by radiological measurements of different angles around the ankle is considered the crucial factor in success of that operation.
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Affiliation(s)
- Wael El-Adly
- Orthopedic Surgery Department, Assiut University, Assiut, Egypt.
- Orthopedic Surgery Department, Assiut University Hospital, University Street, Assiut, 71515, Egypt.
| | | | | | - Ahmed E Osman
- Orthopedic Surgery Department, Assiut University, Assiut, Egypt
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Chou TFA, Tzeng YH, Teng MH, Huang YC, Wang CS, Lin CC, Chiang CC. Trimalleolar Fractures Treated by Open Reduction Internal Fixation Compared With Arthroscopically Assisted Reduction and Minimally Invasive Surgery. Foot Ankle Int 2023; 44:431-442. [PMID: 36946569 DOI: 10.1177/10711007231157676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND Currently, the standard of treatment for trimalleolar (TM) fracture is osteosynthesis through open reduction and internal fixation (ORIF). This study assessed whether arthroscopically assisted reduction and minimally invasive surgery (AARMIS) can be an alternative surgical method for TM fractures. METHODS This retrospective cohort study included 49 patients with TM that were surgically treated. 27 patients received ORIF and 22 patients underwent AARMIS . At baseline, we recorded the patient's demographic features, fracture pattern (AO-OTA and Haraguchi classification), and surgical method. For postoperative results, we examined the patient's radiographic outcome, including time to union, quality of fracture reduction, as well as functional outcomes (American Orthopaedic Foot & Ankle Society ankle hindfoot score, ankle range of motion, and visual analog scale of pain) and perioperative complications. RESULTS At mean follow-up of 46.6±24.6 (ORIF) and 36.4±18.5 months (AARMIS), both groups had comparable radiographic outcomes. No significant difference in rates of early ankle OA were detected. In terms of functional outcome, VAS pain and AOFAS score at postoperative day 3, postoperative month 3, and at final follow-up were not different. In terms of range of motion, we did not find a significant difference in mean range of motion. CONCLUSION Patients with TM fractures treated with AARMIS achieved satisfactory results and was not significantly different in radiographic and functional performance compared with ORIF. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Te-Feng Arthur Chou
- Division of Orthopaedic Trauma, Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei
| | - Yun-Hsuan Tzeng
- Division of Medical Imaging for Health Management, Cheng-Hsin General Hospital, Taipei
- Department of Radiology, School of Medicine, National Yang Ming Chiao Tung University, Taipei
| | - Ming-Hung Teng
- Division of Orthopaedic Trauma, Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei
| | - Yen-Chun Huang
- Division of Orthopaedic Trauma, Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei
| | - Chien-Shun Wang
- Division of Orthopaedic Trauma, Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei
| | - Chun-Cheng Lin
- Division of Orthopaedic Trauma, Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei
| | - Chao-Ching Chiang
- Division of Orthopaedic Trauma, Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei
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Butler JJ, Azam MT, Weiss MB, Kennedy JG, Walls RJ. 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; 31:701-15. [PMID: 36151410 DOI: 10.1007/s00167-022-07144-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [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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Morohashi I, Mogami A, Wakeshima T, Kameda S, Matsuo T, Muraoka T, Obayashi O, Kaneko K, Ishijima M. Early results of intramedullary nail fixation in distal tibia oblique osteotomy for the reduction of soft tissue complications. J Orthop Surg (Hong Kong) 2023; 31:10225536231157136. [PMID: 36785987 DOI: 10.1177/10225536231157136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
PURPOSE During distal tibial oblique osteotomy, external fixators can increase pin site infection risk, whereas plates can cause wound necrosis, necessitating a compromise between soft-tissue position and length. We provide the first report of the early results of intramedullary nail fixation in these osteotomies for avoiding soft tissue complications. METHODS Ten ankles, classed as Takakura-Tanaka stages 3a to 4 and unclassified and treated via distal tibial oblique osteotomy for ankle osteoarthritis between 2017 and 2021, were included. Osteotomy was performed obliquely from the distal medial tibia to the tibiofibular joint. The distal tibial fragment was rotated distally in the coronal plane for realignment. An intramedullary nail fixation was applied for stabilization. The resulting gap was filled with iliac bone graft. Ankles were evaluated on the Japanese Society for Surgery of the Foot ankle-Hindfoot Scale and Self-Administered Foot Evaluation Questionnaire before surgery and at final follow-up. Radiographic assessments were performed. RESULTS Bone union was achieved within 3 months in all patients. There were no cases of wound necrosis or correction loss postsurgery. Japanese Society scale scores significantly improved from 40.3 ± 15.9 to 87.5 ± 12.6 (P < 0.01). Mean self-evaluation scale scores (pain and pain-related, physical functioning and daily living, social functioning, general health and well-being) improved significantly. shoe-related scores did not change significantly but improved. There was no correction loss after surgery, with an average widening of 24.2 mm and opening angle of 22.6° at the osteotomy site. CONCLUSION Our study showed that intramedullary nail for fixation of the osteotomy site in distal tibial oblique osteotomy effectively prevents soft tissues complications even in osteotomy sites with large openings.
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Affiliation(s)
- Itaru Morohashi
- Department of Orthopaedic Surgery, 73832Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan
| | - Atsuhiko Mogami
- Department of Orthopaedic Surgery, 73832Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan
| | - Tomoko Wakeshima
- Department of Orthopaedic Surgery, 73832Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan
| | - So Kameda
- Department of Orthopaedic Surgery, Kameda Hospital, Yokohama, Japan
| | | | | | - Osamu Obayashi
- Department of Orthopaedic Surgery, 73832Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan
| | - Kazuo Kaneko
- 12847Juntendo University, Bunkyo-ku, Tokyo, Japan
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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牵张成形术治疗中重度踝关节炎中远期疗效分析. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2022; 36. [PMID: 36382457 DOI: 10.7507/1002-1892.202206013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To investigate the mid- and long-term effectiveness of external fixator distraction arthroplasty in the treatment of moderate to severe ankle arthritis. METHODS The clinical data of 23 patients with moderate to severe ankle arthritis treated with external fixation distraction arthroplasty who met the selection criteria between January 2007 and November 2019 were retrospectively analyzed. There were 20 males and 3 females; the age ranged from 21 to 65 years, with an average age of 43.7 years. Etiology included 8 cases of primary ankle arthritis, in which 5 cases combined with varus deformity; 15 cases of traumatic ankle arthritis, the cause of injury was 5 cases after ankle fracture surgery, 3 cases after Pilon fracture surgery, 5 cases of chronic ankle instability and repeated sprain, and 2 cases of other causes. According to Takakura staging system, there were 4 cases of stage ⅢA, 12 cases of stage ⅢB, and 7 cases of stage Ⅳ; according to Giannini staging system, there were 5 cases of stage Ⅱ and 18 cases of stage Ⅲ; according to Cheng staging system, 16 cases were in stage Ⅲ, and 7 cases stage Ⅳ. American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and visual analogue scale (VAS) score were used to evaluate the improvement of ankle pain and function before operation and at last follow-up, and the data were analyzed according to different etiological groups. At last follow-up, the surgical results were evaluated subjectively and objectively. The changes of ankle joint space before operation and at last follow-up were compared. The patients were divided into two groups according to their age: ≤45 years old group [young group, 10 cases, aged (35.62±7.41) years old] and >45 years old group [middle-aged and elderly group, 13 cases, aged (54.20±6.20) years old]. The AOFAS ankle-hindfoot score and VAS score were compared before and after operation between the two groups, and the influence of age on distraction arthroplasty was analyzed. RESULTS The external fixator was removed after 3 months of continuous distraction,12 patients got infection around the wire tunnels. All the 23 patients were followed up 13-143 months, with an average of 56.9 months; the follow-up time was (43.46±32.77) months and (69.80±37.79) months in the young group and middle-aged and elderly group, respectively. At last follow-up, the AOFAS ankle-hindfoot score and VAS score significantly improved when compared with those before operation ( P<0.05). According to etiological analysis, there was no significant difference in AOFAS ankle-hindfoot score and VAS score before and after operation ( P>0.05) in Pilon fracture patients, while the significant difference was found in remaining patients ( P<0.05). There was significant difference in AOFAS ankle-hindfoot score before operation between the young group and the middle-aged and elderly group ( t=2.110, P=0.040), but no significant difference in preoperative VAS score and the differences in VAS score and AOFAS ankle-hindfoot score before and after operation between the two groups ( P>0.05). The subjective and objective results of pain evaluation at last follow-up showed that 4 patients had no pain, 12 patients had moderate pain relief, 5 patients had mild pain relief, and 2 patients had no significant pain relief; among the 10 patients who were followed up more than 5 years, there were 2, 5, 2, and 1 patient, respectively; 2 patients who were followed up more than 10 years had moderate pain relief. At last follow-up, the ankle joint space was (3.7±0.4) mm, which significantly increased when compared with before operation [(1.5±0.2) mm] ( t=1.791, P=0.002). The ankle joint space was (2.9±0.5) mm in 10 patients who were followed up more than 5 years, and 3.3 mm and 3.0 mm in 2 patients who were followed up more than 10 years. CONCLUSION Distraction arthroplasty of the ankle joint can achieve satisfactory results in patients with moderate to severe ankle arthritis (except for arthritis caused by Pilon fracture), and age has no significant effect on distraction arthroplasty.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Alajlan A, Santini S, Alsayel F, Teoh KH, Alharbi W, Puls L, Camathias C, Herrera-pérez M, Tejero S, Barg A, Wiewiorski M, Valderrabano V. Joint-Preserving Surgery in Varus Ankle Osteoarthritis. J Clin Med 2022; 11:2194. [PMID: 35456287 PMCID: PMC9031025 DOI: 10.3390/jcm11082194] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/08/2022] [Accepted: 04/12/2022] [Indexed: 02/04/2023] Open
Abstract
Ankle deformity is a disabling condition especially if concomitant with osteoarthritis (OA). Varus ankle OA is one of the most common ankle OA deformities. This deformity usually leads to unequal load distribution in the ankle joint and decreases joint contact surface area, leading to a progressive degenerative arthritic situation. Varus ankle OA might have multiple causative factors, which might present as a single isolated factor or encompassed together in a single patient. The etiologies can be classified as post-traumatic (e.g., after fractures and lateral ligament instability), degenerative, systemic, neuromuscular, congenital, and others. Treatment options are determined by the degree of the deformity and analyzing the pathology, which range from the conservative treatments up to surgical interventions. Surgical treatment of the varus ankle OA can be classified into two categories, joint-preserving surgery (JPS) and joint-sacrificing surgery (JSS) as total ankle arthroplasty and ankle arthrodesis. JPS is a valuable treatment option in varus ankle OA, which should not be neglected since it has showed a promising result, optimizing biomechanics and improving the survivorship of the ankle joint.
