Results of Arthroscopic Ankle Arthrodesis with Fixation Using Two Parallel Headless Compression Screws in a Heterogenic Group of Patients

Abstract

Background:As orthopedic surgeons become skilled in ankle arthroscopy technique and evidence -based data is supporting its use, arthroscopic ankle arthrodesis (AAA) will likely continue to increase, but stabilization methods have not been described clearly. We present a technique for two parallel 7.3-mm headless compression screws fixation (HCSs) for AAA in cases of ankle arthritis with different etiology, both traumatic and non-traumatic, including neuromuscular and inflammatory patients.Materials and Methods:We retrospectively verified 24 consecutive patients (25 ankles) who underwent AAA between 2011 and 2015. The average follow-up was 26 months (range 18 to 52 months). Arthrodesis was performed in 16 patients due to posttraumatic arthritis (in 5 as a sequela of pilon, 6 ankles, 3 tibia fractures, and 2 had arthritis due to chronic instability after lateral ligament injury), in 4 patients due to neuromuscular ankle joint deformities, and in 4 patients due to rheumatoid arthritis.Results:Fusion occurred in 23 joints (92%) over an average of 12 weeks (range 6 to 18 weeks). Ankle arthrodesis was not achieved in 2 joints (8%), both in post-pilon fracture patients. The correct foot alignment was not achieved in 4 feet (16%). None of the treated patients required hardware removal.Conclusion:The presented technique was effective in achieving a high fusion rate in a variety of diseases, decreasing intra- and post-operative hardware complications while maintaining adequate bone stability.

Clinical and Radiological Mid- to Long-term Outcomes Following Ankle Fusion

“…It should be noted, however, that a few patients had poor results with low AOFAS scores and high VAS regarding pain. Neuropathic pain after soft-tissue trauma, painful scars, reduced weight-bearing area of the plantar aspect of the foot due to suboptimal arthrodesis position and osteomyelitis are possible reasons for persisting complaints (5,24,25). One aim of the current study was to determine how long clinical benefit from ankle fusion endures.…”

Re-arthrodesis after primary ankle fusion: 134/1,716 cases from the Swedish Ankle Registry

“… 2017 , Kolodziej et al. 2017 ). A re-arthrodesis rate of 7% was found in 8,474 ankles by Yasui et.al.…”

Pre-Planning Ankle Arthrodesis Using 3d Reconstructed Tomographies

“…High non-consolidation rates reported in all types of fixation make this an important issue. 7,8,15 Many studies focus on the biomechanical stability of different fixation methods 11 ; however, they do not mention how to find the best entry point and the entry angle for the screw, which increases the need for experience and skill of the surgeon, increasing the chance of error. The best positioning and the quantity of screws are still controversial.…”

“…4,5 Screw fixation is the most traditional method, usually made with two crossed screws, one with medial entry and the other with entry. 3,6,7 A third screw was generally added to the anteroposterior axis due to the high incidence of non-consolidations, usually with posterolateral entry into the tibia towards the neck of the talus, known as "home-run" screw ( Figures 1 and 2). [7][8][9][10] The screw is positioned to confront the strong deformation force of the Achilles tendon.…”

“…3,6,7 A third screw was generally added to the anteroposterior axis due to the high incidence of non-consolidations, usually with posterolateral entry into the tibia towards the neck of the talus, known as "home-run" screw ( Figures 1 and 2). [7][8][9][10] The screw is positioned to confront the strong deformation force of the Achilles tendon. [11][12][13] The stability of arthrodesis made only with the screws seems to be sufficient.…”