Supramalleolar Osteotomies for Ankle Osteoarthritis: Clinical and Radiological Outcomes
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Published:
Apr 16, 2024
Keywords:
Ankle osteoarthritis, supramalleolar osteotomy, joint preservation
Main Article Content
Abstract
Introduction: Supramalleolar osteotomies are a treatment option for asymmetric ankle osteoarthritis. Our work aims to describe the clinical, radiographic, and subjective outcomes obtained in patients with ankle osteoarthritis who underwent a supramalleolar osteotomy (SMOT).
Materials and Methods: Retrospective, observational, and descriptive study on patients who underwent SMOT for ankle osteoarthritis between January 2010 and July 2017. The patients’ clinical records were analyzed.
Results: We included 13 patients who underwent SMOT, 8 patients with valgus (61.5%) and 5 (38.5%) with varus rearfoot and ankle misalignment. The mean varus VAS score decreased from 9 ± 0.45 to 3 ± 1 postoperatively (p <0.05) and, in valgus deformities, from a mean 7.88 ± 0.35 to 2.15 ±1.64 postoperatively (p <0.05). The mean AOFAS score changed from 32.8 ± 16.2 to 82.1 ± 13.6 postoperatively in the varus deformity group (p <0.05) and from 31 ± 17.3 preoperatively to 93.1 ± 6.20 postoperatively in the valgus deformity group (p <0.05). Twelve patients (92.3%) achieved radiographic union in an average time of 10.4 weeks.
Conclusion: Supramalleolar osteotomy as a treatment for asymmetric ankle osteoarthritis is a predictable technique with very good clinical andradiological outcomes in the short and medium term.
Materials and Methods: Retrospective, observational, and descriptive study on patients who underwent SMOT for ankle osteoarthritis between January 2010 and July 2017. The patients’ clinical records were analyzed.
Results: We included 13 patients who underwent SMOT, 8 patients with valgus (61.5%) and 5 (38.5%) with varus rearfoot and ankle misalignment. The mean varus VAS score decreased from 9 ± 0.45 to 3 ± 1 postoperatively (p <0.05) and, in valgus deformities, from a mean 7.88 ± 0.35 to 2.15 ±1.64 postoperatively (p <0.05). The mean AOFAS score changed from 32.8 ± 16.2 to 82.1 ± 13.6 postoperatively in the varus deformity group (p <0.05) and from 31 ± 17.3 preoperatively to 93.1 ± 6.20 postoperatively in the valgus deformity group (p <0.05). Twelve patients (92.3%) achieved radiographic union in an average time of 10.4 weeks.
Conclusion: Supramalleolar osteotomy as a treatment for asymmetric ankle osteoarthritis is a predictable technique with very good clinical andradiological outcomes in the short and medium term.
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How to Cite
Conti, L. Ángel, Verbner, J. M., Valenti, P., Parise, A. C., Villena, D. S., Santini Araujo, M. G., Sotelano, P., Cardone, G., Bilbao, F., & Carrasco, N. M. (2024). Supramalleolar Osteotomies for Ankle Osteoarthritis: Clinical and Radiological Outcomes. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 89(2), 121-131. https://doi.org/10.15417/issn.1852-7434.2024.89.2.1703
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Clinical Research
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References
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supramalleolar osteotomy. Foot Ankle Int 2017;38(2):124-32. https://doi.org/10.1177/1071100716673416
3. Barg A, Pagenstert GI, Horisberger M, Paul J, Gloyer M, Henninger HB, et al. Supramalleolar osteotomies for
degenerative joint disease of the ankle joint: indication, technique and results. Int Orthop 2013;37(9):1683-95.
https://doi.org/10.1007/s00264-013-2030-2
4. Zhao HM, Wen XD, Zhang Y, Liang JQ, Liu PL, Li Y, et al. Supramalleolar osteotomy with medial distraction
arthroplasty for ankle osteoarthritis with talar tilt. J Orthop Surg Res 2019;14(1):120. https://doi.org/10.1186/s13018-019-1168-z
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varus ankle arthritis: a biomechanical and clinical study. J Orthop Surg Res 2016;11(1):127.
https://doi.org/10.1186/s13018-016-0462-2
7. Speed JS, Boyd HB. Operative reconstruction of malunited fractures about the ankle joint. J Bone Joint Surg
1936;18(2):270-86.