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Abstract
A full-length standing posteroanterior radiograph that includes the calcaneus (hip-to-calcaneus radiograph) is obtained for evaluation of the mechanical axis of the entire lower limb in patients with a lower limb condition involving malalignment. Such evaluation clarifies several pathomechanical aspects of hindfoot disorders, facilitates surgical planning, and elucidates factors contributing to unsatisfactory results of a particular operation. Whole limb alignment is influenced not only by the knee joint but also by the ankle joint; thus, knee realignment influences hindfoot alignment and vice versa. It is essential to analyze alignment of the whole limb in planning corrective lower limb surgery.
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Affiliation(s)
- Naoki Haraguchi
- Department of Orthopaedic Surgery, St. Marianna University Yokohama Seibu Hospital, 1197-1 Yasashicho, Asahi-ku, Yokohama, Kanagawa 241-0811, Japan.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Shibuya N, McAlister JE, Prissel MA, Piraino JA, Joseph RM, Theodoulou MH, Jupiter DC. Consensus Statement of the American College of Foot and Ankle Surgeons: Diagnosis and Treatment of Ankle Arthritis. J Foot Ankle Surg 2021; 59:1019-1031. [PMID: 32778440 DOI: 10.1053/j.jfas.2019.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 10/20/2019] [Indexed: 02/03/2023]
Affiliation(s)
- Naohiro Shibuya
- Professor, College of Medicine, Texas A&M University, Temple, TX.
| | | | - Mark A Prissel
- Faculty, Advanced Foot and Ankle Reconstruction Fellowship Program, Orthopedic Foot and Ankle Center, Worthington, OH
| | - Jason A Piraino
- Associate Professor, Department of Orthopaedic Surgery and Rehabilitation, University of Florida Health, Gainesville, FL
| | - Robert M Joseph
- Chairman, Department of Podiatric Medicine & Radiology, Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University, North Chicago, IL
| | - Michael H Theodoulou
- Chief, Division of Podiatric Surgery, Cambridge Health Alliance, Instructor of Surgery, Harvard Medical School, Cambridge, MA
| | - Daniel C Jupiter
- Associate Professor, Department of Preventive Medicine and Community, Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, TX
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Song JH, Kang C, Kim TG, Lee GS, Lee JK, Ahn KJ, Kim DH, Lee SW. Perioperative axial loading computed tomography findings in varus ankle osteoarthritis: Effect of supramalleolar osteotomy on abnormal internal rotation of the talus. Foot Ankle Surg 2021; 27:217-23. [PMID: 32402519 DOI: 10.1016/j.fas.2020.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 03/27/2020] [Accepted: 04/21/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND We used axial loading computed tomography (AL CT) to evaluate preoperative and postoperative talocrural joints of patients who underwent supramalleolar osteotomy (SMO) to treat varus ankle osteoarthritis. METHODS We performed retrospective analyses of 16 patients (18 feet) who underwent SMO including fibular osteotomy. Radiographic assessment was performed with weightbearing radiographs and AL CT. Clinical outcomes were assessed based on American Orthopedic Foot & Ankle Society (AOFAS) scale, visual analog scale (VAS) for pain, and Foot and Ankle Ability Measure (FAAM). RESULTS The mean 2-year follow-up tibial-ankle surface angle, talar tilt angle, Takakura stage, and tibial-lateral surface angle were all significantly different relative to preoperative parameters (P<.05). The mean 6-month follow-up talus rotation ratio was significantly corrected compared to the preoperative value (P=.001). The mean 2-year follow-up AOFAS, VAS at gait, and FAAM scores were all significantly improved relative to preoperative measurements (P=.001). CONCLUSIONS Abnormal internal rotation of the talus in mild to moderate varus ankle osteoarthritis found on AL CT was significantly corrected after SMO. LEVEL OF EVIDENCE Therapeutic Level IV.
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Ayyaswamy B, Jain N, Limaye R. Functional and radiological medium term outcome following supramalleolar osteotomy for asymmetric ankle arthritis- A case series of 33 patients. J Orthop 2020; 21:500-6. [PMID: 32999538 DOI: 10.1016/j.jor.2020.08.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/28/2020] [Accepted: 08/31/2020] [Indexed: 02/07/2023] Open
Abstract
Introduction Ankle arthritis is one of the most disabling and painful conditions. Up to 37.5% of ankle arthritis presents as asymmetric arthritis with ankle malalignment. Supramalleolar osteotomy is a joint sparing operation, which aims to realign the ankle joint that will prevent progression of arthritis and relieve patient's symptoms. Aim The aim of this study is to analyse the medium term functional and radiographic outcomes of patients who underwent supramalleolar osteotomy for asymmetric ankle arthritis. Materials and methods This is a retrospective outcome study of medium term outcome for 33 patients who underwent Supramalleolar osteotomy for asymmetric ankle arthritis by a single surgeon. We assessed the functional outcome of the patients with AOFAS and VAS score. The radiological parameters measured were Tibial articular surface ankle (TAS), Hind foot alignment angle (HFA) and Talar tilt angle (TT). We used the paired Student's t-test to compare the preoperative and postoperative radiographic measurements, AOFAS and VAS scores. We set the significance level at P < 0.05. Results We had 21 patients who underwent lateral closing wedge osteotomy for varus deformity and 12 patients who underwent medial closing wedge osteotomy for valgus deformity. The mean followup was 72 months [29-73]. The mean AOFAS score significantly improved by 44.82 ± 7.97 (p < 0.0001). The VAS score significantly improved by 5.06 ± 1.41 (p < 0.0001). All the radiological parameters showed statistically significant improvement. All osteotomy united by 8-10 weeks. We had one case of late deep wound infection, which settled down with by metalwork removal. The arthritis progressed in three cases, two patients had fusion and one patient had ankle replacement. We had 90.9% survival rate for our osteotomy at 6 years. Conclusion Supramalleolar osteotomy is an excellent option for patients with asymmetric ankle arthritis with good functional and radiological outcome and good medium term survival rate.
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Lacorda JB, Jung HG, Im JM. Supramalleolar Distal Tibiofibular Osteotomy for Medial Ankle Osteoarthritis: Current Concepts. Clin Orthop Surg 2020; 12:271-278. [PMID: 32904071 PMCID: PMC7449861 DOI: 10.4055/cios20038] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 05/08/2020] [Indexed: 12/31/2022] Open
Abstract
The supramalleolar osteotomy is a joint-preserving surgical procedure. It is a very good treatment option for the asymmetric varus ankle and medial compartment osteoarthritis. The primary objective of the procedure is to shift medial concentration of stress toward the lateral intact articular cartilage to redistribute the joint loads during ambulation. Several studies have shown that deformities of the ankle result in uneven load distribution in the ankle joint, which eventually leads to articular cartilage degeneration. Since the lateral articular cartilage is intact, joint-sacrificing procedures such as total ankle replacement or ankle arthrodesis are not the most appropriate treatment choices for medial compartment arthritis. Results of supramalleolar osteotomies are very promising in terms of functional outcome and pain relief. In younger patients with medial compartment varus ankle osteoarthritis or even with a normal tibial anterior surface angle, supramalleolar osteotomies can be performed to realign the ankle to promote regeneration of the asymmetrically damaged cartilage. In this review article, we will discuss the indications, complications, surgical techniques, and outcomes of the supramalleolar osteotomy reported in the current literature.
