Motion Versus Fixed Distraction of the Joint in the Treatment of Ankle Osteoarthritis

Saltzman, Charles L.; Hillis, Stephen L.; Stolley, Mary P.; Anderson, Donald D.; Amendola, Annunziato

doi:10.2106/jbjs.k.00018

Cited by 85 publications

(80 citation statements)

References 43 publications

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“…The authors divided malunions above the ankle joint in 2 main groups: following the bimalleolar fracture (Pott's type) and following the trimalleolar fracture (Cotton's type). The authors identified 3 crucial aims of supramalleolar realignment [7] b (eg, before the application of external fixator in the same surgical setting (one-stage procedure) to remove inflamed synovium, unstable cartilage, loose bodies, fibrotic tissue, osteophytes causing impingement [7] c Debridement of fibrotic tissue and impinging osteophytes in ord e r t o i m p r o v e t h e an k l e dorsiflexion [9] Procedure Indications Joint-preserving procedures Arthroscopy/arthrotomy debridement [6,7] • Ankle symptoms from specific joint conditions a • Anterior ankle impingement • Early-stage ankle osteoarthritis with intact joint space a • Posterior tibial osteophytes; posterior impingement symptoms…”

Section: Historical Perspective On Supramalleolar Osteotomymentioning

confidence: 99%

“…• Patients with advanced-stage ankle osteoarthritis with joint space narrowing, combined with ankle distraction procedure c Distraction arthroplasty [8,9] • Patients with mid-stage or advanced-stage ankle osteoarthritis with relatively congruent tibiotalar joint surface and well-preserved ankle joint mobility • Younger patients (younger than 50 years) with post-traumatic ankle osteoarthritis • Partial avascular necrosis of the talus Osteochondral ankle joint resurfacing [10] • Primary symptomatic osteochondral lesions generally after failed arthroscopic curettage and debridement. Corrective osteotomies [11•, 12, 13] • see the text…”

Section: Historical Perspective On Supramalleolar Osteotomymentioning

confidence: 99%

See 1 more Smart Citation

Single-Stage Supramalleolar Osteotomy for Coronal Plane Deformity

Barg

Saltzman

2014

Curr Rev Musculoskelet Med

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A variety of surgical procedures are utilized for management of ankle osteoarthritis. The most common etiology in patients with ankle osteoarthritis is post-traumatic often resulting in asymmetric ankle osteoarthritis with concomitant valgus or varus deformity. A substantial part of tibiotalar joint is often preserved, therefore, in appropriate patients, jointpreserving surgery holds the potential to be a superior treatment option than joint-sacrificing procedures including total ankle replacement or ankle arthrodesis. This review is designed to describe indications and contraindications for single-stage supramalleolar realignment surgery. Complications associated with this type of surgery and postoperative outcome are highlighted using recent literature.

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Section: Historical Perspective On Supramalleolar Osteotomymentioning

confidence: 99%

Section: Historical Perspective On Supramalleolar Osteotomymentioning

confidence: 99%

Single-Stage Supramalleolar Osteotomy for Coronal Plane Deformity

Barg

Saltzman

2014

Curr Rev Musculoskelet Med

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“…A relatively new surgical procedure intended for joint preservation, distraction arthroplasty, does not use any graft material. This procedure employs an external fixator which crosses the ankle joint and applies a distraction force across the tibio-talar articulation [6, 12, 17]. The theory behind distraction arthroplasty is that it allows for the reparative potential of the joint by removing mechanical stress.…”

Section: Introductionmentioning

confidence: 99%

Distraction arthroplasty compared to other cartilage preservation procedures in patients with post-traumatic arthritis: a systematic review

Rivera¹,

Beachler²

2018

Strategies in Trauma and Limb Reconstruction

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Post-traumatic arthritis (PTA) is characterized by the deterioration of articular cartilage temporally associated with an articular injury. With a paucity of literature comparing joint preservation techniques, we performed a systematic review of the literature intending to describe and summarize the results of ankle distraction arthroplasty as it compares with studies on tibio-talar microfracture, allograft, and autograft for ankle joint preservation in the post-traumatic population under 50 years of age. Research databases were searched and abstracts screened for relevance on our topic of interest. Abstracts meeting screening criteria with high interobserver reliability underwent full-manuscript review and coding for pertinent citation, study level, treatment, and outcome variables. Outcome variables for patient-reported pain scales, validated outcome measurement tools, radiographic progression, reoperation/re-treatment rates, and complication rates were recorded. Out of 105 unique citations, 10 publications were included. The distraction arthroplasty studies had 36 out of 181 patients requiring reoperation for complications (19.9%), while other joint-preserving procedures studies had 40 out of 177 patients requiring reoperations for complications (22.6%). Clinical outcome scores at mean follow-up time ranging from 2 to 10 years between studies were similar. Reported results for a variety of cartilage preservation procedures, including distraction arthroplasty, are satisfactory and reoperation rates for complication are similar. Limitations in available data and underlying study quality affect synthesis of the results therein. While distraction arthroplasty is an option for cartilage preservation in patients with PTA of the ankle, the technique is highly specialized which may affect the external validity.Level of evidence: III.

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“…Distraction arthroplasty is indicated for endstage ankle OA with nearly normal alignment in young patients who would prefer to delay arthrodesis or arthroplasty (17). The patients should be compliant with treatment.…”

Section: Operative Treatmentmentioning

confidence: 99%

“…More recently, Tellisi et al (21) reported improvement in the AOFAS scale and Medical Outcomes Study short-form 36-item questionnaire scores in a retrospective cohort of 23 patients at 30 months using the distraction arthroplasty in conjunction with adjunctive procedures. Saltzman et al (17) reported improvements in the outcome scores with both fixed and motion distraction and that motion improved the outcome scores further compared with fixed distraction; however, adding motion to the ring fixator did not improve the range of movement.…”

Section: Operative Treatmentmentioning

confidence: 99%