Supramalleolar Osteotomy With Bone Marrow Stimulation for Varus Ankle Osteoarthritis

Abstract

This study showed improved clinical outcomes after SMO for varus ankle osteoarthritis in comparison to the preoperative assessments. Furthermore, the ICRS grade was significantly associated with the clinical outcomes of SMO at final follow-up and significantly associated with the development of degenerative arthritis of the ankle joint. Therefore, arthroscopic marrow stimulation should be considered with SMO to ensure adequate cartilage regeneration. However, given the ICRS grades observed at the time of the second-look arthroscopies and the progression of degenerative arthritis in 42%, the long-term prognosis in this group of patients is uncertain.

The role of fibular for supramalleolar osteotomy in treatment of varus ankle arthritis: a biomechanical and clinical study

“…The results showed good short- to mid-term outcomes for pain relief, functional improvement, and the resumption of sports and recreation activities [2–5, 7–9, 11, 12, 14–18, 26]. According to the current results, the functional and radiological outcomes all improved significantly (Table 3).…”

“…Previous studies have reported that SMOT could restore the weight-bearing alignment of the ankle joint [3–5], decrease the contact pressure of the medial part of the tibiotalar joint [6], restore the congruence of the tibiotalar joint surface [5, 7, 8], improve the chondromalacia [9], postpone the OA progress [10], and even reverse the radiological ankle OA stages [2, 9, 11, 12]. …”

“…Some authors have proposed combined fibular osteotomy for all SMOT patients [2, 12–16], some have suggested that the fibula should always be preserved [3, 11, 17, 18], and some authors have performed fibular osteotomy depending on the conditions [4, 5, 7, 19]. Few studies have focused on the role of the fibula in SMOT.…”

Effect of Combined Fibular Osteotomy on the Pressure of the Tibiotalar and Talofibular Joints in Supramalleolar Osteotomy of the Ankle: A Cadaveric Study

“…For the medial opening-wedge supramalleolar osteotomy, the osteotomy plane was initiated 4 to 5 cm proximal to the tip of the medial malleolus and directed obliquely toward the syndesmosis, preserving the lateral cortex of the tibia (9,11,13). To create 3 different heights of the osteotomy gap, the osteotomy was stabilized using the H-plate (Arthrex, Naples, FL), which has 3 different block heights (6, 8, and 10 mm) after medial opening of the osteotomy.…”

“…Several clinical studies have reported good results of medial opening-wedge supramalleolar osteotomy with fibular osteotomy for medial ankle arthritis (9,10), but other studies have reported good results with medial opening-wedge supramalleolar osteotomy without fibular osteotomy (11,12). Furthermore, Lee and Cho (13) suggested that their new oblique supramalleolar opening-wedge osteotomy without fibular osteotomy minimizes the adverse effects of mortise distortion and enhances osteotomy site stability by the presence of an intact fibula.…”