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Affiliation(s)
- John Bacus Lacorda
- Department of Orthopedic Surgery, Southern Philippines Medical Center, Davao City, Philippines
| | - Hong-Geun Jung
- Department of Orthopedic Surgery, Konkuk University School of Medicine, Seoul, Korea
| | - Je-Min Im
- Department of Orthopedic Surgery, Konkuk University School of Medicine, Seoul, Korea
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Chilmi MZ, Desnantyo AT, Widhiyanto L, Wirashada BC. Low Tibial and Fibular Osteotomy for Treating Varus-Type Post-Traumatic Ankle Osteoarthritis: A Case Report. Malays Orthop J 2020; 14:145-148. [PMID: 32983392 PMCID: PMC7513647 DOI: 10.5704/moj.2007.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
In Indonesia, arthrodesis becomes a choice of treatment in the absence of ankle arthroplasty implants for young adults. Arthrodesis on ankle osteoarthritis (OA) often leads to functional impairment. Low tibiofibular osteotomy is an alternative and it has been known to be the preferable option for those in the productive-ages. A 22-year-old male with a previous history of a motorbike accident, operated eight years ago, came with persistent pain on the left ankle that has worsened over the years. Plain radiography with a tibial-ankle surface angle (TAS) of 74o (normally 88o-93o) indicated varus deformity. Osteotomy was performed on distal tibia above the syndesmotic joint, as well as on the middle third of fibula. Open wedge osteotomy of the tibia was corrected until the normal TAS angle was reached by fluoroscopy. Cortical allograft was used to fill the osteotomy gap. Instrumentation was performed using a clover leaf® plate with 6 screws insertion for fixation stability. All results were satisfactory. Twelve weeks post-operatively, the patient was performing activities normally. Four-month post-operative radiological evaluation showed fusion of graft and the angle of TAS of 89°. Post-operative functional assessment using the American Academy of Orthopaedic Surgeon (AAOS) Foot and Ankle Measurement (FAM) questionnaires showed significant improvement (pre 89, post 38).
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Affiliation(s)
- M Z Chilmi
- Department of Orthopaedic and Traumatology, Universitas Airlangga, Surabaya, Indonesia
| | - A T Desnantyo
- Department of Orthopaedic and Traumatology, Universitas Airlangga, Surabaya, Indonesia
| | - L Widhiyanto
- Department of Orthopaedic and Traumatology, Universitas Airlangga, Surabaya, Indonesia
| | - B C Wirashada
- Department of Orthopaedic and Traumatology, Universitas Airlangga, Surabaya, Indonesia
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Koo JW, Park SH, Kim KC, Sung IH. The preliminary report about the modified supramalleolar tibial osteotomy for asymmetric ankle osteoarthritis. J Orthop Surg (Hong Kong) 2020; 27:2309499019829204. [PMID: 30782068 DOI: 10.1177/2309499019829204] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Supramalleolar tibial osteotomy (SMO) for asymmetric ankle osteoarthritis (OA) is known to lead to satisfactory. Here, authors present a preliminary report on SMO surgical treatment in patients with asymmetric ankle arthritis. MATERIALS AND METHODS We reviewed cases of asymmetric ankle OA treated by modified SMO between January 2011 and October 2015. Clinical assessment was performed with the use of the ankle and hindfoot score of the American Orthopedic Foot and Ankle Society (AOFAS), foot function index, and visual analogue scale (VAS). Patient satisfaction with surgery and postoperative subjective symptoms were examined. Radiographic evaluation included preoperative and postoperative tibial anterior surface angle (TAS angle), talar tilt angle (TT angle), and tibial lateral surface angle (TLS angle). Takakura stage was measured. RESULTS The average follow-up period was 46.3 months. The AOFAS score was 55.7 ± 6.03 preoperatively and 76.0 ± 4.73 postoperatively. Foot function index was 60.7 ± 8.78 preoperatively and 30.8 ± 7.59 postoperatively. VAS was 7.2 ± 0.53 before surgery and 1.9 ± 0.85 after surgery. Clinical evaluations showed statistically significant improvement. The majority of patients reported satisfactory results in the subjective satisfaction evaluation. TAS angle was 84.6 ± 1.82 preoperatively and 94.0 ± 2.79 postoperatively. TLS angle was 78.8 ± 2.11 preoperatively and 81.8 ± 1.80 postoperatively. TT angle was 3.6 ± 1.26 before surgery and 2.1 ± 0.79 after surgery. Thirteen cases showed radiographic improvement of Takakura stage. Complications were not observed. CONCLUSION Modified SMO is a useful procedure that provides for the union and stability of osteotomy with the advantages of the existing SMO and can be performed without bone graft.
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Affiliation(s)
- Ja Wook Koo
- 1 Department of Orthopedic Surgery, Hanyang University College of Medicine, Hanyang University Hospital, Seoul, South Korea
| | - Sang Hoon Park
- 1 Department of Orthopedic Surgery, Hanyang University College of Medicine, Hanyang University Hospital, Seoul, South Korea
| | - Ki Chun Kim
- 2 Department of Orthopedic Surgery, Seoul Medical Center, Seoul, South Korea
| | - Il-Hoon Sung
- 1 Department of Orthopedic Surgery, Hanyang University College of Medicine, Hanyang University Hospital, Seoul, South Korea
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Buchhorn T, Weber J, Lampert C. Arthrose des oberen Sprunggelenks. Arthroskopie 2020. [DOI: 10.1007/s00142-019-00333-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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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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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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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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Kim YS, Kim YB, Koh YG. Prognostic Factors Affecting Correction Angle Changes After Supramalleolar Osteotomy Using an Opening Wedge Plate for Varus Ankle Osteoarthritis. J Foot Ankle Surg 2019; 58:417-422. [PMID: 30745268 DOI: 10.1053/j.jfas.2018.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Indexed: 02/03/2023]
Abstract
Supramalleolar osteotomy (SMO) has been suggested as an effective salvage treatment for varus ankle osteoarthritis. To identify the prognostic factors affecting the correction angle changes after SMO, a total of 53 consecutive patients (58 ankles) were evaluated retrospectively. Clinical and radiologic outcomes were evaluated, and statistical analyses were performed to identify the prognostic factors associated with the clinical and radiologic outcomes. The mean visual analogue scale scores and the American Orthopaedic Foot and Ankle Society scores improved significantly at the final follow-up (both p <.001). The mean tibial-ankle surface (TAS), talar tilt (TT), and tibial-lateral surface angles improved significantly after surgery, compared with the preoperative assessments (all, p <.001). However, at the final follow-up, these angles had changed significantly, compared with their immediate postoperative values (all p <.001), and the changes in the TAS and TT angles significantly influenced the clinical outcomes at the final follow-up (both p <.05). Male sex, high body mass index (≥26.4 kg/m2), and the existence of the lateral cortex breakages were significantly associated with the changes in the TAS and TT angle (all p <.05). Therefore, surgeons should consider these prognostic factors before performing SMO.
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Affiliation(s)
- Yong Sang Kim
- Surgeon, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, Korea.
| | - Yong Beom Kim
- Professor, Department of Orthopaedic Surgery, College of Medicine, Soonchunhyang University, Seoul, Korea
| | - Yong Gon Koh
- Surgeon, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, Korea
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Ewalefo SO, Dombrowski M, Hirase T, Rocha JL, Weaver M, Kline A, Carney D, Hogan MV. Management of Posttraumatic Ankle Arthritis: Literature Review. Curr Rev Musculoskelet Med 2018; 11:546-557. [PMID: 30327933 PMCID: PMC6220012 DOI: 10.1007/s12178-018-9525-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Trauma is the principle cause of osteoarthritis in the ankle, which is associated with significant morbidity. This review highlights the current literature for the purpose of bringing the reader up-to-date on the management of posttraumatic ankle arthritis, describing treatment efficacy, indications, contraindications, and complications. RECENT FINDINGS Recent studies on osteoarthritis have demonstrated variability among anatomic locations regarding the mechanisms and rates of development for posttraumatic osteoarthritis, which are attributed to newly discovered biological differences intrinsic to each joint. Regarding surgical management of posttraumatic ankle arthritis, osteochondral allograft transplantation of the talus, and supramalleolar osteotomies have demonstrated promising results. Additionally, the outpatient setting was found to be appropriate for managing pain following total ankle arthroplasty, associated with low complication rates and no readmission. Management for posttraumatic ankle arthritis is generally progressive. Initial treatment entails nonpharmacologic options with surgery reserved for posttraumatic ankle arthritis refractory to conservative treatment. Patient demographics and lifestyles should be carefully considered when formulating a management strategy, as outcomes are dependent upon the satisfaction of each set of respective criteria. Ultimately, the management of posttraumatic ankle arthritis should be individualized to satisfy the needs and desires, which are specific to each patient.
