scholarly journals SMOT with Medial Distraction Arthroplasty for Ankle Arthritis with Increased Talar Tilt: A Comparative Study

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0025
Author(s):  
Zhao Hong-Mou
Keyword(s):  
Functional Evaluation ◽  
Ankle Arthritis ◽  
Ankle Osteoarthritis ◽  
Aofas Score ◽  
Hindfoot Alignment ◽  
Distraction Arthroplasty ◽  
Talar Tilt ◽  
And Function ◽  
Varus Ankle Osteoarthritis

Category: Ankle Arthritis Introduction/Purpose: An increased preoperative talar tilt (TT) angle was reported to be positively correlated with treatment failure after supramalleolar osteotomy (SMOT) for varus ankle osteoarthritis. Distraction arthroplasty was reported to have the ability to correct increased TT angles. The purpose of the current study was to compare the outcomes between SMOT with and without medial distraction arthroplasty (MDA) in the treatment of varus ankle osteoarthritis with increased TT angles. Methods: We retrospectively reviewed the functional outcomes and radiological findings of 56 patients who underwent SMOT with or without MDA for varus ankle osteoarthritis with increased TT angles. The AOFAS ankle-hindfoot score and AOS scores were used for functional evaluation. The tibial anterior surface (TAS) angle, talar tilt (TT) angle, tibial medial malleolar (TMM) angle, talocrural (TC) angle, tibial lateral surface (TLS) angle, and hindfoot alignment (HFA) angle were evaluated preoperatively and at the time of the last follow-up. Results: In the SMOT group, the AOFAS score and AOS pain and function scores were significantly improved (P <0.01 for each) at a mean follow-up of 67.5 months. The TAS, TT, TC, TLS, and HFA angles were all significantly improved (P <0.01 for each). Similarly, in the SMOT with MDA group, the AOFAS score, AOS pain and function scores, and the TAS, TT, TC, TLS, and HFA angles were all significantly improved postoperatively (P <0.01 for each) at a mean follow-up of 37.8 months. When comparing the two groups, the postoperative TT angle was significantly smaller in the SMOT with MDA group (P = 0.03) than in the SMOT group. In addition, the failure rate of TT angle correction was significantly higher in the SMOT group (P = 0.02) than in the SMOT with MDA group. Conclusion: SMOT is a promising procedure for functional improvement and malalignment correction for varus ankle osteoarthritis, even in patients with increased talar tilt. SMOT with MDA is a effective method to correct the varus ankle OA with increased talar tilt.

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

2021 ◽  
Vol 16 (1) ◽  
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.

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

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.

scholarly journals Effects of Supramalleolar Osteotomy on Abnormal Internal Rotation of the Talus in Varus Ankle Osteoarthritis

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0045
Author(s):  
Jaehwang Song ◽  
Chan Kang ◽  
Je Hyung Jeon ◽  
Chang Uk Ham
Keyword(s):  
Clinical Outcomes ◽  
Internal Rotation ◽  
Ankle Osteoarthritis ◽  
Fibular Osteotomy ◽  
Linear Relationships ◽  
The Mean ◽  
Talar Tilt ◽  
Varus Ankle Osteoarthritis ◽  
Surface Angle

