scholarly journals Minimum Distraction Gap: How Much Ankle Joint Space Is Enough in Ankle Distraction Arthroplasty?

2013 ◽  
Vol 10 (1) ◽  
pp. 6-12 ◽  
Author(s):  
Austin T. Fragomen ◽  
Thomas H. McCoy ◽  
Kathleen N. Meyers ◽  
S. Robert Rozbruch
Keyword(s):  
Ankle Joint ◽  
Joint Space ◽  
Distraction Arthroplasty

scholarly journals Functional Analysis of Distraction Arthroplasty in the Treatment of Ankle Osteoarthritis

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0049
Author(s):  
Liang Xiaojun ◽  
Zhao Hong-Mou
Keyword(s):  
Ankle Joint ◽  
Failure Rate ◽  
Functional Outcomes ◽  
Joint Space ◽  
Ankle Osteoarthritis ◽  
Distraction Arthroplasty ◽  
Significant Difference ◽  
And Gender ◽  
American Orthopaedic ◽  
Relative Factors

Category: Ankle Arthritis Introduction/Purpose: Ankle joint distraction arthroplasty (AJDA) is an alternative surgical procedure for the management of moderate to severe ankle osteoarthritis. However, the benefit of this procedure and failure relative factors are still in debate. The purpose of current study was to evaluate the functional outcomes of AJDA in treatment of moderate to severe ankle OA; and to evaluate the relative factors correlated with treatment failure. Methods: Forty-six van Dijk stage II and III ankle osteoarthritis patients were included. Fifteen males and 31 females with a mean age of 54.8 (range, 42-71) years were followed with a mean of 42.8 (range, 24-68) months. The Ankle Osteoarthritis Scale (AOS) and American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score were used for functional outcomes evaluation. The talar tilt (TT) angle and ankle joint space distance (AJSD) were evaluated. The risk ratio (RR) was calculated for each potential failure relative factor. Results: The AOS and AOFAS scores were significantly improved at the last followup time (P＜0.01). The AJSD was improved in 61% of patients, and with a significant improvement compared with the preoperative conditions (P＜0.01). The TT angle and range of motion reached no significant difference. The failure rate was 21.7%. Patients with large TT (>=5°) angle (RR=3.81, 95%CI: 1.28-11.33, P=0.02) and obesity (RR=3.58, 95%CI: 1.30-9.89, P=0.01) were found have positive correlation with failure. No correlation was found between failure and gender, or overweight, or side, or age, or type and stage of OA, or pin infection. Conclusion: Current study confirmed the early functional outcomes of ankle distraction arthroplasty. However, this procedure still has a relatively high failure rate, especially for those obesity patients and the patients with large TT angles.

Effect of Microfracture on Functional Outcomes and Subchondral Sclerosis Following Distraction Arthroplasty of the Ankle Joint

2020 ◽  
Vol 41 (6) ◽  
pp. 631-638
Author(s):  
Arianna L. Gianakos ◽  
R. Sterling Haring ◽  
Yoshiharu Shimozono ◽  
Austin Fragomen ◽  
John G. Kennedy
Keyword(s):  
Ankle Joint ◽  
Demographic Data ◽  
Joint Space ◽  
Ankle Arthrodesis ◽  
Activity Levels ◽  
Level Of Evidence ◽  
Distraction Arthroplasty ◽  
Concentrated Bone Marrow ◽  
Post Traumatic ◽  
End Stage

Background: Treatment for post-traumatic osteoarthritis (PTOA) of the ankle remains challenging. Distraction arthroplasty (DA) is an alternative for patients who are averse to or poor candidates for arthrodesis or joint replacement. The purpose of this study was to examine the role of microfracture (MFX) and concentrated bone marrow aspirate (CBMA) on the outcome of patients undergoing DA for end-stage PTOA of the ankle joint. Methods: Ninety-five patients who underwent DA for the treatment of end stage PTOA from 2009 to 2014 were selected from the hospital ankle registry. Demographic data, functional activity levels, complications, and radiographs taken at 6, 12, 24, and 36 months postoperatively were reviewed. Foot and Ankle Outcome Scores (FAOS) were obtained at the same time intervals. A total of 78 patients were included in this study. Interventions were divided into 4 groups for comparison: DA+MFX (n = 8), DA+MFX+CBMA (n = 35), DA+CBMA (n = 22), and DA alone (n = 13). Results: Patients undergoing DA+MFX or DA+MFX+CBMA had significantly worse motion ( P = .003) when compared with DA alone. Patients undergoing MFX had significantly reduced postoperative joint space and a greater length of time to return to activity when compared to subgroups not using MFX ( P = .01). The use of MFX was associated with significantly lower FAOS scores. Conclusion: The current study showed no benefit from MFX when combined with DA in the treatment of PTOA. CBMA may have helped mitigate the adverse effect of MFX but conferred no benefit when used with DA alone. DA remains a useful alternative to ankle arthrodesis and arthroplasty in patients with PTOA. However, MFX and biologic augmentation using CBMA appeared to have no additional benefit. Level of Evidence: Level III, comparative study.

