Abstract
BackgroundMalalignment of the ankle joint has been found after trauma, by neurological disorders, genetic predisposition and other unidentified factors, and results in asymmetrical joint loading. For a medial open wedge supramalleolar osteotomy(SMO), there are some debates as to whether concurrent fibular osteotomy should be performed. We assessed the changes in motion of ankle joint and plantar pressure after supramalleolar osteotomy without fibular osteotomy.MethodsTen lower leg specimens below the knee were prepared from fresh-frozen human cadavers. They were harvested from five males (10 ankles)whose average age was 70 years. We assessed the motion of ankle joint as well as plantar pressure for SS(supra-syndesmotic) SMO and IS(intra-syndesmotic) SMO. After the osteotomy, each specimen was subjected to axial compression from 20 N preload to 350 N representing half-body weight. For the measurement of the motion of ankle joint, the changes in gap and point, angles in ankle joint were measured. The plantar pressure were also recorded using TekScan sensors.ResultsThe changes in the various gap, point, and angles movements on SS-SMO and IS-SMO showed no statistically significant differences between the two groups. Regarding the shift of plantar center of force (COF) were noted in the anterolateral direction, but not statistically significant.ConclusionsSS-SMO and IS-SMO with intact fibula showed similar biomechanical effect on the ankle joint. We propose that IS-SMO should be considered carefully for the treatment of osteoarthrosis when fibular osteotomy is not performed because lateral cortex fracture was less likely using the intrasyndesmosis plane because of soft tissue support.
Highlights
Malalignment of the ankle joint has been found after trauma, by neurological disorders, genetic predisposition and other unidentified factors, and results in asymmetrical joint loading
Lee et al reported that the incidence of lateral cortical fracture in medial open wedge supramalleolar osteotomies (SMO) was less likely to occur at the proximal one-third of the intrasyndesmosis than the suprasyndesmosis [10]
The purpose of this study was to describe the impact of SS-SMO and intrasyndesmotic(IS) SMO with intact fibula on ankle joint motion and plantar pressure and to determine which technique seems to better re-establish ankle alignment in the absence of fibular osteotomy
Summary
Malalignment of the ankle joint has been found after trauma, by neurological disorders, genetic predisposition and other unidentified factors, and results in asymmetrical joint loading. For a medial open wedge supramalleolar osteotomy(SMO), there are some debates as to whether concurrent fibular osteotomy should be performed. We assessed the changes in motion of ankle joint and plantar pressure after supramalleolar osteotomy without fibular osteotomy. Malalignment of the ankle joint can occur because trauma, neurological disorders, genetic predisposition and other unidentified factors, and result in asymmetrical joint loading [1, 2]. Asymmetric and neutral osteoarthritis can reportedly be treated with realignment surgery [3] Both open and close wedge supramalleolar osteotomies (SMO) have been done for the treatment of malalignment of the ankle joint in adults [4]. The purpose of this study was to describe the impact of SS-SMO and intrasyndesmotic(IS) SMO with intact fibula on ankle joint motion and plantar pressure and to determine which technique seems to better re-establish ankle alignment in the absence of fibular osteotomy
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