8. Takakura Y, Tanaka Y, Kumai T, Tamai S. Low tibial osteotomy for osteoarthritis of the ankle. Results of a new
operation in 18 patients. J Bone Joint Surg Br 1995;77(1):50-4. PMID: 782235
9. Krähenbühl N, Akkaya M, Deforth M, Zwicky L, Barg A, Hintermann B. Extraarticular supramalleolar osteotomy in asymmetric varus ankle osteoarthritis. Foot Ankle Int 2019;40(8):936-47. https://doi.org/10.1177/1071100719845928
10. Lee WC, Moon JS, Lee K, Byun WJ, Lee SH. Indications for supramalleolar osteotomy in patients with ankle
osteoarthritis and varus deformity. J Bone Joint Surg Am 2011;93(13):1243-8. https://doi.org/10.2106/JBJS.J.00249
11. Krause F, Veljkovic A, Schmid T. Supramalleolar osteotomies for posttraumatic malalignment of the distal tibia. Foot Ankle Clin 2016;21(1):1-14. https://doi.org/10.1016/j.fcl.2015.09.001
12. Becker AS, Myerson MS. The indications and technique of supramalleolar osteotomy. Foot Ankle Clin
2009;14(3):549-61. https://doi.org/10.1016/j.fcl.2009.06.002
13. Huskisson EC. Measurement of pain. Lancet 1974;2(7889):1127-31. https://doi.org/10.1016/s0140-6736(74)90884-8
14. Kitaoka HB, Alexander IJ, Adelaar RS, A Nunley J, Myerson MS, Sanders M, et al. Clinical rating systems for the
ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int 1997;18(3):187-8. https://doi.org/10.1177/107110079401500701
15. Park BS, Chung CY, Park MS, Sung KH, Choi Y, Park C, et al. Inverse relationship between radiographic lateral
ankle instability and osteochondral lesions of the talus in patients with ankle inversion injuries. Foot Ankle Int
2019;40(12):1368-74. https://doi.org/10.1177/1071100719868476
16. Hayashi K, Tanaka Y, Kumai T, Sugimoto K, Takakura Y. Correlation of compensatory alignment of the subtalar
joint to the progression of primary osteoarthritis of the ankle. Foot Ankle Int 2008;29(4):400-6.
https://doi.org/10.3113/FAI.2008.0400
17. Magerkurth O, Knupp M, Ledermann H, Hintermann B. Evaluation of hindfoot dimensions: a radiological study. Foot Ankle Int 2006;27(8):612-6. https://doi.org/10.1177/107110070602700808
18. Tanaka Y, Takakura Y, Hayashi K, Taniguchi A, Kumai T, Sugimoto K. Low tibial osteotomy for varus-type
osteoarthritis of the ankle. J Bone Joint Surg Br 2006;88(7):909-13. https://doi.org/10.1302/0301-620X.88B7.17325
19. Chopra V, Stone P, Ng A. Supramalleolar osteotomies. Clin Podiatr Med Surg 2017;34(4):445-60.
https://doi.org/10.1016/j.cpm.2017.05.003
20. Kim YS, Youn HK, Kim BS, Choi YJ, Koh YG. Arthroscopic evaluation of persistent pain following supramalleolar
osteotomy for varus ankle osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2016;24(6):1860-7.
https://doi.org/10.1007/s00167-014-3199-7
21. Stamatis ED, Cooper PS, Myerson MS. Supramalleolar osteotomy for the treatment of distal tibial angular
deformities and arthritis of the ankle joint. Foot Ankle Int 2003;24(10):754-64. https://doi.org/10.1177/107110070302401004
22. Hongmou Z, Xiaojun L, Yi L, Hongliang L, Junhu W, Cheng L. Supramalleolar osteotomy with or without fibular
osteotomy for varus ankle arthritis. Foot Ankle Int 2016;37(9):1001-7. https://doi.org/10.1177/1071100716649926
23. Harstall R, Lehmann O, Krause F, Weber M. Supramalleolar lateral closing wedge osteotomy for the treatment of varus ankle arthrosis. Foot Ankle Int 2007;28(5):542-8. https://doi.org/10.3113/FAI.2007.0542
24. Wagner E, Ortiz C, Keller A, Wagner P, Zanolli D, Ahumada X, et al. Artrosis de tobillo localizada: el rol de las
osteotomías. Tobillo y Pie 2013;5(2):114-88. Disponible en: https://jfootankle.com/tobilloypie/article/view/1417
25. Hintermann B, Knupp M, Barg A. Supramalleolar osteotomies for the treatment of ankle arthritis. J Am Acad
Orthop Surg 2016;24(7):424-32. https://doi.org/10.5435/JAAOS-D-12-00124
26. Pagenstert GI, Hintermann B, Barg A, Leumann A, Valderrabano V. Realignment surgery as alternative treatment of varus and valgus ankle osteoarthritis. Clin Orthop Relat Res 2007;462:156-68.
