Extraarticular Supramalleolar Osteotomy for Managing Varus Ankle Osteoarthritis, Alternatives for Osteotomy

Abstract Background There have been debates on the necessity of fibular osteotomy (FO) in supramalleolar osteotomy (SMOT) for the treatment of varus ankle osteoarthritis. The purpose of the current study was to compare the clinical and radiological outcomes between SMOT with and without FO in the treatment of varus ankle osteoarthritis. Methods The SMOT group included 39 patients, and the SMOT with FO group included 24 patients. The basic information reached no significant difference between groups. The American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, Ankle Osteoarthritis Scale (AOS), modified Takakura stage and range of motion (ROM) were used for the functional evaluation. The radiologic parameters were assessed at the last follow-up to compare the degree of talar reduction between the two groups. Results Both groups achieved significant improvements in AOFAS scores, modified Takakura stage, as well as AOS pain and functional scores (P < 0.001). The ROM of the ankle joint in the SMOT group was significantly decreased (P = 0.022). In both groups, all of the radiological parameters were significantly improved (P < 0.01). The tibiofibular clear space (TFCS) was significantly widened in the SMOT group (P < 0.001). No significant difference was found between the two groups according to the functional outcomes. However, the talar tilt angle (TT) and hindfoot alignment angle (HFA) in the SMOT with FO group were significantly smaller than those in the SMOT group (P < 0.05). The TFCS was significantly widened in the SMOT group (P = 0.001). The medial displacement of the talus (MDT) was better reduced in the SMOT with FO group (P = 0.006). Conclusion SMOT is a promising procedure for functional improvement and malalignment correction in varus ankle osteoarthritis but reduces ankle range of motion. If SMOT is combined with FO, talar tilt and medial displacement will be better reduced.

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Fibular osteotomy is helpful for talar reduction in the treatment of varus ankle osteoarthritis with supramalleolar osteotomy

10.21203/rs.3.rs-820783/v1 ◽

2021 ◽

Author(s):

Jing-Qi Liang ◽

Jun-Hu Wang ◽

Yan Zhang ◽

Xiao-Dong Wen ◽

Pei-Long Liu ◽

...

Keyword(s):

Range Of Motion ◽

Functional Evaluation ◽

Ankle Osteoarthritis ◽

Hindfoot Alignment ◽

Fibular Osteotomy ◽

Supramalleolar Osteotomy ◽

Significant Difference ◽

Functional Scores ◽

Talar Tilt ◽

Varus Ankle Osteoarthritis

Abstract Background There have been debates on the necessity of fibular osteotomy (FO) in supramalleolar osteotomy (SMOT) for the treatment of varus ankle osteoarthritis. The purpose of the current study was to compare the clinical and radiological outcomes between SMOT with and without FO in the treatment of varus ankle osteoarthritis. Methods The SMOT group included 39 patients, and the SMOT with FO group included 24 patients. The basic information reached no significant difference between groups. The American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, Ankle Osteoarthritis Scale (AOS), modified Takakura stage and range of motion (ROM) were used for the functional evaluation. The radiologic parameters were assessed at the last follow-up to compare the degree of talar reduction between the two groups. Results Both groups achieved significant improvements in AOFAS scores, modified Takakura stage as well as AOS pain and functional scores (P༜0.001). The ROM of the ankle joint in the SMOT group was significantly decreased (P = 0.022). In both groups, all of the radiological parameters were significantly improved (P༜0.01). The tibiofibular clear space (TFCS) was significantly widened in the SMOT group (P༜0.001). No significant difference was found between the two groups according to the functional outcomes. However, the talar tilt angle (TT) and hindfoot alignment angle (HFA) in the SMOT with FO group were significantly smaller than those in the SMOT group (P༜0.05). The TFCS was significantly widened in the SMOT group (P = 0.001). The medial displacement of the talus (MDT) was better reduced in the SMOT with FO group (P = 0.006). Conclusion SMOT is a promising procedure for functional improvement and malalignment correction in varus ankle osteoarthritis but reduces ankle range of motion. If SMOT is combined with FO, talar tilt and medial displacement will be better reduced.

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Supramalleolar Osteotomy With Distraction Arthroplasty in Treatment of Varus Ankle Osteoarthritis With Large Talar Tilt Angle: A Case Report and Literature Review

The Journal of Foot & Ankle Surgery ◽

10.1053/j.jfas.2017.04.022 ◽

2017 ◽

Vol 56 (5) ◽

pp. 1125-1128 ◽

Cited By ~ 6

Author(s):

Hong-Mou Zhao ◽

Xiao-Jun Liang ◽

Yi Li ◽

Ning Ning ◽

Jun Lu

Keyword(s):

Case Report ◽

Literature Review ◽

Tilt Angle ◽

Ankle Osteoarthritis ◽

Distraction Arthroplasty ◽

Supramalleolar Osteotomy ◽

Talar Tilt ◽

Varus Ankle Osteoarthritis

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Extraarticular Supramalleolar Osteotomy in Asymmetric Varus Ankle Osteoarthritis

Foot & Ankle International ◽

10.1177/1071100719845928 ◽

2019 ◽

Vol 40 (8) ◽

pp. 936-947 ◽

Cited By ~ 5

Author(s):

Nicola Krähenbühl ◽

Mahmut Akkaya ◽

Manja Deforth ◽

Lukas Zwicky ◽

Alexej Barg ◽

...

