Abstract
BackgroundSupramalleolar osteotomy (SMOT) is a well-accepted treatment method for mid-stage varus ankle osteoarthritis (OA). However, few studies have examined the role of fibular osteotomy in SMOT. The objective of the current study was to compare the biomechanical and clinical outcomes of SMOT with and without fibular osteotomy.MethodsEight cadaveric lower legs with 10° varus/valgus SMOT models were tested using a Tekscan ankle sensor. Tibiotalar joint contact with and without fibular osteotomy conditions were compared. Forty-one varus ankle OA patients treated with SMOT were included; 22 underwent fibular osteotomy, and 19 did not. The Maryland foot score and radiological angles were used for clinical evaluation.ResultsThe mean contact area and pressure did not differ significantly between normal and varus/valgus conditions with the fibula preserved. After fibular osteotomy, the mean contact area decreased and the mean contact pressure increased significantly in varus and valgus conditions (P < 0.01). The loading center moved to the opposite direction with and without fibular osteotomy in varus/valgus conditions. After a mean follow-up of 36.6 months (range 17–61), there was no significant difference in the Maryland scores of the two groups. However, in the fibular osteotomy group, the talar tilt angle decreased (P < 0.05), and the tibiocrural angle improved significantly (P < 0.01).ConclusionsFibular osteotomy facilitates the translation of tibiotalar contact pressure and is helpful for varus ankle realignment in patients with large talar tilts and small tibiocrural angles.
Highlights
Supramalleolar osteotomy (SMOT) is a well-accepted treatment method for mid-stage varus ankle osteoarthritis (OA)
Some authors have proposed combined fibular osteotomy for all SMOT patients [2, 12,13,14,15,16], some have suggested that the fibula should always be preserved [3, 11, 17, 18], and some authors have performed fibular osteotomy depending on the conditions [4, 5, 7, 19]
Stufkens et al [6] reported that the tibiotalar contact force shifted in different directions with and without fibular osteotomy after SMOT
Summary
Supramalleolar osteotomy (SMOT) is a well-accepted treatment method for mid-stage varus ankle osteoarthritis (OA). Few studies have examined the role of fibular osteotomy in SMOT. The objective of the current study was to compare the biomechanical and clinical outcomes of SMOT with and without fibular osteotomy. Supramalleolar osteotomy (SMOT) was first introduced by the American authors Speed and Boyd in 1936 [1] and was popularized after Takakura’s report in 1995 for the treatment of early- and mid-stage asymmetric ankle osteoarthritis (OA) [2]. Stufkens et al [6] reported that the tibiotalar contact force shifted in different directions with and without fibular osteotomy after SMOT. No clinical study has directly compared the outcomes of SMOT patients with and without fibular osteotomy. We hypothesized that (1) the tibiotalar joint contact area and stress changes differ in
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