J Korean Foot Ankle Soc.  2017 Dec;21(4):122-127. 10.14193/jkfas.2017.21.4.122.

Supramalleolar Osteotomy for Moderate Degenerative Ankle Osteoarthritis

• Kang JM
• Lee MJ

• KMID: 2398008
• DOI: http://doi.org/10.14193/jkfas.2017.21.4.122

Abstract

This paper reviews the indications and surgical technique of supramalleolar osteotomy as one of the treatments for moderate degenerative ankle osteoarthritis. Although it is technically demanding and requires extensive preoperative planning, supramalleolar osteotomy will be a good treatment option for moderate degenerative ankle osteoarthritis. The osteotomy is designed to shift the weightbearing axis to the lateral side of the ankle joint and unload the medial side of the joint. In our experience, a supramalleolar osteotomy is effective to the treatment of moderate ankle osteoarthritis with a small amount of preoperative talar tilt and varus or normal heel alignment.

Keyword

Osteoarthritis; Ankle; Osteotomy

MeSH Terms

Ankle Joint
Ankle*
Heel
Joints
Osteoarthritis*
Osteotomy*
Weight-Bearing

Figure

• 

  Figure 1. Arthroscopic examination prior to the osteotomy shows a cartilage lesion of the talar dome and medial side of the ankle joint.

• 

  Figure 2. Exposure of medial surface of the distal part of the tibia. Mark the osteotomy site with a Kirschner wire.

• 

  Figure 3. Drill multiple holes at the osteotomy site.

• 

  Figure 4. Connect the holes with a thin osteotome while sparing the lateral tibial cortex.

• 

  Figure 5. Split the medial tibial surface by inserting stacked thin osteo-tomes into the gap.

• 

  Figure 6. Use fluoroscopy to confirm the position. (A) Position of the Kirschner wires and thin osteotome. (B) Check the degree of correction of the tibial plafond. (C) Maintain the opening of the osteotomy site by bone spreader.

• 

  Figure 7. Insertion the appropriate size of the opening wedge by allograft.

• 

  Figure 8. Preoperative weightbearing anteroposterior ankle radiograph.

• 

  Figure 9. Postoperative weightbearing anteroposterior ankle radiograph showing the gap in the osteotomy site packed with allograft.

Reference

11.Valderrabano V., Horisberger M., Russell I., Dougall H., Hinter-mann B. Etiology of ankle osteoarthritis1 Clin Orthop Relat Res1. 2009. 467:1800–61.

21.Thomas RH., Daniels TR. Ankle arthritis1 J Bone Joint Surg Am1. 2003. 85:923–361.

31.Cheng YM., Huang PJ., Hung SH., Chen TB., Lin SY. The surgical treatment for degenerative disease of the ankle1 Int Orthop1. 2000. 24:36–91.

41.Pagenstert GI., Hintermann B., Barg A., Leumann A., Valderrabano V. Realignment surgery as alternative treatment of varus and valgus ankle osteoarthritis1 Clin Orthop Relat Res1. 2007. 462:156–681.

51.Tanaka Y., Takakura Y., Hayashi K., Taniguchi A., Kumai T., Sugimoto K. Low tibial osteotomy for varus-type osteoarthritis of the ankle1 J Bone Joint Surg Br1. 2006. 88:909–131.

61.Stamatis ED., Cooper PS., Myerson MS. Supramalleolar osteotomy for the treatment of distal tibial angular deformities and arthritis of the ankle joint1 Foot Ankle Int1. 2003. 24:754–641.

71.Takakura Y., Tanaka Y., Kumai T., Tamai S. Low tibial osteotomy for osteoarthritis of the ankle1 Results of a new operation in 18 patients1 J Bone Joint Surg Br1. 1995. 77:50–41.

81.Lee WC., Moon JS., Lee K., Byun WJ., Lee SH. Indications for supramalleolar osteotomy in patients with ankle osteoarthritis and varus deformity1 J Bone Joint Surg Am1. 2011. 93:1243–81.

91.Park JT., Eom JS., Jung HG. Supramalleolar tibial osteotomy for medial compartment ankle osteoarthritis1 J Korean Orthop As-soc1. 2013. 48:89–951.

101.Jung HG., Lee DO., Lee SH., Eom JS. Second-look arthroscopic evaluation and clinical outcome after supramalleolar osteotomy for medial compartment ankle osteoarthritis1 Foot Ankle Int1. 2017. 38:1311–71.

111.Kim YS., Park EH., Koh YG., Lee JW. Supramalleolar osteotomy with bone marrow stimulation for varus ankle osteoarthritis: clinical results and second-look arthroscopic evaluation1 Am J Sports Med1. 2014. 42:1558–661.

121.Lee WC., Kim JR. Supramalleolar osteotomy in patients with varus ankle osteoarthritis1 J Korean Foot Ankle Soc1. 2011. 15:119–231.

131.Paley D., Herzenberg JE., Tetsworth K., McKie J., Bhave A. Deformity planning for frontal and sagittal plane corrective osteoto-mies1 Orthop Clin North Am1. 1994. 25:425–651.

141.Mangone PG. Distal tibial osteotomies for the treatment of foot and ankle disorders1 Foot Ankle Clin1. 2001. 6:583–971.

151.Cheng YM., Huang PJ., Hong SH., Lin SY., Liao CC., Chiang HC, et al. Low tibial osteotomy for moderate ankle arthritis1 Arch Or-thop Trauma Surg1. 2001. 121:355–81.

161.Takakura Y., Takaoka T., Tanaka Y., Yajima H., Tamai S. Results of opening-wedge osteotomy for the treatment of a posttraumatic varus deformity of the ankle1 J Bone Joint Surg Am1. 1998. 80:213–81.

171.Pagenstert G., Leumann A., Hintermann B., Valderrabano V. Sports and recreation activity of varus and valgus ankle osteo- arthritis before and after realignment surgery1 Foot Ankle Int1. 2008. 29:985–931.

181.Labib SA., Raikin SM., Lau JT., Anderson JG., SooHoo NF., Carette S, et al. Joint preservation procedures for ankle arthritis1 Foot Ankle Int1. 2013. 34:1040–71.