Ankle fusion outcomes utilizing anterior ankle plating techniques: A systematic review

Abstract

Ankle arthrodesis is a time-tested surgical treatment for end-stage ankle arthritis. Fixation constructs continue to evolve with recent advancements in anterior ankle plating. A systematic review of anterior approach ankle arthrodesis using anterior plating was performed to analyze outcomes such as time to weight bearing, union rate, and complications. A systematic literature search was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed. Inclusion criteria were as follows: 1) prospective or retrospective comparative study or consecutive case series reporting clinical outcomes following ankle arthrodesis; 2) surgeon technique includes anterior incisional approach with anterior plating construct; 3) minimum 3 months follow-up; and 4) reported outcomes including time to weight bearing, union or nonunion rate, complications, and patient population characteristics including age and comorbidities. Thirteen citations met inclusion criteria. Studies were organized into three groups based on similar time to weightbearing protocols. Mean time to weightbearing was as follows: Group A. 0.6 weeks, Group B. 6 weeks, and Group C. 9 weeks with fusion rates of 95.1%, 94.6%, and 97.7%, respectively. The average time to weightbearing post-operation across all groups was 4.6 weeks with a mean union rate of 95.5% (range 82.4-100%). Wound healing complications and infection rates did not increase with earlier weight bearing guidelines. This systemic review revealed comparable fusion rates across different weight bearing regimens following anterior plate fixation for ankle arthrodesis, supporting re-evaluation of historically accepted post-operative weightbearing protocols.