Abstract
BackgroundArthroscopic ankle arthrodesis (AAA) is recognized as the standard treatment for the end-stage ankle arthritis. Two-screw configuration fixation is a typical technique for AAA; however, no consensus has been reached on how to select most suitable inserted position and direction. For better joint reduction, we developed a new configuration (2 home run-screw configuration: 2 screws are inserted from the lateral-posterior and medial-posterior malleolus into the talar neck) and investigated whether it turned out to be better than the other commonly used 2-screw configurations.MethodsIn this study, we investigated three kinds of 2-screw configurations: 2 “home run”-screw configuration (group A), crossed transverse configuration (the screw is inserted from the medial malleolus into the anterior talus and the other from the lateral tibia maintains posterior talus, group B), and 2 parallel screw configuration (2 parallel screws are inserted from the posteromedial side of the tibia into talus, group C). The effects of the above three insertions on the loading stress of the tibio-talar joint were comparatively analyzed with a three-dimensional finite element model.ResultsGroup A was better than groups B and C in respect of stress distribution uniformity and superior to both groups B and C in anti-flexion strength and anti-internal rotation strength. Group A was slightly worse than group C but better than group B in anti-dorsiflexion and anti-valgus and varus strength.ConclusionsTwo “home run”-screw configuration facilitates the reduction of anterior talus dislocation of end-stage ankle arthritis. Our finite element analysis demonstrates the configuration is superior to crossed transverse and parallel configuration for arthroscopic ankle arthrodesis in terms of stress distribution and initial stability.
Highlights
Arthroscopic ankle arthrodesis (AAA) is recognized as the standard treatment for the end-stage ankle arthritis
Three different forms of assembly were used to represent the 2 “home run”-screw configuration (2 screws are inserted from the lateral-posterior and medial-posterior malleolus into the talar neck, group A, Fig. 1a), crossed transverse configuration, and 2 parallel screws configuration (2 parallel screws are inserted from the posteromedial side of the tibia into talus, group C, Fig. 1c)
Stress distribution of ankle arthrodesis Considering that the models contained many nodes and elements, the maximum stress of each part, the maximum, and the average von Mises stress of the contact surface were calculated and are shown in Table 6 and Figs. 3 and 4
Summary
Arthroscopic ankle arthrodesis (AAA) is recognized as the standard treatment for the end-stage ankle arthritis. Two-screw configuration fixation is a typical technique for AAA; no consensus has been reached on how to select most suitable inserted position and direction. We developed a new configuration (2 home run-screw configuration: 2 screws are inserted from the lateral-posterior and medial-posterior malleolus into the talar neck) and investigated whether it turned out to be better than the other commonly used 2-screw configurations. Ankle arthrodesis is still the most important treatment for the end-stage ankle arthritis [1]. Arthroscopic ankle arthrodesis (AAA) has been shown to offer the advantages of better clinical scores, fewer complications, a shorter hospital stay, and less blood loss compared with open ankle arthrodesis (OAA) [2, 3]. Cannulated screws are commonly utilized for internal fixation. Zhu et al Journal of Orthopaedic Surgery and Research (2018) 13:263
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