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Ankle arthrodesis through minimally-invasive transfibular approach: a new surgical technique

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

The purpose of our work was to demonstrate the surgical technique of ankle arthrodesis using the minimally-invasive transfibular (MITF) approach, which minimizes soft tissue damage and is advantageous for high-risk patients.

Methods

In this prospective study, a total of 12 patients with end-stage varus ankle osteoarthritis, including high-risk individuals, underwent ankle arthrodesis using the MITF approach. The technique involves a unique osteotomy at the joint space level, minimizing soft tissue detachment from the fibula. The primary outcomes assessed included bony union, time to weight-bearing, correction of varus deformity, and functional outcomes measured by the American Orthopedic Foot and Ankle Society (AOFAS) hindfoot scale. However, the study’s limitations encompass a small sample size and the absence of a control group.

Results

At 6 months post-operation, all patients achieved bony union, with a mean time to union of 13.7 ± 5.2 weeks. The average time to initiate weight-bearing without additional support was 11.2 ± 3.8 weeks. Preoperative varus deformity (17.08 ± 8.36 degrees) and talar tilt (8.75 ± 4.33 degrees) were successfully corrected, with postoperative alignment within 0–5 degrees of valgus. Functional outcomes showed a significant improvement in AOFAS scores from 37.83 ± 7.79 points preoperatively to 77.42 ± 5.63 points one year after surgery (p = 0.002). Minor complications occurred in two patients, both effectively treated with local therapy and antibiotics.

Conclusions

The MITF approach for ankle arthrodesis demonstrates promising results in addressing end-stage varus ankle osteoarthritis, even in high-risk patients. However, the study’s limitations highlight the need for a prospective comparative clinical trial with a larger sample size to ascertain the technique’s effectiveness and safety definitively.

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Authors and Affiliations

  1. Department of Pediatric Orthopedics and Hand Surgery, Specialized Orthopedic University Hospital “Prof. B. Boychev”, Nikola Petkov str. 56, Gorna Banya, 1614, Sofia, Bulgaria

    Anton A. Semenistyy & Raytcho I. Kehayov

  2. Department of Orthopedics and Traumatology, Medical University of Sofia, Sofia, Bulgaria

    Anton A. Semenistyy & Raytcho I. Kehayov

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  1. Anton A. Semenistyy
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Correspondence to Anton A. Semenistyy.

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This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Specialized Orthopedic University Hospital “Prof. B. Boychev” (12.08.2020/№ A21-C0820).

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Informed consent was obtained from all individual participants included in the study.

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Semenistyy, A.A., Kehayov, R.I. Ankle arthrodesis through minimally-invasive transfibular approach: a new surgical technique. Eur J Orthop Surg Traumatol (2024). https://doi.org/10.1007/s00590-024-03950-6

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