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Affiliation(s)
- Samuel O Ewalefo
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
- Texas A&M College of Medicine, Bryan, TX, USA.
| | - Malcolm Dombrowski
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Takashi Hirase
- Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Jorge L Rocha
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Mitchell Weaver
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Alex Kline
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Dwayne Carney
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - MaCalus V Hogan
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Guo C, Liu Z, Xu Y, Li X, Zhu Y, Xu X. Supramalleolar Osteotomy Combined With an Intra-articular Osteotomy for the Reconstruction of Malunited Medial Impacted Ankle Fractures. Foot Ankle Int 2018; 39:1457-1463. [PMID: 30188184 DOI: 10.1177/1071100718795309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND: Malunion of a medial impacted ankle fracture may cause varus ankle deformity. This retrospective study examined the use of supramalleolar osteotomy combined with an intra-articular osteotomy in patients with malunited medial impacted ankle fractures. METHODS: Twenty-four patients with malunited medial impacted ankle fracture were treated between January 2011 and December 2014. Using Weber's classification, 10 had type A fractures and 14 had type B, and with the AO classification, 20 had 44A2 and 4 had 44B3. All of these patients had varus ankle deformity. Supramalleolar osteotomy combined with an intra-articular osteotomy was performed. The visual analog scale (VAS) for pain during daily activities, the Olerud and Molander Scale and the modified Takakura classification stage were used to determine the clinical outcomes and a radiographic analysis was performed. RESULTS: The radiographic parameters, including the tibial ankle surface (TAS) angle and talar tilt angle (TTA), showed significant differences between the preoperative and follow-up assessments. The mean tibial lateral surface (TLS) did not show a significant change. The average Olerud and Molander Scale score improved significantly from 56.4 ± 6.21 preoperatively to 77.0 ± 6.11 at the latest follow-up ( P < .01). The mean VAS decreased significantly from 6.7 ± 0.8 preoperatively to 3.1 ± 0.6 at the latest follow-up ( P < .01). No significant difference in the modified Takakura classification stage was observed between the preoperative assessment and the last follow-up. CONCLUSIONS: The use of a supramalleolar osteotomy combined with an intra-articular osteotomy was an effective option for the treatment of malunited medial impacted ankle fractures associated with varus ankle deformity. LEVEL OF EVIDENCE: Level IV, retrospective case series.
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Affiliation(s)
- Changjun Guo
- 1 Department of Orthopaedics, Rui Jin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zongbao Liu
- 2 Department of Orthopaedics, Zhangjiagang First People's Hospital Affiliated to Soochow University, zhangjiagang, China
| | - Yangbo Xu
- 3 Department of Bone and Joint Surgery Affiliated Hospital of Southwest Medical University, Luzhou,China
| | - Xingchen Li
- 1 Department of Orthopaedics, Rui Jin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuan Zhu
- 4 Department of Orthopaedics, Rui Jin Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiangyang Xu
- 1 Department of Orthopaedics, Rui Jin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,4 Department of Orthopaedics, Rui Jin Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Walcher MG, Fraissler L, Konrads C, Plumhoff P, Hoberg M, Rudert M. [Osteotomies of the distal tibia]. Oper Orthop Traumatol 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Zhao HM, Liang XJ, Li Y, Ning N, Lu J. Supramalleolar Osteotomy With Distraction Arthroplasty in Treatment of Varus Ankle Osteoarthritis With Large Talar Tilt Angle: A Case Report and Literature Review. J Foot Ankle Surg 2018; 56:1125-1128. [PMID: 28558996 DOI: 10.1053/j.jfas.2017.04.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Indexed: 02/03/2023]
Abstract
We treated a 57-year-old female with modified Takakura stage 3B varus ankle osteoarthritis. Her preoperative talar tilt angle was 21.3°. The patient wished to avoid ankle joint arthrodesis or replacement. Therefore, medial opening wedge supramalleolar osteotomy with fibular osteotomy was used for her varus ankle osteoarthritis. Also, fixed medial distraction arthroplasty was performed to improve her talar tilt. After 3 months, the external device was removed, and the patient was allowed partial weightbearing and began full weightbearing 4 months postoperatively after the osteotomy site had reached bony union radiographically. At the 3-year follow-up visit, a radiograph showed the medial ankle joint space enlargement had been maintained. The talar tilt angle had decreased to 3.3°, and the modified Takakura stage had improved to stage 1. The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scale score had improved from 26 points preoperatively to 85 points at 3 years postoperatively. Our findings suggested that good clinical and radiologic results can be achieved with supramalleolar osteotomy combined with distraction arthroplasty in the treatment of varus ankle osteoarthritis with a large talar tilt angle.
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Affiliation(s)
- Hong-Mou Zhao
- Orthopedist, Department of Foot and Ankle Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, China
| | - Xiao-Jun Liang
- Professor and Chief, Department of Foot and Ankle Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, China.
| | - Yi Li
- Assistant Professor, Department of Foot and Ankle Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, China
| | - Ning Ning
- Orthopedist, Department of Orthopaedic Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, China
| | - Jun Lu
- Assistant Professor, Department of Foot and Ankle Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, China
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Jung HG, Lee DO, Lee SH, Eom JS. Second-Look Arthroscopic Evaluation and Clinical Outcome After Supramalleolar Osteotomy for Medial Compartment Ankle Osteoarthritis. Foot Ankle Int 2017; 38:1311-1317. [PMID: 28868922 DOI: 10.1177/1071100717728573] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the clinical and radiologic outcomes of medial compartment ankle osteoarthritis after supramalleolar osteotomy (SMO) without the bone marrow stimulation procedure and confirm cartilage recovery by second-look arthroscopy. METHODS Twenty-two ankles that were followed for more than 1 year after SMO were retrospectively reviewed. Visual analog scale pain scores and American Orthopaedic Foot & Ankle Society ankle-hindfoot scores were used for functional evaluations. The tibial anterior surface angle and tibial lateral surface angle were measured on radiographs, and ankle osteoarthritis was classified by Takakura stage. Among the 22 patients, 21 underwent ankle arthroscopy prior to SMO, and second-look arthroscopy was performed in 16 patients 1 year postoperatively. Tibiotalar cartilage regeneration was evaluated according to the modified Outerbridge classification for the 14 patients who had undergone SMO without the bone marrow stimulation procedure. RESULTS The mean visual analog scale and American Orthopaedic Foot & Ankle Society scores significantly improved from 6.5 preoperatively to 1.1 postoperatively and from 60.7 preoperatively to 87.1 postoperatively, respectively ( P < .05). The mean tibial anterior surface and tibial lateral surface angles significantly improved from 83.5° and 76.9° preoperatively to 93.8° and 80.2° postoperatively, respectively ( P < .05). All preoperative Takakura stage IIIa cases and IIIb case improved to postoperative stage II. On second-look arthroscopy, cartilage regeneration of the medial compartment of the tibiotalar joint was observed in 12 of 14 patients (85%), whereas cartilage deterioration was not observed in any patient. CONCLUSIONS SMO without the bone marrow stimulation procedure for medial ankle osteoarthritis demonstrated cartilage regeneration in the medial tibiotalar joint in most patients by second-look arthroscopy, as well as satisfactory clinical and radiologic outcomes. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Hong-Geun Jung
- 1 Department of Orthopedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Dong-Oh Lee
- 2 Department of Orthopaedic Surgery, Myun-Ji Hospital, Konkuk University School of Medicine, Deokyang-gu, Goyang-si, Kyunggi-do, Republic of Korea
| | - Sang-Hun Lee
- 1 Department of Orthopedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Joon-Sang Eom
- 1 Department of Orthopedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea
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Abstract
Various types of re-alignment surgery are used to preserve the ankle joint in cases of intermediate ankle arthritis with partial joint space narrowing.The short-term and mid-term results after re-alignment surgery are promising, with substantial post-operative pain relief and functional improvement that is reflected by high rates of patient satisfaction.In this context, re-alignment surgery can preserve the joint and reduce the pathological load that acts on the affected area.Good clinical and radiological outcomes can be achieved in asymmetrical ankle osteoarthritis by understanding the specific deformities and appropriate indications for different surgical techniques. Cite this article: EFORT Open Rev 2017;2:324-331. DOI: 10.1302/2058-5241.2.160021.
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Affiliation(s)
- Young Yi
- Department of Orthopaedic Surgery, Inje University, Seoul Paik Hospital, 85, 2-ga, Jeo-dong, Jung-gu, Seoul, 100-032, Republic of Korea
| | - Woochun Lee
- Seoul Foot and Ankle Center, Dubalo Orthopaedic Clinic, 764-30, Bang bae dong, Seochogu, Seoul, 06554, Republic of Korea
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Zhao H, Zhang Y, Hu D, Li Y, Liang X, Liu C, Wang J. [Supramalleolar osteotomy treatment of varus ankle osteoarthritis with or without fibular osteotomy]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2017; 31:284-289. [PMID: 29806255 DOI: 10.7507/1002-1892.201611110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To compare the functional and radiological outcomes of supramalleolar osteotomy (SMOT) between with and without fibular osteotomy for varus ankle osteoarthritis. Methods Between April 2009 and April 2014, 41 patients (41 feet) with mid-staged varus ankle osteoarthritis were treated with SMOT. Fibular osteotomy was not performed in 19 cases (group A), and fibular osteotomy was performed in 22 cases (group B). There was no significant difference in gender, age, side, body mass index, osteoarthritis stage, pathogeny, American Orthopedic Foot and Ankle Society (AOFAS) ankle-hind score, ankle osteoarthritis scale (AOS) pain and function scores, range of motion (ROM) of the ankle joint, tibial articular surface angle (TAS), talar tilt angle (TT), tibiocrural angle (TC), and tibial lateral surface angle (TLS) between 2 groups ( P>0.05). The bone union was observed after operation, and functional and radiological outcomes were compared between 2 groups at last follow-up. Results All incisions healed by stage I, and no surgery related complications occurred. The mean follow-up time was 36.6 months (range, 16-55 months). Pain and limited activity were observed in 1 case of groups A and B respectively, and ankle arthrodesis was performed. All cases achieved bony union; the bone union time was (3.6±0.4) months in group A and (3.9±0.7) months in group B, showing no significant difference ( t=1.61, P=0.12). At last follow-up, no significant difference was found in TAS, TLS, TT, and TC between groups ( P>0.05). However, group B was significantly better than group A in improvement of TT and TC ( P<0.05). The AOFAS ankle-hind score, AOS pain and function scores, ROM of the ankle joint showed no significant difference between groups ( P>0.05). According to the modified Takakura stage, the improvement rates of groups A and B were 55.6% and 57.1%, respectively; no significant difference was found between 2 groups ( χ2=0.01, P=0.92). Conclusion SMOT with fibular osteotomy is helpful in correction of TT and TC in patients with relative longer fibula.
