Supramalleolar Tibial Osteotomy for Medial Compartment Ankle Osteoarthritis

Jong-Tae Park; Joon-Sang Eom; Hong-Geun Jung

doi:10.4055/jkoa.2013.48.2.89

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Park, Eom, and Jung: Supramalleolar Tibial Osteotomy for Medial Compartment Ankle Osteoarthritis

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2013; 48(2): 89-95.

Published online: 25 April 2013

DOI: https://doi.org/10.4055/jkoa.2013.48.2.89

Supramalleolar Tibial Osteotomy for Medial Compartment Ankle Osteoarthritis

Jong-Tae Park, M.D., Joon-Sang Eom, M.D., Hong-Geun Jung, M.D., Ph.D.

Department of Orthopedic Surgery, Konkuk University School of Medicine, Seoul, Korea.

Correspondence to: Hong-Geun Jung, M.D., Ph.D. Department of Orthopedic Surgery, Konkuk University School of Medicine, 120 Neungdong-ro, Gwangjin-gu, Seoul 143-729, Korea. TEL: +82-2-2030-7609, FAX: +82-2-2030-7369, jungfoot@hanmail.net

Received 2 September 2012 Revised 28 October 2012 Accepted 28 November 2012

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The aim of this study is to evaluate the clinical and radiologic outcomes of supramalleolar tibial osteotomy for medial compartment ankle osteoarthritis (OA) and to verify the efficacy of the supramalleolar osteotomy.

Materials and Methods

This study is based on 9 ankles of the medial compartment ankle OA treated with supramalleolar tibial osteotomy from August 2007 to June 2011 with at least 1 year follow-up. As for the functional evaluation, visual analogue scale (VAS) pain scores and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores were evaluated. On radiographs, tibial anterior surface (TAS) angles, tibial lateral surface angles were measured. The severity of ankle OA was classified by the Takaura staging system.

Results

The mean VAS pain scores improved to 0.6 and AOFAS scores improved to 89.3. Radiographically, TAS angle increased to 93.5° postoperatively. Seven ankles showed improvement of the ankle arthritis grading from IIIa to II according to Takakura's staging.

Conclusion

Supramalleolar tibial osteotomy for patients with medial compartment varus ankle OA showed satisfactory clinical and radiological outcome. We confirmed that the procedure is recommendable for medial compartment varus ankle OA especially for Takakura stage IIIa.

Keywords: medial compartment ankle osteoarthritis, supramalleolar tibial osteotomy, Takakura stage

Figures and Tables

Figure 1

(A) Anteroposterior view demonstrates measurement of tibial anterior surface angle (TAS) and talar tilt angle (TT). (B) Measurement of wedge angle (astrix) and wedge height (arrow). (C) Lateral view demonstrates measurement of tibial lateral surface angle (TLS).

Figure 2

A 55-year-old woman with medial compartment ankle osteoarthritis. (A) Preoperative standing radiograph (B) treated by supramalleolar tibial and fibula osteotomies, which resulted in an excellent functional outcome.

Table 1

Takakura Stage of Ankle Osteoarthritis7)

Table 2

Demographic Data of the Patients

R/L, right/left; Preop., preoperative; Postop., postoperative; AOFAS, American Orthopaedic Foot and Ankle Society; VAS, visual analogue scale; ROM, range of motion; DF/PF, dorsiflexion/plantarflexion; F, female; M, male.

Table 3

Radiological Evaluation of the Patients

Osteotomy angle is formed by a line drawn from medial osteotomy cortex to lateral osteotomy cortex and tibial plafond (Case 1 was done transverse osteotomy, and another 8 ankles was done oblique osteotomy. Mean osteotomy angle is calculated except one transverse osteotomy angle). Preop., preoperative; Postop., postoperative; TAS, tibial anterior surface; TLS, tibial lateral surface; F, female; M, male.

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