Low Tibial Osteotomy

Jun Young Choi; Jin Soo Suh

doi:10.14193/jkfas.2014.18.4.141

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Choi and Suh: Low Tibial Osteotomy

Review Article

J Korean Foot Ankle Soc 2014;18(4):141-146.

Published online: 19 January 2014

DOI: https://doi.org/10.14193/jkfas.2014.18.4.141

Low Tibial Osteotomy

Jun Young Choi, Jin Soo Suh

Department of Orthopedic Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea

Corresponding Author: Jin Soo Suh Department of Orthopedic Surgery, Inje University Ilsan Paik Hospital, 170 Juhwa-ro, Ilsanseo-gu, Goyang 411-706, Korea Tel: 82-31-910-7968, Fax: 82-31-910-7967, E-mail: sjs0506@paik.ac.kr

Received 23 October 201411 November 2014 Accepted 12 November 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Low tibial osteotomy is an extra-articular procedure that realigns the mechanical axis, restoring ankle function. It is also an alternative surgical procedure to manage early osteoarthritis of the ankle joint. This can mainly address ankle varus/valgus, as well as procurvatum/ recurvatum, internal/external rotation, equinus, calcaneus, and limb length discrepancy. The authors describe the history, mechanism, indications, and limitations of low tibial osteotomy focused on osteoarthritis of the ankle with varus malalignment reviewing several articles published thus far.

Keywords: Supramalleolar osteotomy, Ankle, Osteoarthritis

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Figure 1.

(A) Tibial anterior surface angle (TAS) is the angle between tibial axis and distal tibial articular surface on the weightbearing anteroposterior image. (B) Tibial-lateral surface angle (TLS) is the same angle on the weight-bearing lateral image.

Table 1.

Different Results of Low Tibial Osteotomy Varied by Authors

Study	First author	Follow-up	Main conclusion
1	Takakura³²⁾	6 yr 11 mo	18 patients
			Outcome: “excellent” 6, “good” 9, “fair” 3
			TAS 82.3^o→93.8^o; TLS 77.4^o→81.6^o
2	Cheng³⁸⁾	47.7 mo	18 ankles (6 posttraumatic)
			Outcome: rating scale 49.6→88.5; outerbridge classification grade 3, 4→1, 2
			TAS 81^o→90^o; TLS 79^o→82^o
3	Tanaka³³⁾	8 yr 3 mo	25 patients (26 ankles); Takakura stage 2: 3 ankles, 3a: 11 ankles, 3b: 12 ankles
			Outcome: clinical score 51→79
			TAS 82.7^o→98.2^o; TLS 78.5^o→84.7^o; varus tilt angle 7.3^o→5.0^o
4	Lee³⁶⁾	2 yr 3 mo	16 ankles
			Outcome: AOFAS score 62.3→82.1; Takakura stage 2.9→2.3
			Talar tilt 6.6^o→4.5^o; TAS 84.7^o→99.6^o; TLS 74.9^o→84.8^o
5	Park⁵⁰⁾	2 yr 2 mo	9 patients; Takakura stage 2: 1 patient, 3a: 8 patients
			Outcome: AOFAS score 59→89.3; VAS 6.5→0.6
			TAS 83.1^o→93.5^o; TLS 73^o→79^o; talar tilt 4.3^o→2.4^o
6	Pagenstert²¹⁾		35 patients; TARA/ankle fusion was postponed in 91%
7	Knupp⁵¹⁾	45 mo	29 patients; all posttraumatic varus osteoarthritis
			Operative performed: 17 medial opening osteotomy, 12 lateral closing osteotomy
			Outcome: AOFAS score 52→73; VAS 4.4→2.6

TAS: tibial anterior surface angle, TLS: tibial lateral surface angle, AOFAS: American Orthopaedic Foot and Ankle Society, VAS: visual analogue scale

TARA: total ankle replacement arthroplasty.

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