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Affiliation(s)
- Hongmou Zhao
- Department of Foot and Ankle Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an Shaanxi, 710054, P.R.China
| | - Yan Zhang
- Department of Foot and Ankle Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an Shaanxi, 710054, P.R.China
| | - Dong Hu
- Department of Foot and Ankle Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an Shaanxi, 710054, P.R.China
| | - Yi Li
- Department of Foot and Ankle Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an Shaanxi, 710054, P.R.China
| | - Xiaojun Liang
- Department of Foot and Ankle Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an Shaanxi, 710054,
| | - Cheng Liu
- Department of Foot and Ankle Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an Shaanxi, 710054, P.R.China
| | - Junhu Wang
- Department of Foot and Ankle Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an Shaanxi, 710054, P.R.China
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Affiliation(s)
- Markus Knupp
- 1 Department of Orthopaedic Surgery, Kantonsspital Baselland, Switzerland
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Zhao H, Liang X, Li Y, Yu G, Niu W, Zhang Y. The role of fibular for supramalleolar osteotomy in treatment of varus ankle arthritis: a biomechanical and clinical study. J Orthop Surg Res 2016; 11:127. [PMID: 27776517 PMCID: PMC5078953 DOI: 10.1186/s13018-016-0462-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 09/28/2016] [Indexed: 12/18/2022] Open
Abstract
Background Supramalleolar osteotomy (SMOT) is a well-accepted treatment method for mid-stage varus ankle osteoarthritis (OA). However, few studies have examined the role of fibular osteotomy in SMOT. The objective of the current study was to compare the biomechanical and clinical outcomes of SMOT with and without fibular osteotomy. Methods Eight cadaveric lower legs with 10° varus/valgus SMOT models were tested using a Tekscan ankle sensor. Tibiotalar joint contact with and without fibular osteotomy conditions were compared. Forty-one varus ankle OA patients treated with SMOT were included; 22 underwent fibular osteotomy, and 19 did not. The Maryland foot score and radiological angles were used for clinical evaluation. Results The mean contact area and pressure did not differ significantly between normal and varus/valgus conditions with the fibula preserved. After fibular osteotomy, the mean contact area decreased and the mean contact pressure increased significantly in varus and valgus conditions (P < 0.01). The loading center moved to the opposite direction with and without fibular osteotomy in varus/valgus conditions. After a mean follow-up of 36.6 months (range 17–61), there was no significant difference in the Maryland scores of the two groups. However, in the fibular osteotomy group, the talar tilt angle decreased (P < 0.05), and the tibiocrural angle improved significantly (P < 0.01). Conclusions Fibular osteotomy facilitates the translation of tibiotalar contact pressure and is helpful for varus ankle realignment in patients with large talar tilts and small tibiocrural angles.
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Affiliation(s)
- Hongmou Zhao
- Foot and Ankle Surgery Department, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, 710054, China
| | - Xiaojun Liang
- Foot and Ankle Surgery Department, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, 710054, China.
| | - Yi Li
- Foot and Ankle Surgery Department, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, 710054, China
| | - Guangrong Yu
- Foot and Ankle Surgery Department, Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China
| | - Wenxin Niu
- Laboratory of Biomechanics, Tongji University School of Medicine, Shanghai, 200092, China
| | - Yan Zhang
- Foot and Ankle Surgery Department, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, 710054, China
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Abstract
BACKGROUND Supramalleolar osteotomy (SMOT) is an alternative operative procedure for the management of early and midstage varus ankle arthritis. However, whether fibular osteotomy is needed is controversial. The purpose of the current study was to evaluate the functional and radiologic outcomes of pre- and postoperative SMOT, and to compare the outcomes between patients with and without fibular osteotomy. METHODS Forty-one Takakura stage 2 and 3 varus ankle osteoarthritis patients treated with SMOT were included. Fourteen males and 27 females with a mean age of 50.7 (range, 32-71) years were followed with a mean of 36.6 (range, 17-61) months. There were 22 cases with fibular osteotomy and 19 without. The American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, Maryland foot score, and Ankle Osteoarthritis Score (AOS) were used for pre- and postoperative functional evaluation. The tibial articular surface angle (TAS), talar tilt (TT), tibiocrural angle (TC), and tibial lateral surface angle (TLS) were evaluated pre- and postoperatively. RESULTS At the last follow-up, the mean AOFAS score (from 50.8 to 83.1 points) and Maryland score (from 58.3 to 81.6 points) in overall were improved (P < .01); the mean AOS pain (from 42.6 to 26.1 points) and function (from 53.4 to 36.8 points) scores were decreased (P < .01). For radiologic evaluation, all the included parameters were improved (P < .05) except TLS. The mean Takakura stage was decreased (P < .01). No significant difference could be detected in comparing the functional outcomes between those with and without fibular osteotomy. However, in the fibular osteotomy group, TT was decreased (P < .05) and TC was improved (P < .01) significantly. CONCLUSION SMOT was promising, with substantial functional improvement and malalignment correction for varus ankle arthritis. Fibular osteotomy may be necessary in cases with large TT and small TC angles. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Zhao Hongmou
- Foot and Ankle Surgery Department, Honghui Hospital, Xi'an Jiaotong University College of Medicine, China
| | - Liang Xiaojun
- Foot and Ankle Surgery Department, Honghui Hospital, Xi'an Jiaotong University College of Medicine, China
| | - Li Yi
- Foot and Ankle Surgery Department, Honghui Hospital, Xi'an Jiaotong University College of Medicine, China
| | - Liu Hongliang
- Foot and Ankle Surgery Department, Honghui Hospital, Xi'an Jiaotong University College of Medicine, China
| | - Wang Junhu
- Foot and Ankle Surgery Department, Honghui Hospital, Xi'an Jiaotong University College of Medicine, China
| | - Liu Cheng
- Foot and Ankle Surgery Department, Honghui Hospital, Xi'an Jiaotong University College of Medicine, China
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Abstract
Supramalleolar osteotomy is a joint-preserving surgical treatment for patients with asymmetric valgus or varus ankle arthritis. The primary goal of the procedure is to realign the spatial relationship between the talus and tibia and thereby normalize joint loading within the ankle. Procedures to balance the soft tissues, as well as hindfoot osteotomy and arthrodesis, may also be necessary. Clinical studies of supramalleolar osteotomy demonstrate that correction of the altered biomechanics associated with asymmetric arthritis improves functional outcomes.
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Kim YS, Youn HK, Kim BS, Choi YJ, Koh YG. Arthroscopic evaluation of persistent pain following supramalleolar osteotomy for varus ankle osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2016; 24:1860-7. [PMID: 25073945 DOI: 10.1007/s00167-014-3199-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 07/16/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE The purposes of this study were to investigate pain experienced by patients after supramalleolar osteotomy for varus ankle osteoarthritis and to analyse correlations between this pain and arthroscopic findings. METHODS Twenty-nine patients (31 ankles) who underwent arthroscopic evaluation after supramalleolar osteotomy were reviewed retrospectively. The visual analog scale (VAS) was used to assess pain, and the patients were instructed to record the time point, location, and character of the pain. The tibial-ankle surface angle, talar tilt, and tibial-lateral surface angle were measured on radiographs. RESULTS The location, time point, and character of the pain experienced by the patients changed after supramalleolar osteotomy. The mean VAS score was significantly improved after supramalleolar osteotomy at the time of the arthroscopic evaluation (P < 0.001) and improved further after the arthroscopic procedures (P = 0.026). During arthroscopy, pathologic lesions such as adhesions, synovitis, and soft-tissue impingement were identified. A significant correlation was found between adhesions and dull pain and pain at rest (P = 0.016 and P = 0.005, respectively). In addition, soft-tissue impingement in the lateral gutter was significantly correlated with dull pain, pain at rest, and clicking pain (P = 0.001, P = 0.035, and P = 0.042, respectively). No significant correlations were found between post-operative radiographic measurements and development of pathologic lesions. CONCLUSIONS With the use of arthroscopy, persistent pain experienced after supramalleolar osteotomy was found to be associated with adhesions, synovitis, and soft-tissue impingement in medial and lateral gutters of the ankle. Arthroscopy can be helpful in identifying and treating painful lesions commonly seen after supramalleolar osteotomy. An understanding of these painful lesions will help patients have more realistic expectations regarding the supramalleolar osteotomy. LEVEL OF EVIDENCE Case series study, Level IV.