Category: Ankle Arthritis; Basic Sciences/Biologics Introduction/Purpose: Varus ankle osteoarthritis, which is induced by asymmetric joint load in the ankle due to varus malalignment and characterized by a loss of cartilage in the medial talar dome or medial clear space in the ankle mortise, accounts for a large proportion of ankle osteoarthritis osteoarthritis. Realignment surgery, such as supramalleolar osteotomy (SMO) is an effective surgical procedure for treating varus ankle osteoarthritis. In previous study using weightbearing computed tomography (WBCT) by other group, the abnormal internal rotation of the talus was often seen in patients with varus ankle osteoarthritis. We used axial loading three-dimensional computed tomography (AL 3D CT) to evaluate preoperative and postoperative talocrural joints of patients who underwent SMO to treat varus ankle osteoarthritis. Methods: We performed retrospective analyses of 12 patients (14 feet) who underwent SMO and fibular osteotomy. Fibular osteotomy was performed by scarf osteotomy and the center of hinge was fixed with cortical screw. For SMO, distal tibial medial sharp spike of bone produced after the opening wedge osteotomy was resected and used for the autogenous strut bone graft in the osteotomy gap. Tibial-ankle surface angle (TAS), talar tilt angle (TT), Takakura stage, and tibial-lateral surface angle (TLS) was evaluated with weightbearing radiographs before operation and at 2-year follow-up. Talus rotation ration and presence of medial gutter contact was investigated with AL CT before operation and at 6-month follow-up (Figure A-D : preoperative, E-H : postoperative).Clinical outcomes were assessed based on the preoperative and 2-year follow-up American Orthopaedic 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 TAS, TT, Takakura stage, and TLS were all significantly different relative to preoperative parameters (P < .05). The mean 6-month follow-up talus rotation ratio was significantly restored compared to preoperative value (P = .001). The mean 2-year follow-up clinical outcomes were all significantly improved relative to preoperative measurements (P = .001). The preoperative talus rotation ratio had moderately positive linear relationships with preoperative Takakura stage and preoperative anterior talar translation (P < .05). Among the variables of interest, preoperative anterior talar translation was most strongly related to the preoperative talus rotation ratio (r = 0.655, P < .05). The postoperative talus rotation ratio had moderately positive linear relationships with postoperative Takakura stage and preoperative talar tilt angle (P < .05). Conclusion: In summary, abnormal internal rotation of the talus in mild to moderate varus ankle osteoarthritis, as observed by AL CT, was significantly restored after SMO combined with fibular osteotomy. SMO yielded successful radiological and clinical outcomes. Based on these results, we believe that correction of abnormal internal rotation of the talus is an important prognostic factor in patients with varus ankle osteoarthritis, and we recommend that clinicians investigate such abnormality perioperatively.

Joint Preservation Surgery for Varus Ankle Arthritis with Large Talar Tilt

2021 ◽  
pp. 107110072110272
Author(s):  
Chul Hyun Park ◽  
Ji Beom Kim ◽  
Jaeyoung Kim ◽  
Young Yi ◽  
Woo-Chun Lee
Keyword(s):  
Case Series ◽  
Clinical Results ◽  
Posterior Tibial Tendon ◽  
Ankle Arthritis ◽  
Level Of Evidence ◽  
Hindfoot Alignment ◽  
Joint Preservation ◽  
Small Series ◽  
Talar Tilt

Background: Varus ankle arthritis with large talar tilt (TT) is a challenging condition when considering joint preservation surgery. Three-dimensional deformity of the talus has been demonstrated with weightbearing computed tomography in varus ankle arthritis with large TT. The aim of this study was to investigate the clinical and radiographic results of posterior tibial tendon (PTT) transfer generally combined with bony realignment for varus ankle arthritis with large TT in nonparalytic ankle arthritis and to determine the indications for PTT transfer. Methods: This study includes 23 ankles with varus arthritis and TT larger than 7.5 degrees. Patients were categorized into improved (19 ankles) and unimproved (4 ankles) groups according to the postoperative clinical results at the last follow-up. Clinical and radiographic results were compared between the groups. A cut-off point for preoperative TT that indicated a borderline between improved and unimproved groups was determined to suggest the appropriate indication for joint preservation surgery. Results: In the improved group, TT, radiographic stage, Meary angle, and hindfoot alignment significantly improved at 6 months after surgery and were maintained at the last follow-up. In the unimproved group, the radiographic parameters mentioned above did not improve at 6 months after surgery, and TT decreased to 0.8 degrees as radiographic stage had progressed to end-stage arthritis at the last follow-up. In this small series, the cut-off point for predicting failure of surgery was 14.3 degrees of preoperative TT. Conclusion: PTT transfer often combined with bony realignment procedures may be a reasonable option for treating painful varus ankle arthritis with TT less than 14 degrees and hindfoot varus. Level of Evidence: Level IV, case series.

scholarly journals The Radiographic Support for Distal Tibia Medial Opening-Wedge Osteotomy with Fibular Valgization Osteotomy for Medial Ankle Osteoarthritis

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0033
Author(s):  
Jung-Won Lim ◽  
Hong-Geun Jung
Keyword(s):  
Patient Satisfaction ◽  
Clinical Outcomes ◽  
Medial Compartment ◽  
Wedge Osteotomy ◽  
Functional Evaluation ◽  
Ankle Arthritis ◽  
Ankle Pain ◽  
Ankle Osteoarthritis ◽  
Surgical Option