scholarly journals Clinical Outcomes of Distraction Arthroplasty with Arthroscopic Microfracture for Advanced Stage Ankle Osteoarthritis

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0022
Author(s):  
Yasunari Ikuta ◽  
Tomoyuki Nakasa ◽  
Yusuke Tsuyuguchi ◽  
Yuki Ota ◽  
Munekazu Kanemitsu ◽  
...  
Keyword(s):  
Weight Bearing ◽  
Joint Space ◽  
Ankle Arthrodesis ◽  
Younger Patients ◽  
Distraction Arthroplasty ◽  
Arthroscopic Microfracture ◽  
Initial Surgery ◽  
Distraction Device ◽  
Active Patients

Category: Ankle Arthritis, Arthroscopy Introduction/Purpose: Ankle trauma is highly implicated in the etiology of osteoarthritis (OA) of the ankle, and posttraumatic ankle OA is often observed in younger patients. In advanced stages, ankle arthrodesis has been considered as a gold standard treatment, and total ankle arthroplasty is also developed over the past decade for older patients. However, the surgical treatment of severe ankle OA for younger, active patients remains challenging. Ankle distraction arthroplasty is an alternative option for treatment of severe ankle OA in younger patients. The distraction device enables joint distraction with ankle motion that induces cartilage repair of the ankle. This study aimed to clarify the clinical outcome of the ankle distraction arthroplasty with arthroscopic microfracture for ankle OA in younger patients. Methods: This retrospective analysis included 7 ankle OA patients who underwent distraction arthroplasty with arthroscopic microfracture, in 5 men and 2 women, with a mean age of 45.9 years (range, 39-62). Range of motion (ROM) and American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score were evaluated as the clinical outcomes. The talotibial joint space was identified as anterior, center and posterior segment on lateral view. The width of joint space in each segment was measured on pre- and post-operative weight-bearing radiographs. The distraction device was removed at 3 months after initial surgery, and second look arthroscopy was also performed at the same time. The arthroscopic findings were assessed retrospectively. Results: All 7 patients were followed with a mean follow-up period of 4.2 years. One patient who had the worst preoperative AOFAS score of 19 converted to arthroscopic ankle arthrodesis at 2 years after the initial surgery. The mean total ROM and AOFAS score improved from 29.3 to 37.1 (p = 0.028), from 41.7 to 76.1 (p = 0.018), respectively. Weight-bearing radiographs showed a width of ankle joint space with anterior, center and posterior of 1.9 mm, 1.8 mm, 2.0 mm at preoperative status and 2.9 mm, 2.8 mm, 2.9 mm at final follow-up status. Second look arthroscopy revealed that the fibrous cartilage like tissue covered the cartilage defect area at the talotibial joint in all patients. Conclusion: Our findings suggest that the distraction arthroplasty with arthroscopic microfracture could be a useful option for active patients with advanced stage of ankle OA. Good clinical status and the width of joint space had been preserved for a maximum of seven years. Further follow-up was required to elucidate the long-term clinical results.

Step-Cut Osteotomy of the Medial Malleolus for Exposure of the Medial Ankle Joint Space

Foot & Ankle ◽  
1991 ◽  
Vol 11 (4) ◽  
pp. 242-243 ◽  
Author(s):  
Ian J. Alexander ◽  
J. Tracy Watson
Keyword(s):  
Ankle Joint ◽  
Joint Space ◽  
Medial Malleolus

Width of the Medial Tibiotalar Joint

1997 ◽  
Vol 38 (4) ◽  
pp. 520-522 ◽  
Author(s):  
B. Fiirgaard ◽  
J. K. Iversen ◽  
A. de Carvalho
Keyword(s):  
Healthy Volunteers ◽  
Ankle Joint ◽  
Plantar Flexion ◽  
Joint Space ◽  
Neutral Position ◽  
Tibiotalar Joint ◽  
Joint Injuries ◽  
Left Ankle

Purpose: To determine the extent to which the width of the space in the medial tibiotalar joint depends on plantar flexion. Material and Methods: Thirty healthy volunteers were studied by means of a.p. roentgenograms of the left ankle both in a neutral position and in plantar flexion. Results: The medial joint space showed significant widening (average 0.65 mm) between the neutral position and plantar flexion. Conclusion: When ankle joint injuries are studied on radiographs, the position of the foot must be taken into consideration.