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Affiliation(s)
- Yong Sang Kim
- Department of Orthopaedic Surgery, Center for Stem Cell and Arthritis Research, Yonsei Sarang Hospital, 478-3, Bangbae-dong, Seocho-gu, Seoul, Korea.
| | - Hyun Kook Youn
- Department of Orthopaedic Surgery, Bala Hospital, Daegu, Korea
| | - Bom Soo Kim
- Department of Orthopaedic Surgery, Inha University Graduate School of Medicine, Incheon, Korea
| | - Yun Jin Choi
- Department of Orthopaedic Surgery, Center for Stem Cell and Arthritis Research, Yonsei Sarang Hospital, 478-3, Bangbae-dong, Seocho-gu, Seoul, Korea
| | - Yong Gon Koh
- Department of Orthopaedic Surgery, Center for Stem Cell and Arthritis Research, Yonsei Sarang Hospital, 478-3, Bangbae-dong, Seocho-gu, Seoul, Korea
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Kim YS, Lee M, Koh YG. Additional mesenchymal stem cell injection improves the outcomes of marrow stimulation combined with supramalleolar osteotomy in varus ankle osteoarthritis: short-term clinical results with second-look arthroscopic evaluation. J Exp Orthop 2016; 3:12. [PMID: 27206975 PMCID: PMC4875581 DOI: 10.1186/s40634-016-0048-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 05/17/2016] [Indexed: 01/08/2023] Open
Abstract
Background Supramalleolar osteotomy (SMO) is reported to be an effective treatment for varus ankle osteoarthritis by redistributing the load line within the ankle joint. Mesenchymal stem cells (MSCs) have been proposed as a new treatment option for osteoarthritis on the basis of their cartilage regeneration ability. The purpose of this study was to compare the clinical, radiological, and second-look arthroscopic outcomes between MSC injection with marrow stimulation and marrow stimulation alone in patients with varus ankle osteoarthritis who have undergone SMO. Methods In this retrospective study, 62 patients (64 ankles) with varus ankle osteoarthritis underwent second-look arthroscopy at a mean of 12.8 months after arthroscopic marrow stimulation combined with SMO; 33 ankles were subjected to marrow stimulation alone (group I), and 31 were subjected to marrow stimulation with MSC injection (group II). Clinical outcome measures included a visual analog scale (VAS) for pain and the American Orthopaedic Foot and Ankle Society (AOFAS) score. Radiological outcome variables included the tibial–ankle surface (TAS), talar tilt (TT), and tibial–lateral surface (TLS) angles. In second-look arthroscopy, cartilage regeneration was evaluated using the International Cartilage Repair Society (ICRS) grade. Results The mean VAS score improved significantly from 7.2 ± 1.0 to 4.7 ± 1.4 in group I and from 7.3 ± 0.8 to 3.7 ± 1.5 in group II at the final follow-up (P < 0.001 for both groups). The mean AOFAS score also improved significantly from 61.7 ± 5.8 to 80.9 ± 6.7 in group I and from 60.6 ± 6.1 to 85.2 ± 5.1 in group II at the final follow-up (P < 0.001 for both groups). There were significant differences in the mean VAS and AOFAS scores between groups at the final follow-up (P = 0.002 and 0.010, respectively). At second-look arthroscopy, there were significant differences in ICRS grades between groups(P = 0.015 for medial aspect of the talar dome, P = 0.044 for medial aspect of the tibial plafond, and P = 0.005 for articular surface of the medial malleolus). ICRS grades were significantly correlated with clinical outcomes in both groups (all P < 0.05). Mean TAS, TT, and TLS angles improved significantly after SMO in both groups but were not significantly correlated with clinical outcomes or ICRS grade (all n.s.). Conclusions The clinical and second-look arthroscopic outcomes of MSC injection with marrow stimulation were better compared to those of marrow stimulation alone in patients with varus ankle osteoarthritis who have undergone SMO. Furthermore, the ICRS grade is significantly correlated with clinical outcome.
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Affiliation(s)
- Yong Sang Kim
- Department of Orthopaedic Surgery, Center for Stem Cell & Arthritis Research, Yonsei Sarang Hospital, 478-3, Bangbae-dong, Seocho-gu, Seoul, Korea.
| | - Moses Lee
- Department of Orthopaedic Surgery, Center for Stem Cell & Arthritis Research, Yonsei Sarang Hospital, 478-3, Bangbae-dong, Seocho-gu, Seoul, Korea
| | - Yong Gon Koh
- Department of Orthopaedic Surgery, Center for Stem Cell & Arthritis Research, Yonsei Sarang Hospital, 478-3, Bangbae-dong, Seocho-gu, Seoul, Korea
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Kim YS, Kim BS, Koh YG, Lee JW. Efficacy of multimodal drug injection after supramalleolar osteotomy for varus ankle osteoarthritis: A prospective randomized study. J Orthop Sci 2016; 21:316-22. [PMID: 26926419 DOI: 10.1016/j.jos.2016.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 01/06/2016] [Accepted: 02/01/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Optimal management of postoperative pain is important to ensure patient comfort and functional improvement. Despite the frequent use of multimodal drug injection for pain control after orthopedic surgery, few studies have evaluated its use after supramalleolar osteotomy. METHODS Supramalleolar osteotomy was performed in 62 patients (65 ankles). Thirty patients (31 ankles) were randomly assigned to receive multimodal drug injection (injection group) and 32 patients (34 ankles) were assigned to receive no multimodal drug injection (control group). The two groups were compared with regard to the degree of postoperative pain, the number of times patients pushed the patient-controlled analgesia (PCA) button, the total amount of fentanyl administered, and the frequency of additional diclofenac sodium injections. RESULTS The injection group had significant pain reduction during the first 36 postoperative hours compared to the control group. There were significant differences between the groups in the number of times that patients pushed the PCA button as well as the total amount of fentanyl administered up to 24 h postoperatively. The mean frequency of additional diclofenac sodium injections in the first 12 postoperative hours was significantly less in the injection group compared to that in the control group. CONCLUSION Multimodal drug injection was effective in reducing pain and decreasing both fentanyl and diclofenac sodium usage in patients undergoing supramalleolar osteotomy. Therefore, multimodal drug injection should be considered for improved pain control and patient comfort in the early postoperative period after supramalleolar osteotomy.
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Affiliation(s)
- Yong Sang Kim
- Department of Orthopaedic Surgery, Yonsei Sarang Hospital, 478-3, Bangbae-dong, Seocho-gu, Seoul 137-060, Republic of Korea.
| | - Bom Soo Kim
- Department of Orthopaedic Surgery, Inha University Graduate School of Medicine, 27, Inhang-ro, Jung-gu, Incheon 400-711, Republic of Korea
| | - Yong Gon Koh
- Department of Orthopaedic Surgery, Yonsei Sarang Hospital, 478-3, Bangbae-dong, Seocho-gu, Seoul 137-060, Republic of Korea
| | - Jin Woo Lee
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea
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Abstract
Supramalleolar osteotomies of the tibia (SMOT) for posttraumatic distal tibial malalignment has shown to reduce pain, improve function and radiographic signs of osteoarthritis, and delay ankle arthrodesis or total joint replacement. The procedure also protects the articular cartilage from further degenerative processes by shifting and redistributing loads in the ankle joint. It is technically demanding and requires extensive preoperative planning. The type of osteotomy (opening vs closing wedge) does not influence the final outcome. However, based on the limited evidence, a grade I treatment recommendation has been given for supramalleolar osteotomies of the tibia to treat mild to moderate ankle arthritis in the presence of distal tibial malalignment.
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Affiliation(s)
- Fabian Krause
- Department of Orthopaedic Surgery, Inselspital, University of Berne, Freiburgstrasse, Berne 3010, Switzerland.
| | - Andrea Veljkovic
- University of Health Network, 1000-1200 Burrard Street, Vancouver, British Columbia V6Z2C7, Canada
| | - Timo Schmid
- Department of Orthopaedic Surgery, Inselspital, University of Berne, Freiburgstrasse, Berne 3010, Switzerland
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Santos ALG, Demange MK, Prado MP, Fernandes TD, Giglio PN, Hintermann B. Cartilage lesions and ankle osteoarthrosis: review of the literature and treatment algorithm. Rev Bras Ortop 2015; 49:565-72. [PMID: 26229863 PMCID: PMC4487502 DOI: 10.1016/j.rboe.2014.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 10/21/2013] [Indexed: 12/11/2022] Open
Abstract
The main etiology of ankle osteoarthrosis is post-traumatic and its prevalence is highest among young individuals. Thus, this disease has a great socioeconomic impact and gives rise to significant losses of patients’ quality of life. The objective of its treatment is to eliminate pain and keep patients active. Therefore, the treatment should be staged according to the degree of degenerative evolution, etiology, joint location, systemic condition, bone quality, lower-limb alignment, ligament stability and age. The treatment algorithm is divided into non-surgical therapeutic methods and options for surgical treatment. Joint preservation, joint replacement and arthrodesis surgical procedures have precise indications. This article presents a review on this topic and a proposal for a treatment algorithm for this disease.
