SLR - December 2011 - Jeremy Perse
Reference: Lee, W.C., Moon, J.S., Lee, K., Byun, W.J., Lee, S.H., (2011). Indications for Supramalleolar Osteotomy in Patients with Ankle Osteoarthritis and Varus Deformity. The Journal Of Bone & Joint Surgery, Inc., July 2011. 93, 1243-1248
Scientific Literature Review
Reviewed by: Jeremy Perse, DPM
Residency Program: University Hospitals Richmond Medical Center & OCPM
Podiatric Relevance:
The aim of this study was to determine the efficacy of supramalleolar osteotomy for the treatment of ankle joint osteoarthritis and varus heel deformity.
Methods:
Supramalleolar tibial osteotomy was used for the treatment of ankle osteoarthritis in sixteen ankles of sixteen patients. The mean patient age was 55.2 years and the median post operative follow-up period was 2.3 years. The modified Takakura classification system was used for evaluation of osteoarthritis. Stage 1 indicates sclerosis and osteophyte formation without joint space narrowing; Stage 2, medial joint space narrowing; Stage 3A, loss of medial joint space with subchondral bone contact limited to the medial malleolus; Stage 3B, subchondral bone contact extending to the roof of the dome of the talus; Stage 4, loss of the entire joint space with subchondral bone contact throughout the entire ankle joint. Radiographic weight-bearing assessment was also performed using anteriorposterior, lateral, and hindfoot relationships. Clinical assessment was performed using the American Orthopaedic Foot & Ankle Society (AOFAS) scale. Clinical and postoperative talar tilt and degree of lateral subfibular pain were compared clinically and radiographically.
Results:
The mean AOFAS score, radiographic stage, and values for all radiographic parameters improved following surgery. The mean AOFAS score was higher (p=0.02) and the mean radiographic stage was lower (p=0.03) in the group with low postoperative talar tilt as compared to the group with high talar tilt. Lateral subfibular pain correlated with lower AOFAS scores, greater postoperative angulation between the tibia and ankle joint surface, and greater postoperative heel valgus.
Conclusions:
This study highlights the potential efficacy of supramalleolar osteotomy for the correction of ankle joint osteoarthritis. The supramalleolar osteotomy can be an effective and reliable procedure for the treatment of ankle joint osteoarthritis in patients with minimal talar tilt and neutral to varus heel alignment.