The Treatment of Severe Posttraumatic Arthritis of the Ankle Joint

Abstract

Posttraumatic ankle arthritis consists of a progressive alteration of the hyaline cartilage, sclerosis of the subchondral bone, and osteophyte and loose-body formation as a result of an ankle injury. It may develop after nonoperative or surgical repair of an ankle injury in the form of cartilage damage, lateral malleolus malunion with shortening and valgus deformity, tibial plafond disruption and cartilage damage, malunion or necrosis of the talus, or joint instability1-5. The aim of the current study was to present our treatment guidelines for severe posttraumatic stage-2 or 3 ankle arthritis6 on the basis of the results for a series of 190 patients. One hundred and ninety patients ranging from seventeen to seventy years of age who had stage-2 or 3 posttraumatic ankle arthritis (Table I) were managed between 1994 and 2004. View this table: TABLE I Ankle Arthritis Classification System Surgical strategies were decided according to the stage of arthritis, the age of the patient, the quality of joint alignment, and the range of motion of the adjacent foot joints (the midtarsal, Lisfranc, and subtalar joints) according to the algorithm described in Table II. View this table: TABLE II Decision-Making Algorithm All patients were examined clinically and radiographically, and the American Orthopaedic Foot and Ankle Society (AOFAS) clinical rating score7 was calculated both preoperatively and at the time of follow-up. The AOFAS score was graded as excellent (80 to 100), good (70 to 79), fair (60 to 69), or poor (≤59). Patients who were managed with allograft were also studied with computed tomography and magnetic resonance imaging. A cartilage biopsy was performed during hardware removal at 1.5 years of follow-up. ### Surgical Strategies #### Stage-2 Arthritis with Preserved Ankle Anatomy: Arthroscopic Debridement and Ankle Arthrodiastasis (Fig. 1) Twelve patients ranging from twenty-one to forty-eight years of age were managed with arthroscopic debridement and arthrodiastasis with an external fixator8. Standard arthroscopic approaches were used, and debridement of degenerated cartilage …