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Affiliation(s)
- Alexandre Leme Godoy Santos
- Institute of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), São Paulo, SP, Brazil
| | - Marco Kawamura Demange
- Institute of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), São Paulo, SP, Brazil
| | - Marcelo Pires Prado
- Orthopedics and Rehabilitation Center, Hospital do Coração, São Paulo, SP, Brazil
| | - Tulio Diniz Fernandes
- Institute of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), São Paulo, SP, Brazil
| | - Pedro Nogueira Giglio
- Institute of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), São Paulo, SP, Brazil
| | - Beat Hintermann
- Department of Orthopedics, Kantonsspital, Liestal, Switzerland
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Abstract
Supramalleolar osteotomies are a surgical treatment option for asymmetric varus or valgus ankle arthritis where at least 50% of the joint surface is spared. Procedure selection requires significant preoperative planning for appropriate execution. Thus, the surgeon must be familiar with the principles of deformity correction. With appropriate patient selection and proper preoperative planning, the procedure has been shown to yield excellent results, redistributing forces more evenly across the ankle joint by restoring the mechanical axis of the lower leg with minimal complications.
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Affiliation(s)
- Jennifer L Mulhern
- Foot and Ankle Department, Coordinated Health, 2775 Schoenersville Road, Bethlehem, PA 18017, USA
| | - Nicole M Protzman
- Clinical Education and Research Department, Coordinated Health, 3435 Winchester Road, Allentown, PA 18104, USA
| | - Stephen A Brigido
- Foot and Ankle Department, Coordinated Health, 2775 Schoenersville Road, Bethlehem, PA 18017, USA.
| | - Premjit Pete S Deol
- Orthopaedics Department, Panorama Orthopedics & Spine Center, 660 Golden Ridge Road, Suite 250, Golden, CO 80401, USA
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40
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Abstract
Introduction A patient with medial ankle osteoarthritis and a widened ankle mortise can be treated successfully with an oblique distal tibial osteotomy, without fibular osteotomy, to narrow the mortise and shift the weight-bearing axis to a more normal position. Step 1: Patient Positioning and Preoperative Assessment With the patient under spinal or general anesthesia, check for mortise widening with a valgus stress test. Step 2: Surgical Approach Expose the ankle joint through an anterior approach. Step 3: Corrective Osteotomy Perform an oblique osteotomy of the distal part of the tibia and narrow the widened mortise by shifting the osteotomized fragment. Step 4: Fixation and Bone-Grafting Stabilize the osteotomy site with a locking plate and apply bone graft to the osteotomy site. Step 5: Closure Close the soft tissue in layers. Results Eighteen patients (fifteen female and three male; mean age, fifty-seven years) with symptomatic medial ankle osteoarthritis and mortise widening underwent distal tibial oblique osteotomy without fibular osteotomy between 2008 and 2011. Indications Contraindications Pitfalls & Challenges
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Affiliation(s)
- Tae-Keun Ahn
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam 463-712, South Korea. E-mail address:
| | - Young Yi
- Department of Orthopaedic Surgery, Seoul Foot and Ankle Center, Seoul Paik Hospital, Inje University, 85, 2-ga, Jeo-dong, Jung-gu, Seoul 100-032, South Korea. E-mail address for Y. Yi: . E-mail address for J.-H. Cho: . E-mail address for W.-C. Lee:
| | - Jae-Ho Cho
- Department of Orthopaedic Surgery, Seoul Foot and Ankle Center, Seoul Paik Hospital, Inje University, 85, 2-ga, Jeo-dong, Jung-gu, Seoul 100-032, South Korea. E-mail address for Y. Yi: . E-mail address for J.-H. Cho: . E-mail address for W.-C. Lee:
| | - Woo-Chun Lee
- Department of Orthopaedic Surgery, Seoul Foot and Ankle Center, Seoul Paik Hospital, Inje University, 85, 2-ga, Jeo-dong, Jung-gu, Seoul 100-032, South Korea. E-mail address for Y. Yi: . E-mail address for J.-H. Cho: . E-mail address for W.-C. Lee:
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Haraguchi N, Ota K, Tsunoda N, Seike K, Kanetake Y, Tsutaya A. Weight-bearing-line analysis in supramalleolar osteotomy for varus-type osteoarthritis of the ankle. J Bone Joint Surg Am 2015; 97:333-9. [PMID: 25695986 DOI: 10.2106/jbjs.m.01327] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND We determined the preoperative and postoperative passing points of the mechanical axis of the lower limb at the level of the tibial plafond using a new method involving a full-length standing posteroanterior radiograph that includes the calcaneus (a hip-to-calcaneus radiograph) and correlated them to the clinical results after supramalleolar osteotomy for ankle osteoarthritis. METHODS We reviewed the hip-to-calcaneus radiographs of fifty lower limbs of forty-one patients treated for lower limb malalignment at our institution. The mechanical axis point of the ankle was the point at which the mechanical axis divides the coronal length of the plafond, expressed as a percentage. Four independent observers performed all measurements twice. Supramalleolar tibial osteotomy was performed in twenty-seven ankles (twenty-four patients) to treat moderate varus-type osteoarthritis of the ankle. The mean follow-up period was 2.8 years (range, two to 5.3 years). Clinical assessment was based on the American Orthopaedic Foot & Ankle Society (AOFAS) scale. RESULTS Interobserver and intraobserver reliability in identifying the mechanical ankle joint axis point were very high. The mean postoperative mechanical axis point was 50% (range, 13% to 70%) in ankles for which the preoperative point was ≤0%, whereas the mean postoperative point was 81% (range, 48% to 113%) in ankles for which the preoperative point was >0%. The mean change in AOFAS score was significantly less for patients with a preoperative point of ≤0% than for those with a preoperative point of >0% (p=0.004). Improvement was significantly greater in ankles with a postoperative mechanical ankle joint axis point of ≥80% than in ankles with a postoperative mechanical ankle joint axis point of <60% (p=0.030). CONCLUSIONS Traditional tibial correction resulted in great variation in the locations of the postoperative mechanical ankle joint axis point. In ankles with the preoperative point more medial than the tibial plafond, the point was insufficiently moved to the lateral side, and the clinical outcomes were less satisfactory.
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Affiliation(s)
- Naoki Haraguchi
- Departments of Orthopaedic Surgery (N.H., K.O., N.T., and K.S.) and Radiology (Y.K. and A.T.), Tokyo Metropolitan Police Hospital, 4-22-1 Nakano, Nakanoku, Tokyo 164-8541, Japan. E-mail address for N. Haraguchi:
| | - Koki Ota
- Departments of Orthopaedic Surgery (N.H., K.O., N.T., and K.S.) and Radiology (Y.K. and A.T.), Tokyo Metropolitan Police Hospital, 4-22-1 Nakano, Nakanoku, Tokyo 164-8541, Japan. E-mail address for N. Haraguchi:
| | - Naoya Tsunoda
- Departments of Orthopaedic Surgery (N.H., K.O., N.T., and K.S.) and Radiology (Y.K. and A.T.), Tokyo Metropolitan Police Hospital, 4-22-1 Nakano, Nakanoku, Tokyo 164-8541, Japan. E-mail address for N. Haraguchi:
| | - Koji Seike
- Departments of Orthopaedic Surgery (N.H., K.O., N.T., and K.S.) and Radiology (Y.K. and A.T.), Tokyo Metropolitan Police Hospital, 4-22-1 Nakano, Nakanoku, Tokyo 164-8541, Japan. E-mail address for N. Haraguchi:
| | - Yoshihiko Kanetake
- Departments of Orthopaedic Surgery (N.H., K.O., N.T., and K.S.) and Radiology (Y.K. and A.T.), Tokyo Metropolitan Police Hospital, 4-22-1 Nakano, Nakanoku, Tokyo 164-8541, Japan. E-mail address for N. Haraguchi:
| | - Atsushi Tsutaya
- Departments of Orthopaedic Surgery (N.H., K.O., N.T., and K.S.) and Radiology (Y.K. and A.T.), Tokyo Metropolitan Police Hospital, 4-22-1 Nakano, Nakanoku, Tokyo 164-8541, Japan. E-mail address for N. Haraguchi:
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Santos ALG, Demange MK, Prado MP, Fernandes TD, Giglio PN, Hintermann B. Lesão de cartilagem e osteoartrose do tornozelo: revisão da literatura e algoritmo de tratamento. Rev Bras Ortop 2014; 49:565-72. [DOI: 10.1016/j.rbo.2013.10.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Abstract
A variety of surgical procedures are utilized for management of ankle osteoarthritis. The most common etiology in patients with ankle osteoarthritis is post-traumatic often resulting in asymmetric ankle osteoarthritis with concomitant valgus or varus deformity. A substantial part of tibiotalar joint is often preserved, therefore, in appropriate patients, joint-preserving surgery holds the potential to be a superior treatment option than joint-sacrificing procedures including total ankle replacement or ankle arthrodesis. This review is designed to describe indications and contraindications for single-stage supramalleolar realignment surgery. Complications associated with this type of surgery and postoperative outcome are highlighted using recent literature.
