Supramalleolar osteotomy for the treatment of ankle osteoarthritis leads to favourable outcomes and low complication rates at mid-term follow-up: a systematic review

Abstract

Purpose The purpose of this systematic review was to evaluate both the clinical and radiographic outcomes following supramalleolar osteotomy (SMO) in patients with ankle osteoarthritis, and to analyse the level of evidence (LOE) and quality of evidence (QOE) of the included studies. Methods A systematic review of the MEDLINE, EMBASE, and Cochrane Library databases was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies reporting clinical data following SMO for the treatment of ankle osteoarthritis were included and assessed. The level and quality of evidence of the included studies were also evaluated. Results Twenty-four studies with 1160 patients (1182 ankles) were included. Overall, 78.8% patients presented with posttraumatic ankle osteoarthritis. The weighted mean AOFAS score improved from 52.6 ± 9.7 (range 33.8-78.4) preoperatively to 78.1 ± 5.7 postoperatively at weighted mean follow-up of 50.4 ± 18.6 months (range 24.5-99.0). The most frequently utilised radiographic parameter was the tibial anterior surface angle, which improved from a preoperative weighted mean of 86.3° ± 5.6° (range 76.0°-102.0°) to a postoperative weighted mean of 89.9° ± 3.7° (range 84.9°-99.6°). The complication rate was 5.1% with non-union as the most commonly reported complication (1.6%). Secondary procedures were carried out in 28.2% of patients, the most common of which was implant and hardware removal (17.6%). The failure rate was 6.8%. Two studies were LOE II, 3 studies were LOE III, and 19 studies were LOE IV. The mean Modiied Coleman Methodology Score was 59.3 ± 6.6 and the mean MINORS criteria score of all the included studies was 9.5 ± 3.7. Conclusion This systematic review demonstrates good clinical and radiological outcomes, together with a low failure rate at mid-term follow-up following supramalleolar osteotomy in patients with ankle osteoarthritis. However, a moderate reoperation rate (28.2%) was reported. A low failure rate (6.8%) was reported, which must be interpreted in light of the shortcomings of the design of the included studies and a relatively short follow-up period. In addition, there is a low level and quality of evidence in the current literature with inconsistent reporting of data which underscores the need for further higher quality research to be conducted. Our review highlights that SMO may be an efective and safe procedure in the setting of early-tointermediate-stage ankle osteoarthritis.

Comparative Efficacy of SMOT with Ilizarov Technique and SMOT with Internal Fixation in Varus Ankle Osteoarthritis

“…In the surgical treatment of varus ankle osteoarthritis, arthroscopic debridement, medial distraction arthroplasty, and SMOT have gained wide attention for their advantages in pain relief and increased ROM without sacri cing the ankle joint. In recent years, numerous clinical studies on SMOT have consistently demonstrated its effective deformity correction, satisfactory outcomes, and good clinical e cacy, making it an increasingly preferred option for joint-preserving surgery in patients with varus ankle osteoarthritis [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] . SMOT techniques include closed wedge, open wedge, dome osteotomy, tractional, rotational, and stepped osteotomy, often combined with other surgical approaches.…”

“…This surgical technique can effectively correct deformities, restore joint alignment, preserve joint function, improve articular cartilage conditions, protect the epiphyseal plates in adolescents, delay the progression of OA, and postpone or avoid ultimate surgeries. It is suitable for patients aged <65 years, with higher body mass index (BMI), varus deformity >15° associated with ankle osteoarthritis, ankle fusion contraindication, subtalus deformities, and previous treatment or alternative options before ultimate surgery [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] . The Ilizarov technique can achieve deformity correction through bone and soft tissue traction methods and is suitable for patients with reduced bone quality, poor soft tissue conditions, poor coverage, leg length discrepancy, and unstable complex deformity osteotomy sites [26][27][28][29][30][31][32][33][34][35][36] .…”

A Review on Phytopharmacological Properties of Caesalpinia crista

“…Osteoarthritis (OA) is a chronic pain disease with whole arthropathies such as synovitis, osteophyte formation etc [1][2][3][4] . OA showed the articular cartilage degeneration and persistent pain, causing disability, loss of function, decreased quality of life [5][6][7] .…”