https://doi.org/10.1097/BLO.0b013e318124a462
27. Lim JW, Kang SJ, Im JM, Kwon SH, Jung HG. Evaluation of clinico-radiological outcome of fibular valgization
osteotomy with supra-malleolar osteotomy in patients with ankle osteoarthritis. Int Orthop 2023;47(8):2013-21.
https://doi.org/10.1007/s00264-023-05822-w
28. Kim YS, Kim YB, Koh YG. Prognostic factors affecting correction angle changes after supramalleolar osteotomy using an opening wedge plate for varus ankle osteoarthritis. J Foot Ankle Surg 2019;58(3):417-22.
https://doi.org/10.1053/j.jfas.2018.09.003
2. Krähenbühl N, Zwicky L, Bolliger L, Schädelin S, Hintermann B, Knupp M. Mid- to long-term results of
supramalleolar osteotomy. Foot Ankle Int 2017;38(2):124-32. https://doi.org/10.1177/1071100716673416
3. Barg A, Pagenstert GI, Horisberger M, Paul J, Gloyer M, Henninger HB, et al. Supramalleolar osteotomies for
degenerative joint disease of the ankle joint: indication, technique and results. Int Orthop 2013;37(9):1683-95.
https://doi.org/10.1007/s00264-013-2030-2
4. Zhao HM, Wen XD, Zhang Y, Liang JQ, Liu PL, Li Y, et al. Supramalleolar osteotomy with medial distraction
arthroplasty for ankle osteoarthritis with talar tilt. J Orthop Surg Res 2019;14(1):120. https://doi.org/10.1186/s13018-019-1168-z
5. Koo JW, Park SH, Kim KC, Sung IH. The preliminary report about the modified supramalleolar tibial osteotomy
for asymmetric ankle osteoarthritis. J Orthop Surg 2019;27(1):2309499019829204. https://doi.org/10.1177/2309499019829204
6. Zhao H, Liang X, Li Y, Yu G, Niu W, Zhang Y. The role of fibular for supramalleolar osteotomy in treatment of
varus ankle arthritis: a biomechanical and clinical study. J Orthop Surg Res 2016;11(1):127.
https://doi.org/10.1186/s13018-016-0462-2
7. Speed JS, Boyd HB. Operative reconstruction of malunited fractures about the ankle joint. J Bone Joint Surg
1936;18(2):270-86.
8. Takakura Y, Tanaka Y, Kumai T, Tamai S. Low tibial osteotomy for osteoarthritis of the ankle. Results of a new
operation in 18 patients. J Bone Joint Surg Br 1995;77(1):50-4. PMID: 782235
9. Krähenbühl N, Akkaya M, Deforth M, Zwicky L, Barg A, Hintermann B. Extraarticular supramalleolar osteotomy in asymmetric varus ankle osteoarthritis. Foot Ankle Int 2019;40(8):936-47. https://doi.org/10.1177/1071100719845928
10. Lee WC, Moon JS, Lee K, Byun WJ, Lee SH. Indications for supramalleolar osteotomy in patients with ankle
osteoarthritis and varus deformity. J Bone Joint Surg Am 2011;93(13):1243-8. https://doi.org/10.2106/JBJS.J.00249
11. Krause F, Veljkovic A, Schmid T. Supramalleolar osteotomies for posttraumatic malalignment of the distal tibia. Foot Ankle Clin 2016;21(1):1-14. https://doi.org/10.1016/j.fcl.2015.09.001
12. Becker AS, Myerson MS. The indications and technique of supramalleolar osteotomy. Foot Ankle Clin
2009;14(3):549-61. https://doi.org/10.1016/j.fcl.2009.06.002
13. Huskisson EC. Measurement of pain. Lancet 1974;2(7889):1127-31. https://doi.org/10.1016/s0140-6736(74)90884-8
14. Kitaoka HB, Alexander IJ, Adelaar RS, A Nunley J, Myerson MS, Sanders M, et al. Clinical rating systems for the
ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int 1997;18(3):187-8. https://doi.org/10.1177/107110079401500701
15. Park BS, Chung CY, Park MS, Sung KH, Choi Y, Park C, et al. Inverse relationship between radiographic lateral
ankle instability and osteochondral lesions of the talus in patients with ankle inversion injuries. Foot Ankle Int
2019;40(12):1368-74. https://doi.org/10.1177/1071100719868476
16. Hayashi K, Tanaka Y, Kumai T, Sugimoto K, Takakura Y. Correlation of compensatory alignment of the subtalar
joint to the progression of primary osteoarthritis of the ankle. Foot Ankle Int 2008;29(4):400-6.