Keyword(s):

Survival Rate ◽

Clinical Outcomes ◽

Retrospective Cohort ◽

Survival Rates ◽

Ankle Osteoarthritis ◽

Level Of Evidence ◽

Supramalleolar Osteotomy ◽

Preoperative Stage ◽

Valuable Treatment ◽

Varus Ankle Osteoarthritis

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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Arthroscopic evaluation of persistent pain following supramalleolar osteotomy for varus ankle osteoarthritis

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-014-3199-7 ◽

2014 ◽

Vol 24 (6) ◽

pp. 1860-1867 ◽

Cited By ~ 5

Author(s):

Yong Sang Kim ◽

Hyun Kook Youn ◽

Bom Soo Kim ◽

Yun Jin Choi ◽

Yong Gon Koh

Keyword(s):

Persistent Pain ◽

Ankle Osteoarthritis ◽

Supramalleolar Osteotomy ◽

Arthroscopic Evaluation ◽

Varus Ankle Osteoarthritis

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Supramalleolar Fornix Osteotomy Combined Fibular Segamental Resection for Varus Ankle Osteoarthritis

10.21203/rs.3.rs-189247/v1 ◽

2021 ◽

Author(s):

Nengyuan Weng ◽

Kainan Li ◽

Zhengxia Hu ◽

Xuan Liu ◽

Tao Zhang ◽

...

Keyword(s):

Lateral Displacement ◽

Weight Bearing ◽

Distal Tibia ◽

Deformity Correction ◽

Ankle Osteoarthritis ◽

Imaging Evaluation ◽

Supramalleolar Osteotomy ◽

Significant Difference ◽

Varus Ankle Osteoarthritis ◽

Better Than

Abstract Background: To investigate the safety and clinical effect of supramalleolar fornix osteotomy combined with fibular segmental resection in the treatment of varus ankle osteoarthritis (VAO). Methods: from July 2014 to July 2020, 38 patients with Takakura stage II - III VAO in Affiliated Hospital of Chengdu University were retrospectively analyzed, including 31 males and 7 females, 21 left ankles and 17 right ankles. They were divided into open osteotomy group (21 cases) and fornix osteotomy group (17 cases). According to the American Society of foot and ankle surgery ankle and hindfoot score (AOFAS) and visual analogue scale (VAS) for pain function and pain score; weight-bearing ankle acupoints and lateral X-ray imaging evaluation. Results: 38 patients were followed up for 16-54 months (mean 41 months). The healing time of the supramalleolar osteotomy group (3.33 ± 0.90 months) was significantly shorter than that of the open osteotomy group (6.09 ± 1.74 months) (t = -5.932, P = 0.000). The postoperative FAS score of fornix osteotomy group (85.65 ± 6.49) was significantly better than that of open osteotomy group (63.05 ± 6.42), and the postoperative VAS score of fornix osteotomy group (2.12 ± 1.05) was significantly better than that of open osteotomy group (4.38 ± 1.60) (P < 0.05). The improvement of anterior angle of distal tibia, talus inclination angle and talus lateral displacement in the fornix osteotomy group was significantly better than that in the open osteotomy group (P < 0.05); the postoperative lateral angle of distal tibia in the fornix osteotomy group was 82.05 ± 1.74 ° on average, and that in the open osteotomy group was 80.17 ± 1.34 ° on average, with no significant difference between the two groups (P > 0.05). Conclusion: The treatment of VAO with supramalleolar fornix osteotomy combined fibular segamental resection can effectively solve the anterior and talus lesions. The deformity correction around CORA can avoid the lateral displacement of the talus and effectively reduce the incidence of postoperative ankle degeneration. Short term follow up convinced better function restoration compared with open supramalleolar osteotomy.

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The Effect of Fibular Osteotomy on Talus Position in Supramalleolar Osteotomy

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00120 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0012

Author(s):

Ki-Sun Sung ◽

Dae-Wook Kim

Keyword(s):

Coronal Plane ◽

Ankle Osteoarthritis ◽

Fibular Osteotomy ◽

Lateral Translation ◽

Radiographic Parameters ◽

Supramalleolar Osteotomy ◽

Significant Difference ◽

Varus Ankle Osteoarthritis ◽

Metal Failure

Category: Ankle Arthritis Introduction/Purpose: A supramalleolar osteotomy (SMO) creates angulation and translation of the ankle joint. However, when the fibular osteotomy was not performed, the amount of shifting of the osteotomized fragment might be limited by the fibula. We use three different radiographic parameters to evaluate the extent of lateral translation of the talus in coronal plane after SMO with or without fibular osteotomy. Methods: Forty-two patients (44 cases) that were followed for more than 6 months after SMO with or without fibular osteotomy were retrospectively reviewed. Their mean (range) age and mean follow-up period were 55.6 years (24–74 years) and 19.9 months (6–84 months), respectively. The American Orthopedic Foot and Ankle Society (AOFAS) Ankle Hindfoot score was used for clinical evaluation of the patients. The radiological evaluations included tibial anterior surface (TAS) angle, tibial lateral surface (TLS) angle, talar tilt (TT) angle, tibiocrural (TC) angle, tibio-talar center (TTC) angle, talar center migration (TCM), talar translation ratio (TTR), and Takakura stage. We compared the improvements of the clinical and radiographic parameters between the two groups according to fibular osteotomy, and we assessed the types of complications after surgery. Results: The improvement of the AOFAS Ankle Hindfoot score was 29.9 ± 17.4 in the fibular osteotomy(FO) group and 26.1 ± 13.8 in the fibular preservation (FP) group, without significant difference between the two groups (p = 0.481). The FO group showed a significant improvement in Takakura stage, TAS angle, TT angle, TC angle, TTC angle, TCM, and TTR. No postoperative complication was found in the FO group, but one metal failure was observed in the FP group. Conclusion: Fibular osteotomy showed more satisfactory lateral translation of the talus after SMO and decreased Takakura stage, although the AOFAS Ankle Hindfoot score was not significantly different. Therefore, SMO with fibular osteotomy could result in better radiological parameters in coronal plane for varus ankle osteoarthritis.

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