Supramalleolar osteotomy in post-traumatic valgus ankle osteoarthritis

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To assess how the level of the deformity, the stage of the osteoarthritic process, and the role of additional surgeries impact radiographic and clinical outcomes following an extra-articular medial closing supramalleolar osteotomy for treatment of post-traumatic valgus ankle osteoarthritis.


About 56 consecutive patients who underwent an extra-articular medial closing wedge osteotomy for post-traumatic valgus ankle osteoarthritis were retrospectively analyzed. Subgroups were formed according to the pre-operative level of deformity and preoperative stage of ankle osteoarthritis. Additional surgical steps required to achieve a properly balanced hindfoot were also noted. Radiographic and clinical outcomes of each subgroup were compared with each other, and the role of additional surgical steps required to achieve a balanced hindfoot was investigated.


Radiographic and clinical outcomes improved significantly between pre-operative assessment and the last follow-up. Patients with a pre-operative supramalleolar deformity showed superior radiographic outcomes compared to patients with an intra-articular deformity. Clinical outcomes did not differ significantly between these two subgroups. The pre-operative stage of ankle osteoarthritis significantly impacted radiographic outcomes but did not influence clinical outcome measures. An additional fibula or calcaneus osteotomy was necessary for 55% and 23% of all patients, respectively.


Extra-articular medial closing supramalleolar osteotomies show satisfactory mid- to long-term radiographic and clinical outcomes in patients with post-traumatic valgus ankle osteoarthritis.

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The authors thank Maxwell Weinberg, a study coordinator at the University of Utah Orthopedic Center, who provided editorial support.

Funding information

This work was supported by a grant from the University of Basel (Excellent Junior Research Grant).

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Correspondence to Nicola Krähenbühl.

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Conflict of interests

Alexej Barg has received personal fees from Medartis (not related to the article) during the conduct of the study. Nicola Krähenbühl, Roman Susdorf, and Beat Hintermann declare that they have no conflict of interests.

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Level of Evidence: Level IV, retrospective case series

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Krähenbühl, N., Susdorf, R., Barg, A. et al. Supramalleolar osteotomy in post-traumatic valgus ankle osteoarthritis. International Orthopaedics (SICOT) (2020) doi:10.1007/s00264-019-04476-x

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  • Ankle osteoarthritis
  • Valgus deformity
  • Supramalleolar osteotomy
  • Realignment surgery