https://doi.org/10.3113/FAI.2008.0400
17. Magerkurth O, Knupp M, Ledermann H, Hintermann B. Evaluation of hindfoot dimensions: a radiological study. Foot Ankle Int 2006;27(8):612-6. https://doi.org/10.1177/107110070602700808
18. Tanaka Y, Takakura Y, Hayashi K, Taniguchi A, Kumai T, Sugimoto K. Low tibial osteotomy for varus-type
osteoarthritis of the ankle. J Bone Joint Surg Br 2006;88(7):909-13. https://doi.org/10.1302/0301-620X.88B7.17325
19. Chopra V, Stone P, Ng A. Supramalleolar osteotomies. Clin Podiatr Med Surg 2017;34(4):445-60.
https://doi.org/10.1016/j.cpm.2017.05.003
20. Kim YS, Youn HK, Kim BS, Choi YJ, Koh YG. Arthroscopic evaluation of persistent pain following supramalleolar
osteotomy for varus ankle osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2016;24(6):1860-7.
https://doi.org/10.1007/s00167-014-3199-7
21. Stamatis ED, Cooper PS, Myerson MS. Supramalleolar osteotomy for the treatment of distal tibial angular
deformities and arthritis of the ankle joint. Foot Ankle Int 2003;24(10):754-64. https://doi.org/10.1177/107110070302401004
22. Hongmou Z, Xiaojun L, Yi L, Hongliang L, Junhu W, Cheng L. Supramalleolar osteotomy with or without fibular
osteotomy for varus ankle arthritis. Foot Ankle Int 2016;37(9):1001-7. https://doi.org/10.1177/1071100716649926
23. Harstall R, Lehmann O, Krause F, Weber M. Supramalleolar lateral closing wedge osteotomy for the treatment of varus ankle arthrosis. Foot Ankle Int 2007;28(5):542-8. https://doi.org/10.3113/FAI.2007.0542
24. Wagner E, Ortiz C, Keller A, Wagner P, Zanolli D, Ahumada X, et al. Artrosis de tobillo localizada: el rol de las
osteotomías. Tobillo y Pie 2013;5(2):114-88. Disponible en: https://jfootankle.com/tobilloypie/article/view/1417
25. Hintermann B, Knupp M, Barg A. Supramalleolar osteotomies for the treatment of ankle arthritis. J Am Acad
Orthop Surg 2016;24(7):424-32. https://doi.org/10.5435/JAAOS-D-12-00124
26. Pagenstert GI, Hintermann B, Barg A, Leumann A, Valderrabano V. Realignment surgery as alternative treatment of varus and valgus ankle osteoarthritis. Clin Orthop Relat Res 2007;462:156-68.
https://doi.org/10.1097/BLO.0b013e318124a462
27. Lim JW, Kang SJ, Im JM, Kwon SH, Jung HG. Evaluation of clinico-radiological outcome of fibular valgization
osteotomy with supra-malleolar osteotomy in patients with ankle osteoarthritis. Int Orthop 2023;47(8):2013-21.
https://doi.org/10.1007/s00264-023-05822-w
28. Kim YS, Kim YB, Koh YG. Prognostic factors affecting correction angle changes after supramalleolar osteotomy using an opening wedge plate for varus ankle osteoarthritis. J Foot Ankle Surg 2019;58(3):417-22.
https://doi.org/10.1053/j.jfas.2018.09.003