Category: Ankle; Ankle Arthritis Introduction/Purpose: Supramalleolar osteotomy (SMO) has recently been accepted as the major surgical option for treating painful asymmetric ankle arthritis. The effectivenss of additional fibular valgization osteotomy during SMO procedure is still controversial. This study aimed to evaluate radiological and clinical outcomes of medial compartment ankle osteoarthritis (OA) after SMO with fibular valgization osteotomy. Also, the study is aimed to describe the radiographic support for the SMO with additional fibular osteotomy in relieving the medial ankle pain. Methods: The study is based on 45 cases of medial compartment ankle arthritis (43 patients) with moderate to severe medial ankle pain (at least 1-year follow-up). SMO and fibular valgization oblique osteotomy was performed concomitantly in 37 ankles (82.2%). As for the functional evaluation, visual analogue scale (VAS) pain scores, American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scores and patient satisfaction were evaluated. On radiographs, tibial anterior surface angles (TAS), tibial lateral surface angles (TLS), and talar tilt angles (TT) were measured and the severity of ankle OA was classified by the Takakura stage. The evaluation of the effect of fibular valgization osteotomy entailed a comparison of new radiological measurement (medial clear space gap distance and talus center migaration distance) between two groups: Group 1 (with 37 cases of SMO with fibular valgization osteotomy) and Group 2 (with 8 cases of SMO without fibular valgization osteotomy). Results: The mean VAS pain score decreased from preoperative 6.5 to postoperative 1.3, and AOFAS score significantly improved from preoperative 60.4 to 88.3 at final follow-up. 91 percent (41 ankles) of the patients were satisfied with surgery. Mean TAS improved from preoperative 83.8° to postoperative 94.9° and TLS from 78.5° to 82.0°. 23 of 30 Takakura stage IIIa cases (77%) and 3 of 7 stage IIIb cases (42%) improved to stage II after SMO at final follow-up. Mean fibular valgization osteotomy angle was 12.4°. Medial gutter space gap distance improved from preoperative 0.7mm to postoperative 2.10mm. Talus center migration distance improved from -0.53mm to 2.03mm. Both radiologic parameters showed statistically significant differences between two groups, but there was no correlation between radiologic parameters and clinical outcomes. Conclusion: SMO for the patients with painful medial compartment ankle OA achieved favorable clinical and radiological outcomes. Also, high patient satisfaction (91%) as well as the improvement of Takakura stage was observed. SMO with additional fibular valgization osteotomy yielded widening of medial gutter space and recovery of talus center. Therefore, additional fibular valgization osteotomy during SMO could be optimal surgical option for the recovery of normal ankle mechanical axis.

scholarly journals Supramalleolar osteotomy combined with lateral ligament reconstruction and talofibular immobilization for varus ankle osteoarthritis with excessive talar tilt angle

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Wenqing Qu ◽  
Dajiang Xin ◽  
Shengjie Dong ◽  
Wenliang Li ◽  
Yanping Zheng
Keyword(s):  
Tilt Angle ◽  
Ligament Reconstruction ◽  
Weight Bearing ◽  
Lateral Ligament ◽  
Ankle Osteoarthritis ◽  
Supramalleolar Osteotomy ◽  
Talar Tilt ◽  
Ankle Function ◽  
Varus Ankle Osteoarthritis

Abstract Background Although supramalleolar osteotomy is the main joint-preserving method for the treatment of varus ankle osteoarthritis, it tends to be ineffective when ankle osteoarthritis presents in combination with an excessive talar tilt angle. The purpose of this study was to present a new surgical technique, supramalleolar osteotomy combined with lateral ligament reconstruction and talofibular immobilization, for the treatment of varus ankle osteoarthritis with an excessive talus tilt angle and to evaluate the clinical and radiological results. Methods From January 2013 to October 2016, a total of 17 patients with 17 cases of varus ankle arthritis with excessive talar tilt angles (larger than 7.3°) underwent surgical treatment using our new technique. The American Orthopaedic Foot and Ankle Society (AOFAS) clinical ankle-hindfoot scale and a visual analogue scale (VAS) were used to evaluate ankle function and pain before surgery and at the last follow-up. The medial distal tibial angle (MDTA), anterior distal tibial angle (ADTA), talar tilt angle (TTA), and hindfoot moment arm values (HMAVs) were evaluated on weight-bearing radiographs acquired preoperatively and at the last follow-up. Results The AOFAS score improved significantly from 45.8 ± 2.1 before surgery to 84.8 ± 1.8 after surgery (p < 0.001), and the VAS score decreased from 4.9 ± 0.4 to 1.1 ± 0.2 (p < 0.001). The MDTA, TTA, and HMAV changed from 80.9° ± 0.4° to 90.1° ± 0.4°, 11.7° ± 0.6° to 1.4° ± 0.3°, and 12.6 mm ± 0.8 mm to 4.2 mm ± 0.6 mm, respectively (each p < 0.001). The ADTA showed no obvious change (p = 0.370). The staging of 11 cases (65%) improved. Intramuscular vein thrombosis of the lower limbs occurred in 1 patient 1 week after surgery, and superficial infection occurred in 1 patient. Conclusions Supramalleolar osteotomy combined with lateral ligament reconstruction and talofibular immobilization can correct the load of the weight-bearing ankle and effectively improve the ankle function. As the talar tilt angle can be significantly improved after surgery, this technique can be used for the treatment of varus ankle osteoarthritis with an excessive TTA.

