OBJECTIVE: Joint-preserving osteotomies in patients with symptomatic varus malalignment of the ankle. Osseous procedures together with soft-tissue rebalancing are performed at the level of the distal tibia/fibula or calcaneus. Realignment of the joint line will subsequently reduce intraarticular forces at the ankle and thereby slow down the degenerative process. INDICATIONS: Varus malalignment of the ankle with remaining cartilage in the tibiotalar joint. CONTRAINDICATIONS: Severe neurovascular deficiencies. Severe instability of the hindfoot. Severe cartilage lesions of the entire ankle (grade 3-4 according to Outerbridge). SURGICAL TECHNIQUE: Varus deformities of the distal tibia: medial opening-wedge osteotomy or lateral closing-wedge osteotomy. The lateral closing procedure requires an osteotomy of the fibula. Varus deformity of the hindfoot: valgization by lateral closing- wedge osteotomy of the calcaneus and lateral shift of the calcaneal tuberosity, i.e., Z-shaped osteotomy. Additional procedures at the first metatarsal and softtissue procedures must be considered in all these patients. POSTOPERATIVE MANAGEMENT: Immobilization in a non-weight-bearing cast for 6-8 weeks. Thereafter, increase in weight bearing as tolerated. Physiotherapy for muscular strengthening and restoration of gait pattern. RESULTS: Twelve patients with an osteotomy of the distal tibia presented with a significant reduction of pain on a visual analog scale (p = 0.0001) and an increased range of motion of 33 degrees (5-55 degrees ) preoperatively compared to 39 degrees (25-50 degrees ) postoperatively. Radiologic assessment also revealed an improvement of preexisting arthritic signs. All 18 patients treated with a Z-shaped calcaneal osteotomy reported pain relief with osseous consolidation after 6 months.
OBJECTIVE: Joint-preserving osteotomies in patients with symptomatic varus malalignment of the ankle. Osseous procedures together with soft-tissue rebalancing are performed at the level of the distal tibia/fibula or calcaneus. Realignment of the joint line will subsequently reduce intraarticular forces at the ankle and thereby slow down the degenerative process. INDICATIONS: Varus malalignment of the ankle with remaining cartilage in the tibiotalar joint. CONTRAINDICATIONS: Severe neurovascular deficiencies. Severe instability of the hindfoot. Severe cartilage lesions of the entire ankle (grade 3-4 according to Outerbridge). SURGICAL TECHNIQUE: Varus deformities of the distal tibia: medial opening-wedge osteotomy or lateral closing-wedge osteotomy. The lateral closing procedure requires an osteotomy of the fibula. Varus deformity of the hindfoot: valgization by lateral closing- wedge osteotomy of the calcaneus and lateral shift of the calcaneal tuberosity, i.e., Z-shaped osteotomy. Additional procedures at the first metatarsal and softtissue procedures must be considered in all these patients. POSTOPERATIVE MANAGEMENT: Immobilization in a non-weight-bearing cast for 6-8 weeks. Thereafter, increase in weight bearing as tolerated. Physiotherapy for muscular strengthening and restoration of gait pattern. RESULTS: Twelve patients with an osteotomy of the distal tibia presented with a significant reduction of pain on a visual analog scale (p = 0.0001) and an increased range of motion of 33 degrees (5-55 degrees ) preoperatively compared to 39 degrees (25-50 degrees ) postoperatively. Radiologic assessment also revealed an improvement of preexisting arthritic signs. All 18 patients treated with a Z-shaped calcaneal osteotomy reported pain relief with osseous consolidation after 6 months.
Authors: Alexej Barg; Matthias D Wimmer; Martin Wiewiorski; Dieter C Wirtz; Geert I Pagenstert; Victor Valderrabano Journal: Dtsch Arztebl Int Date: 2015-03-13 Impact factor: 5.594