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 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 The Effect of Fibular Osteotomy on Talus Position in Supramalleolar Osteotomy

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.

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 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.

scholarly journals Single-Surgeon Experience with Supramalleolar Osteotomy

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
Alexej Barg ◽  
Charles Saltzman
Keyword(s):  
Prospective Study ◽  
Range Of Motion ◽  
Wedge Osteotomy ◽  
Short Term ◽  
Ankle Osteoarthritis ◽  
Radiographic Outcomes ◽  
Supramalleolar Osteotomy ◽  
Sf 36 ◽  
Significant Difference ◽  
Surgeon Experience

Category: Ankle, Ankle Arthritis Introduction/Purpose: Supramalleolar osteotomy is a joint-preserving option for patients with asymmetric ankle osteoarthritis. However, it remains unclear whether tibiotalar tilt can be effectively corrected by this procedure. The objective of this prospective study was to evaluate the short-term clinical and radiographic outcomes in patients who underwent a supramalleolar osteotomy procedure performed by one surgeon. Methods: A total of 16 patients with asymmetric ankle osteoarthritis and a concomitant supramalleolar deformity were included in this prospective study: 7 patients with valgus (medial closing wedge osteotomy) and 9 patients with varus deformity (medial opening wedge osteotomy). There were 11 male and 5 female patients with a mean age of 41.6 ± 10.9 years. Intraoperative and postoperative complications were recorded and analyzed. Clinical and radiographic outcomes were assessed after a mean follow- up of 3.6 ± 1.1 years. The clinical assessment included pain assessment (VAS), functional assessment (range of motion and AOFAS hindfoot score), and quality of life (SF-36). The radiographic assessment included alignment measurements (medial distal tibial angle, tibiotalar tilt, calcaneal moment arm) and osteoarthritis degree assessment in the tibiotalar joint. Outcomes were compared between both patient groups: valgus vs. varus ankle osteoarthritis. Results: In 10 of 16 patients, removal of hardware was performed. There was significant pain relief from 5.8 ± 0.8 to 2.4 ± 0.8. The AOFAS score increased significantly from 36 ± 12 to 84 ± 10. The average range of motion increased from 31 ± 5 to 33 ± 4. All categories of the SF-36 score showed significant improvement. Preoperatively, tibiotalar tilt was 4.8 ± 2.4 in the varus group and 1.8 ± 2.4 in the valgus group. Postoperatively, tibiotalar tilt improved significantly in both groups, however, there was significant difference between both groups with 2.3 ± 1.6 (varus) vs. 0.2 ± 0.5 (valgus) (p=0.005). Postoperative clinical outcomes were comparable in both groups. One patient showed progressive ankle osteoarthritis requiring ankle arthrodesis. Conclusion: Our prospective study demonstrated encouraging short-term results in patients with asymmetric ankle osteoarthritis who underwent supramalleolar osteotomy. A significant clinical and radiographic improvement can be expected. However, especially in patients with varus osteoarthritis, tibiotalar tilt cannot be fully corrected.

scholarly journals Supramalleolar Fornix Osteotomy Combined Fibular Segamental Resection for Varus Ankle Osteoarthritis

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.

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.

Factors Affecting the Clinical Outcomes of Surgically Treated Ankle Fractures Associated with the Posterior Malleolar Fragment

2021 ◽  
Vol 111 (5) ◽  
Author(s):  
Mehmet Kuyumcu ◽  
Emre Bilgin ◽  
Hasan Bombacı
Keyword(s):  
Clinical Outcomes ◽  
Fragment Size ◽  
Statistical Significance ◽  
Ankle Fractures ◽  
Foot And Ankle ◽  
Ankle Osteoarthritis ◽  
Posterior Malleolus ◽  
Significant Difference ◽  
Functional Scores ◽  
The Mean

Background This study was performed to determine the factors that influence the clinical outcomes of surgically treated ankle fractures associated with the posterior malleolus (PM). Methods We evaluated 42 fractures of 42 patients. Posterior malleolus fracture size was calculated using computed tomography. Posterior malleolar fractures with a size less than 10% were left nonfixated. The decision for larger fragments was performed using fluoroscopy following the fixation of other components. If the joint was found to be congruent, the PM was left nonfixated. Otherwise, the PM was reduced and fixated. Clinical outcomes were evaluated based on Weber, Freiburg, and American Orthopaedic Foot and Ankle Society scores. Ankle osteoarthritis was determined according to the Canadian Orthopaedic Foot and Ankle Society classification. The effect of PM fixation, age, PM fragment size, waiting period before surgery, presence of ankle dislocation, and number of injured malleoli on clinical outcomes were assessed. Statistical significance was set at a value of P &lt; .05. Results The mean patients age was 48.5 ± 14.9 years (range, 20–84 years) and the mean follow-up was 23.7 ± 8.6 months (range, 12–56 months). Fixation of the PM was performed solely in 12 patients. Postoperative displacement of the PM and articular step were less than 2 mm in all fractures. Statistically significant worse outcomes were demonstrated based on functional scores in the patients with a PM size greater than or equal to 25% (P = .042, P = .038, and P = .048, respectively) and in patients aged 60 years or older (P = .005, P = .007, and P = .018, respectively). However, there was no significant difference between functional scores and the other factors. Ankle osteoarthritis was observed at a higher rate in patients with PM size greater than or equal to 25% and in patients aged 60 years or older. Conclusions Clinical outcomes of the patients are mainly influenced by the patient's age and PM fragment size. However, if the tibiotalar joint is congruent, comparable results can be obtained in PM fixated or nonfixated patients.

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