Ankle Joint Distraction Arthroplasty

2013 ◽  
Vol 18 (3) ◽  
pp. 459-470 ◽  
Author(s):  
Alexej Barg ◽  
Annunziato Amendola ◽  
Douglas N. Beaman ◽  
Charles L. Saltzman
Keyword(s):  
Ankle Joint ◽  
Distraction Arthroplasty ◽  
Joint Distraction

scholarly journals Long-term effects of lateral wedge orthotics on hip and ankle joint space widths

2017 ◽  
Vol 51 ◽  
pp. 36-40
Author(s):  
Mehmet E. Tezcan ◽  
Berna Goker ◽  
Roy Lidtke ◽  
Joel A. Block
Keyword(s):  
Ankle Joint ◽  
Joint Space ◽  
Long Term Effects

Relationship Between Tibiotalar Joint Space and Ankle Function Following Ankle Surgery

2020 ◽  
pp. 107110072096249
Author(s):  
Jess Mullens ◽  
Ingrid K. Stake ◽  
Lauren M. Matheny ◽  
Blake Daney ◽  
Thomas O. Clanton
Keyword(s):  
Ankle Joint ◽  
Physical Component Summary ◽  
Short Form ◽  
Joint Space ◽  
Ankle Arthrodesis ◽  
Level Of Evidence ◽  
Joint Preserving Surgery ◽  
Ankle Surgery ◽  
Ankle Function

Background: Joint-preserving procedures of the ankle may postpone the need for ankle arthrodesis (AA) or total ankle replacement (TAR). The challenge for the surgeon is to determine which patients may benefit from these joint-preserving procedures. We hypothesized that patents with less than 2 mm of ankle joint space on preoperative radiographs would report inferior outcomes following joint-preserving surgery compared with those with 2 mm or greater joint space. Methods: Patients 18 years of age or older treated with joint-preserving ankle surgery with a minimum of 2 years of follow-up were considered for study inclusion. The ankle joint space was measured on standardized weightbearing preoperative radiographs. At follow-up, patients completed questionnaires including the Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL) and Sports subscales, the Short Form-12 (SF-12) Physical Component Summary and Mental Component Summary, the Tegner Activity Scale, and satisfaction with outcome. Results: A total of 251 patients were included in the study. Forty-three patients had an ankle joint space of less than 2 mm. Compared with the 208 patients with an ankle joint space of 2 mm or greater, they had inferior FAAM ADL, FAAM Sports, and SF-12 Physical Component Summary scores ( P = .001, P = .001, and P = .006, respectively). Additionally, a statistically significant positive correlation between joint space distance and the FAAM ADL ( P = .012, r = 0.158), FAAM Sports ( P < .001, r = 0.301), and SF-12 Physical Component Summary ( P < .010, r = 0.163) scores was found. Conclusion: Patients with a preoperatively narrowed ankle joint space of less than 2 mm had significantly lower outcome scores following joint-preserving ankle surgery compared with patients with preserved ankle joint space. These results may assist clinicians in selecting patients who may benefit from ankle joint–preserving procedures, as well as counseling patients with a narrowed ankle joint space regarding expected outcome after joint-preserving ankle surgery. Level of Evidence: Level II, prognostic comparative study.

scholarly journals Effectiveness of distal tibial osteotomy with distraction arthroplasty in varus ankle osteoarthritis

2019 ◽  
Author(s):  
Koji Nozaka ◽  
Naohisa Miyakoshi ◽  
Takeshi Kashiwagura ◽  
Yuji Kasukawa ◽  
Hidetomo Saito ◽  
...  
Keyword(s):  
Ankle Joint ◽  
External Fixator ◽  
Weight Bearing ◽  
Tibial Osteotomy ◽  
Ankle Arthritis ◽  
Ankle Osteoarthritis ◽  
Distraction Arthroplasty ◽  
Circular External Fixator ◽  
Joint Distraction ◽  
Tibiotalar Arthrodesis

Abstract Background: Advanced to end-stage ankle osteoarthritis in highly active older individuals has traditionally been treated using tibiotalar arthrodesis. With tibiotalar arthrodesis, high levels of pain-free function are possible; however, there is a loss of ankle joint movement and a risk of future arthrosis in the adjacent joints. Distraction arthroplasty is a simple method that allows joint cartilage repair; however, the results are currently mixed, with some reports showing improved pain scores and others showing no improvement. Distal tibial osteotomy (DTO) without fibular osteotomy, a type of joint preservation surgery, has garnered attention in recent years. However, to our knowledge, there are no reports on DTO with joint distraction using a circular external fixator. Therefore, the purpose of this study was to examine the effect of DTO with joint distraction using a circular external fixator on ankle osteoarthritis. Methods: A total of 21 patients with medial ankle arthritis were examined. Arthroscopic synovectomy and a microfracture procedure were performed. Subsequently, angled osteotomy and correction of the distal tibia were performed. After ankle conditions improved, stabilization of the ankle joint was performed. An external fixator was used in all patients. In addition, joint distraction of about 5.8 mm was performed. All patients were allowed full weight-bearing walking immediately after surgery. Results: The anteroposterior mortise angle during weight-bearing, lateral mortise angle during weight-bearing, and talar tilt angle and anterior translation of the talus on ankle stress radiography significantly improved (P < 0.05). In addition, signal changes on magnetic resonance imaging improved in all patients. Visual analogue scale and American Orthopedic Foot & Ankle Society scores also improved significantly (P < 0.05). No severe complications were observed. Conclusion: DTO with joint distraction may be useful for older patients with a high physical activity level as a joint-preserving surgery for medial ankle osteoarthritis. Level of evidence: Level IV, retrospective case series Key words : distal tibial osteotomy, medial ankle arthritis, joint distraction, circular external fixator

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