J Korean Foot Ankle Soc.  2021 Mar;25(1):50-53. 10.14193/jkfas.2021.25.1.50.

Interpositional Arthroplasty Using Tibialis Anterior Tendon for Talonavicular Arthritis after Ankle Arthrodesis: A Case Report

• Cho SH
• Seo MS
• Lee EC
• Nam DC

• KMID: 2513654
• DOI: http://doi.org/10.14193/jkfas.2021.25.1.50

Abstract

Ankle arthrodesis has been used frequently for end-stage ankle arthritis that does not respond to conservative treatment. On the other hand, there are concerns regarding the degenerative changes to the adjacent joint, such as the subtalar or talonavicular joint, due to the altered biomechanics after the loss of ankle motion. Because the arthrodesis for these midtarsal joints may overload stress on another contiguous joint, a salvage procedure should be considered rather than joint sacrificing. This paper reports a case of talonavicular arthritis after malunited ankle arthrodesis that was treated with interpositional arthroplasty using the tibialis anterior tendon.

Keyword

Tarsal joints; Arthritis; Arthroplasty; Tendons

Figure

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  Figure. 1 (A) The plain anteroposterior radiography taken before supramalleolar osteotomy shows well consolidation status of tibiotalar arthrodesis. (B) Anterior translated talus compared with the longitudinal axis of tibia is visible. (C) Obvious varus deformity of heel is identified by hindfoot alignment view. (D, E) Complete union of open wedged osteotomy site on distal tibia (arrowheads) and overgrown bony spur around dorsal aspect of talonavicular joint are visible (arrow). (F) Improvement of hindfoot varus deformity is identified.

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  Figure. 2 (A) Sagittal computed tomography scan shows juxta-articular hypertrophic spur at the dorsal aspect of talonavicular joint, especially navicular side, as well as irregular articular surface. (B) Focal arthritic change is also visible on the lateral aspect of subtalar joint, which was asymptomatic, from 3-dimensional reconstructed view.

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  Figure. 3 (A, B) Talonavicular joint space was distracted by use of pin distractor, which was verified by fluoroscopy. (C, D) Medial half of tibialis anterior tendon was harvested longitudinally, then placed into the talonavicular joint as an anchovy shape.

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  Figure. 4 (A, B) Immediate postoperative radiography shows restored joint space and flush dorsal surface of talonavicular joint. (C, D) Well maintained talonavicular joint space without further adjacent joint arthritic change is identified at 11 months postoperatively.

Reference

1. Takakura Y, Tanaka Y, Sugimoto K, Akiyama K, Tamai S. 1999; Long-term results of arthrodesis for osteoarthritis of the ankle. Clin Orthop Relat Res. (361):178–85. doi: 10.1097/00003086-199904000-00023. DOI: 10.1097/00003086-199904000-00023. PMID: 10212611.

2. Fuchs S, Sandmann C, Skwara A, Chylarecki C. 2003; Quality of life 20 years after arthrodesis of the ankle. A study of adjacent joints. J Bone Joint Surg Br. 85:994–8. doi: 10.1302/0301-620x.85b7.13984. DOI: 10.1302/0301-620X.85B7.13984. PMID: 14516034.

3. Buck P, Morrey BF, Chao EY. 1987; The optimum position of arthrodesis of the ankle. A gait study of the knee and ankle. J Bone Joint Surg Am. 69:1052–62. DOI: 10.2106/00004623-198769070-00014. PMID: 3654697.

4. Hefti FL, Baumann JU, Morscher EW. 1980; Ankle joint fusion: determination of optimal position by gait analysis. Arch Orthop Trauma Surg. 96:187–95. doi: 10.1007/BF00457782. DOI: 10.1007/BF00457782. PMID: 7425807.

5. Patel A, Eleftheriou KI, Anand A, Rosenfeld P. 2013; Bilateral excision arthroplasty and interpositional allograft for severe talonavicular osteoarthritis. Foot Ankle Int. 34:1294–8. doi: 10.1177/1071100713484006. DOI: 10.1177/1071100713484006. PMID: 23564423.

6. Matsumoto T, Kasai T, Uchio A, Izawa N, Takuo J, Tanaka S. 2020; Excision arthroplasty with interpositional Achilles tendon autograft: a novel approach to talonavicular joint osteoarthritis associated with ankle arthrodesis. J Foot Ankle Surg. 59:440–4. doi: 10.1053/j.jfas.2019.08.029. DOI: 10.1053/j.jfas.2019.08.029. PMID: 32131019.

7. Kim DH, Berkowitz MJ. 2014; Allograft dermal matrix interpositional arthroplasty in the treatment of failed revision arthrodesis at the talonavicular joint. Foot Ankle Int. 35:619–22. doi: 10.1177/1071100714528497. DOI: 10.1177/1071100714528497. PMID: 24677219.