Anterior distal tibial plafond-plasty for the treatment of posttraumatic ankle osteoarthritis with anterior translation of the talus

Xingchen Li,Yuan Zhu,Chonglin Yang,Xiangyang Xu,Yang Xu,Changjun Guo

doi:10.1038/s41598-021-83946-y

Xingchen Li, Yuan Zhu + Show 4 more

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https://doi.org/10.1038/s41598-021-83946-y

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Journal: Scientific Reports	Publication Date: Feb 23, 2021
Citations: 4	License type: open-access

Affiliation: Ruijin Hospital, Shanghai Jiao Tong University

Abstract

Posttraumatic ankle osteoarthritis (OA) represents a significant challenge to orthopedic surgeons, especially in cases of anterior talar translation and concomitant impaction of the anterior distal tibial plafond. The aim of this study was to evaluate the clinical outcomes of an intra-articular osteotomy for the management of these patients. A total of 21 patients meeting our criteria were retrospectively reviewed. Sixteen patients sustained initial pilon fractures, while five patients had Weber type C ankle fractures. Anterior distal tibial plafond-plasty was performed to address the impaction and anterior translation of the talus. The American Orthopedic Foot and Ankle Society (AOFAS) hindfoot score and visual analog scale (VAS) score were utilized as clinical outcomes. The lateral talar station (LTS), tibial lateral surface (TLS) angle, tibial anterior surface angle and talocrural angle were evaluated pre- and postoperatively. The modified Kellgren-Lawrence score was used for the evaluation of sagittal ankle OA. The average age at surgery was 35 years, and the average follow-up duration was 34 months. The AOFAS hindfoot score increased from 26 to 71 (p < 0.01), and the VAS score improved from 7 to 2 (p < 0.01). The LTS improved from 9.0 to 2.3 mm (p < 0.01), and the TLS angle improved from 72° to 81° (p < 0.01). Of the 21 patients, 18 showed improvement in or no worsening of ankle OA on the sagittal plane, while 3 developed advanced ankle OA. A congruent ankle joint on the sagittal plane could be achieved by anterior distal tibial plafond-plasty. This is a valuable treatment option for the salvage of posttraumatic ankle OA with anterior translation of the talus.

Highlights

Posttraumatic ankle osteoarthritis (OA) represents a significant challenge to orthopedic surgeons, especially in cases of anterior talar translation and concomitant impaction of the anterior distal tibial plafond
For selected patients with mild to mid-stage ankle OA, corrective osteotomy could be an alternative for salvage of the ankle joint
We felt that a series of intra-articular osteotomies of the distal tibial plafond would help to achieve a congruent ankle joint on the sagittal plane

Summary

Introduction

Posttraumatic ankle osteoarthritis (OA) represents a significant challenge to orthopedic surgeons, especially in cases of anterior talar translation and concomitant impaction of the anterior distal tibial plafond. A congruent ankle joint on the sagittal plane could be achieved by anterior distal tibial plafond-plasty. This is a valuable treatment option for the salvage of posttraumatic ankle OA with anterior translation of the talus. The philosophy of supramalleolar osteotomy is to shift the load and redistribute the stress within the ankle joint by rearranging the alignment of the hindfoot Most of these reports have focused on deformity correction on the coronal plane. Scheidegger et al.[16] reported a retrospective study of flexion osteotomy in a total of 39 patients with distal tibial recurvatum deformity This technique was designed to correct extra-articular deformity on the sagittal plane.

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