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

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.

Relationship between talofibular impingement and increased talar tilt in incongruent varus ankle osteoarthritis

Purpose This study aimed to evaluate the relationship between talofibular impingement and increased talar tilt in incongruent varus ankle osteoarthritis. Methods: Incongruent varus ankle osteoarthritis was defined as a talar tilt of more than 4° on standard ankle anteroposterior radiographs. We retrospectively reviewed 30 patients with unilateral incongruent varus ankle osteoarthritis with normal alignment of the contralateral ankle. All patients underwent bilateral weightbearing computed tomography and standing plain radiographs. The talar tilt and the distance between the talar lateral process and lateral malleolar tip were measured from a standing ankle anteroposterior radiograph of both sides. Talar and fibular spurs were assessed on the coronal and axial views of weightbearing computed tomography. After simulating the correction of the talar tilt in varus ankle osteoarthritis, talofibular bony impingement was reassessed. Results: On the varus side, the distance between the talar lateral process and the lateral malleolar tip was significantly shorter than that on the contralateral side ( p < .001). Talar spur was present in the varus side of all 30 patients on the axial view of weightbearing computed tomography and in the control side of 10 patients. After the simulation of talar tilt correction, talofibular impingement (overlap) occurred in all 30 patients with a larger extent in the severe talar tilt subgroup ( p < .001). Conclusion: Talofibular impingement by lateral gutter osteophytes is closely related to increased talar tilt in patients with incongruent varus ankle osteoarthritis. Therefore, lateral gutter osteophytes should be resected to stabilize mortise and improve clinical outcomes.

Simulated weightbearing computed tomography for verification of radiographic staging of varus ankle osteoarthritis: a cross-sectional study

Background Varus ankle osteoarthritis is classified using only weightbearing anteroposterior ankle radiographs; however, sagittal ankle alignment may also affect the position and extent of joint space obliteration. We hypothesized that the sagittal alignment of the ankle may also affect the position and extent of joint space obliteration visible on the coronal section; therefore, we identified the sites of joint space obliteration in patients with stage 3 varus ankle osteoarthritis for comparison with the sites observed on simulated weightbearing computed tomography and investigated the effects of anterior and posterior ankle subluxation. Methods Simulated weightbearing computed tomography scans of 83 ft with varus ankle osteoarthritis (26 stage 3a, 57 stage 3b) were performed to check for joint space obliteration in the ankle. Further classification as exhibiting either anterior, posterior, or no subluxation on weightbearing lateral radiographs was performed. Results Anterior, posterior, and no subluxation was seen in 5, 9, and 12 ankles among the 26 classified as stage 3a, respectively, and in 22, 12, and 23 ankles among the 57 classified as stage 3b, respectively. The mean tibial lateral surface angle on weightbearing lateral radiographs in stage 3a ankles was 75.6, 83.3, and 80.3 degrees in the anterior, posterior, and no subluxation groups, respectively; and 75.5, 86.6, and 82.7 degrees in stage 3b ankles (p < .05). In stage 3b ankles, widespread joint space obliteration was observed at the anterior distal articular surface of the tibia in all 22 ankles with anterior subluxation and at the posterior distal articular surface of the tibia in all 12 ankles with posterior subluxation. Conclusions Simulated weightbearing computed tomography revealed joint space obliteration at the anterior distal articular surface of the tibia in stage 3b ankles with anterior subluxation and at the posterior side in stage 3a and 3b ankles with posterior subluxation. In some patients with stage 3 varus ankle osteoarthritis, the obliteration of the joint space is difficult to evaluate accurately using only weightbearing anteroposterior radiographs; weightbearing lateral radiographs should also be performed.

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

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.

Supramalleolar Fornix Osteotomy Combined Fibular Segamental Resection for Varus Ankle Osteoarthritis

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.

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

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.

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

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.