scholarly journals Supramalleolar osteotomy with medial distraction arthroplasty for ankle osteoarthritis with talar tilt

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Hong-Mou Zhao ◽  
Xiao-Dong Wen ◽  
Yan Zhang ◽  
Jing-Qi Liang ◽  
Pei-Long Liu ◽  
...  
Keyword(s):  
Ankle Osteoarthritis ◽  
Distraction Arthroplasty ◽  
Supramalleolar Osteotomy ◽  
Talar Tilt

scholarly journals Ankle Mortise Instability in Multiple Hereditary Exostoses

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0016
Author(s):  
M Pierce Ebaugh ◽  
Greg Grenier ◽  
Satbir Singh ◽  
Oussama Abousamra ◽  
Kevin Klingele
Keyword(s):  
Distal Tibia ◽  
Ankle Arthritis ◽  
Aofas Score ◽  
Multiple Hereditary Exostoses ◽  
Normal Limits ◽  
Sf 36 ◽  
Pediatric Foot ◽  
The Mean ◽  
Ankle Valgus

Category: Ankle, Ankle Arthritis, Pediatric Foot and Ankle Introduction/Purpose: Ankle valgus has been reported in 50% of patients with multiple hereditary exostoses (MHE) and, untreated, results in early arthrosis. Widening of the ankle mortise has also been reported; however, there has been a lack of data regarding its natural history and management. Alterations of mortise anatomy result in poor functional outcomes and accelerated arthrosis of the ankle. The aim of our study was to report the characteristics and outcomes of mortise widening in a group of patients with MHE. Methods: A total of 13 patients with MHE and mortise widening (16 ankles) were identified. Age, sex, BMI, laterality, origin of osteochondroma, pain, instability, clinical deformity, operative data, and complications were recorded. Mortise (M), Talocrural angle (TC), and Tibiotalar angle (TT) measurements were collected on preoperative and last follow up radiographs. The majority of patients underwent medial distal tibia hemiepiphysiodesis. Post-surgical AOFAS and SF36 scores were collected. Results: Preoperatively, no patient complained of instability, however, 9/16 ankles were painful and 14/16 were clinically in valgus. Patients underwent surgery at an age of 11.8 years (9.7-15). Radiographic and clinical follow up were 2.6 years (0.2-7.3) and 6 years (1.5-11.7), respectively. There were no significant differences between pre/postoperative M, TC, TT angles. Operative patients improved mean M (5.17 to 4.63 mm) and TT (8.71 to 4.54 degrees), neither angle reached normal values. TC (fibular length) was within normal limits (82.2 to 84.8). Questionnaires were obtained for 8/16 ankles, at a mean age of 19 years (13-25.1). The average AOFAS score was 66.7 out of 100. Patients scored 8.6/10 for alignment, 32/40 for pain, 25.6/50 for function. SF-36 scores were excellent. Conclusion: The improvement in M and TT was modest and their values remained outside the normal limits. TC angle was within normal limits but displayed an overall fibular shortening and thus, decreased lateral buttress with potential for talar shift. This was reflected in the mean functional and overall AOFAS score. However, our patients are functionally compensating as evidenced by SF36 scores. More studies are needed to optimize the management of MHE patients with ankle malalignment. Earlier valgus correction and possible addition of fibular lengthening to simultaneously address mortise widening may need to be considered to prevent early ankle arthritis.

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