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Affiliation(s)
- Alexej Barg
- Head Foot and Ankle Surgery, Department of Orthopedic Surgery, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland,
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Kim YS, Park EH, Koh YG, Lee JW. Supramalleolar Osteotomy With Bone Marrow Stimulation for Varus Ankle Osteoarthritis: Clinical Results and Second-Look Arthroscopic Evaluation. Am J Sports Med 2014; 42:1558-66. [PMID: 24769408 DOI: 10.1177/0363546514530669] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Supramalleolar osteotomy (SMO), which redistributes the load line within the ankle joint, has been reported as an effective treatment for varus ankle osteoarthritis. However, no study has examined cartilage regeneration in the medial compartment of the ankle after SMO. HYPOTHESIS/PURPOSE This study aimed to investigate the clinical and radiological outcomes of SMO and to identify the association between the outcomes of SMO and cartilage regeneration evaluated by second-look arthroscopy. The hypothesis was that cartilage regeneration would be an important predictor of the outcomes of SMO and that arthroscopic marrow stimulation would aid in cartilage regeneration. STUDY DESIGN Case series; Level of evidence, 4. METHODS A total of 31 ankles were retrospectively evaluated after arthroscopic marrow stimulation with SMO for varus ankle osteoarthritis; second-look arthroscopy was conducted for all these ankles. Clinical outcome measures included a visual analog scale (VAS) for pain and the American Orthopaedic Foot and Ankle Society (AOFAS) score. Radiological outcome variables included the tibial-ankle surface angle (TAS), talar tilt (TT), and tibial-lateral surface angle (TLS), and progression of degenerative arthritis of the ankle was assessed. In the second-look arthroscopy, cartilage regeneration was evaluated using the International Cartilage Repair Society (ICRS) grade. RESULTS The mean ± standard deviation VAS and AOFAS scores were 7.1 ± 0.8 and 62.9 ± 4.0 preoperatively, and they significantly improved to 3.4 ± 1.3 and 83.1 ± 7.5, respectively (P < .001, for both) at the time of the second-look arthroscopy (mean, 13.2 months postoperatively). However, at final follow-up (mean, 27.4 months postoperatively), they were significantly decreased to 4.1 ± 1.6 and 79.9 ± 8.0, respectively, compared with the values at second-look arthroscopy (P < .001, for both). The mean TAS, TT, and TLS improved significantly after SMO but showed no significant correlation with the clinical outcomes and ICRS grade (P > .05 for all three). At second-look arthroscopy, the ICRS overall repair grades were normal in 1 (3%), nearly normal in 7 (23%), abnormal in 13 (42%), and severely abnormal in 10 (32%). Progressive degenerative arthritis was observed in 13 cases (42%). The ICRS grade was significantly associated with the clinical outcomes (P < .0001) and development of degenerative arthritis of the ankle joint (P = .002). CONCLUSION This study showed improved clinical outcomes after SMO for varus ankle osteoarthritis in comparison to the preoperative assessments. Furthermore, the ICRS grade was significantly associated with the clinical outcomes of SMO at final follow-up and significantly associated with the development of degenerative arthritis of the ankle joint. Therefore, arthroscopic marrow stimulation should be considered with SMO to ensure adequate cartilage regeneration. However, given the ICRS grades observed at the time of the second-look arthroscopies and the progression of degenerative arthritis in 42%, the long-term prognosis in this group of patients is uncertain.
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Affiliation(s)
- Yong Sang Kim
- Center for Stem Cell & Arthritis Research, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, Korea
| | - Eui Hyun Park
- Department of Orthopaedic Surgery, Yonsei Altair Hospital, Seoul, Korea
| | - Yong Gon Koh
- Center for Stem Cell & Arthritis Research, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, Korea
| | - Jin Woo Lee
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
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Barg A, Pagenstert GI, Horisberger M, Paul J, Gloyer M, Henninger HB, Valderrabano V. Supramalleolar osteotomies for degenerative joint disease of the ankle joint: indication, technique and results. Int Orthop 2014; 37:1683-95. [PMID: 23959222 DOI: 10.1007/s00264-013-2030-2] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Accepted: 07/09/2013] [Indexed: 01/24/2023]
Abstract
Patients with varus or valgus hindfoot deformities usually present with asymmetric ankle osteoarthritis. In-vitro biomechanical studies have shown that varus or valgus hindfoot deformity may lead to altered load distribution in the tibiotalar joint which may result in medial (varus) or lateral (valgus) tibiotalar joint degeneration in the short or medium term. The treatment of asymmetric ankle osteoarthritis remains challenging, because more than half of the tibiotalar joint surface is usually preserved. Therefore, joint-sacrificing procedures like total ankle replacement or ankle arthrodesis may not be the most appropriate treatment options. The shortand midterm results following realignment surgery, are very promising with substantial pain relief and functional improvement observed post-operatively. In this review article we describe the indications, surgical techniques, and results from of realignment surgery of the ankle joint in the current literature.
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Affiliation(s)
- Alexej Barg
- Orthopaedic Department, University Hospital of Basel, University of Basel, Switzerland
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47
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Abstract
More than half of the patients with ankle osteoarthritis have a malalignment of the hindfoot. These patients might benefit from joint-preserving realignment surgery. This article provides an overview of the effects of asymmetric ankle osteoarthritis on the patients' biomechanical and neuromuscular gait patterns in comparison to data from healthy subjects. Furthermore, data from gait analyses after joint-preserving realignment surgery are presented that give an indication of the biomechanical and neuromuscular adaptations to supramalleolar osteotomies.
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Affiliation(s)
- Corina Nüesch
- Osteoarthritis Research Center, University Hospital of Basel, University of Basel, Spitalstrasse 21, Basel 4031, Switzerland.
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48
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Abstract
Osteoarthritis (OA) is defined as the syndrome of joint pain and dysfunction caused by substantial joint degeneration. In general, OA is the most common joint disease and is one of the most frequent and symptomatic health problems for middle-aged and older people: OA disables more than 10% of people who are older than 60 years. This article reviews the etiology of ankle OA, and describes the onset and development of posttraumatic ankle OA, the most common form of OA in the tibiotalar joint. Various methods of clinical and radiographic assessment are described in detail.
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Affiliation(s)
- Alexej Barg
- Orthopaedic Department, Osteoarthritis Research Center Basel, University Hospital of Basel, University of Basel, Spitalstrasse 21, Basel CH-4031, Switzerland.
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Schmid T, Zurbriggen S, Zderic I, Gueorguiev B, Weber M, Krause FG. Ankle joint pressure changes in a pes cavovarus model: supramalleolar valgus osteotomy versus lateralizing calcaneal osteotomy. Foot Ankle Int 2013; 34:1190-7. [PMID: 23897971 DOI: 10.1177/1071100713500473] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND A fixed cavovarus foot deformity can be associated with anteromedial ankle arthrosis due to elevated medial joint contact stresses. Supramalleolar valgus osteotomies (SMOT) and lateralizing calcaneal osteotomies (LCOT) are commonly used to treat symptoms by redistributing joint contact forces. In a cavovarus model, the effects of SMOT and LCOT on the lateralization of the center of force (COF) and reduction of the peak pressure in the ankle joint were compared. METHODS A previously published cavovarus model with fixed hindfoot varus was simulated in 10 cadaver specimens. Closing wedge supramalleolar valgus osteotomies 3 cm above the ankle joint level (6 and 11 degrees) and lateral sliding calcaneal osteotomies (5 and 10 mm displacement) were analyzed at 300 N axial static load (half body weight). The COF migration and peak pressure decrease in the ankle were recorded using high-resolution TekScan pressure sensors. RESULTS A significant lateral COF shift was observed for each osteotomy: 2.1 mm for the 6 degrees (P = .014) and 2.3 mm for the 11 degrees SMOT (P = .010). The 5 mm LCOT led to a lateral shift of 2.0 mm (P = .042) and the 10 mm LCOT to a shift of 3.0 mm (P = .006). Comparing the different osteotomies among themselves no significant differences were recorded. No significant anteroposterior COF shift was seen. A significant peak pressure reduction was recorded for each osteotomy: The SMOT led to a reduction of 29% (P = .033) for the 6 degrees and 47% (P = .003) for the 11 degrees osteotomy, and the LCOT to a reduction of 41% (P = .003) for the 5 mm and 49% (P = .002) for the 10 mm osteotomy. Similar to the COF lateralization no significant differences between the osteotomies were seen. CONCLUSION LCOT and SMOT significantly reduced anteromedial ankle joint contact stresses in this cavovarus model. The unloading effects of both osteotomies were equivalent. More correction did not lead to significantly more lateralization of the COF or more reduction of peak pressure but a trend was seen. CLINICAL RELEVANCE In patients with fixed cavovarus feet, both SMOT and LCOT provided equally good redistribution of elevated ankle joint contact forces. Increasing the amount of displacement did not seem to equally improve the joint pressures. The site of osteotomy could therefore be chosen on the basis of surgeon's preference, simplicity, or local factors in case of more complex reconstructions.
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Affiliation(s)
- Timo Schmid
- Inselspital, University of Berne, Berne, Switzerland
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50
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Abstract
A varus or valgus talar tilt that increases under weight-bearing is commonly seen in osteoarthritic ankles. Loss of peritalar stability may be the underlying cause for the talus shifting and rotating on the calcaneonavicular surfaces, as given by applied forces. The instability pattern and the resulting deformity can be assessed and classified using weight-bearing conventional radiographs. Appropriate osseous balancing may be the most appropriate treatment to restore a regular position of talus within the ankle mortise. In cases with severe peritalar instability, subtalar fusion may be advised. Soft tissue reconstruction may be needed to achieve physiologic balance of the hindfoot complex.
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