Treatment of symptomatic end-stage osteoarthritis of the ankle with anterolateral approach and an anatomical plate

Abstract

The aim of this paper is to describe the anterolateral approach using an anatomical plate for ankle arthrodesis and to present the first mid-term results with this technique in ahigh-risk population. The indication for arthrodesis of the ankle joint with this described technique is moderate to severe osteoarthritis of the ankle. In addition to the general contraindications typical of any operation, there is a specific contraindication in cases of active infection of the soft tissues and accompanying osteomyelitis at the ankle. The incision is made along the course of the peroneus tertius muscle. After that, the mobilization of the peroneus superficialis nerve is carried out, followed by the mobilization of the long extensor tendons, especially the extensor digitorum muscle in amedial direction opening the capsule and removal of the residual cartilage on the distal tibia and talus. Subsequently, the subchondral sclerosis is opened, and the implantation of a suitable osteosynthesis material, e.g., an anatomical angle-stable plate, is carried out. Finally, wound closure is performed involving the muscle belly of the extensor digitorum muscle covering the plate. Immobilization of the ankle for 5-7days in adorsal knee-high splint. Retention in awalker after decongestion for another 5weeks. Increased loading can be done after X‑ray/computed tomography (CT) control from the 6thweek. In all, 11patients were observed retrospectively for an average of 14months. There were no complications. The European Foot and Ankle Society (EFAS) score improved significantly from 3.3 to 17.8 points. All patients were subjectively satisfied with the result and would have the operation again.