Introduction Supramalleolar osteotomies have been reported to be effective in the treatment of moderate primary and traumatic osteoarthritis of the ankle joint.
Step 1: Arthroscopic Examination Perform an arthroscopic examination prior to the osteotomy in every patient to evaluate the status of the articular cartilage of the tibia and talus.
Step 2: Fibular OsteotomyBend a seven-hole plate slightly more than the natural contour of the distal part of the fibula, insert screws, and complete the osteotomy.
Step 3: Tibial OsteotomyAttempt to achieve a tibial-talar angle of 95° (5° of valgus).
Step 4: Fixation and Bone-Grafting of Tibial Osteotomy SiteApply a seven-hole plate and pack graft into the osteotomy gap.
Step 5: Postoperative Care After routine wound closure, apply a short leg cast and do not allow weight-bearing for six weeks after surgery.
Results In our series of sixteen patients with moderate medial ankle osteoarthritis, the mean American Orthopaedic Foot & Ankle Society (AOFAS) score, radiographic stage, and values for all radiographic parameters measured improved significantly after surgery.
What to Watch For Indications
Pitfalls & Challenges
Supramalleolar osteotomies have been reported to be effective in the treatment of moderate primary and traumatic osteoarthritis of the ankle joint1-5 The osteotomy is designed to shift the weight-bearing axis to the lateral side of the ankle joint and unload the medial side of the joint. However, Tanaka et al.3 reported that the joint space cannot be restored to normal in ankles with >10° of talar tilt.
In our experience, a supramalleolar osteotomy has been effective clinically and radiographically in the treatment of moderate ankle osteoarthritis with a small amount of preoperative talar tilt and varus or normal heel alignment. The reconstruction occurs in five stages (Video 1):
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