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Evaluation of clinico-radiological outcome of fibular valgization osteotomy with supra-malleolar osteotomy in patients with ankle osteoarthritis

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Abstract

Purpose

There are controversies about combining distal tibia medial opening-wedge osteotomy (DTMO) with fibular valgization osteotomy (FVO) when performing supramalleolar osteotomy (SMO) for medial ankle osteoarthritis. This study aimed to assess the effect of FVO on the coronal translation of the mechanical axis by comparing the improvement of radiological indices after DTMO with and without FVO.

Methods

Forty-three ankles (mean follow-up: 42.0 months) were reviewed after SMO. Among them, 35/43 (81.4%) underwent DTMO with FVO, while 8/43 (18.6%) underwent DTMO only. To evaluate the effect of FVO radiologically, the medial gutter space (MGS) and talus centre migration (TCM) were measured.

Results

Post-operatively, MGS and TCM were not significantly different after DTMO only and DTMO with FVO. However, the improvement of MGS was significantly higher in the combined FVO group (0.8 mm (standard deviation [SD] 0.8 mm) vs. 1.5 mm (SD 0.8 mm); p = 0.015). More lateral translation of the talus was achieved in the FVO group (5.1 mm (SD 2.3 mm) vs. 7.5 mm (SD 3.0 mm); p = 0.033). However, the changes in the MGS and TCM were not significantly correlated with the clinical outcomes (p > 0.05).

Conclusion

Our radiological evaluation confirmed a significant medial gutter space widening and lateral talar translation after the addition of FVO. The SMO with fibular osteotomy allows greater shifting of the talus and, therefore, the weight-bearing axis.

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Data availability

All data generated or analyzed during this study are included in this published article.

Code availability

Not applicable.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Chung-Ang University Gwangmyeong Hospital, 110, Deokan-ro, Gyeonggi-do, 14353, Gwangmyeong-si, Republic of Korea

    Jung-Won Lim

  2. Department of Orthopaedic Surgery, Konkuk University Medical Centre, Konkuk University School of Medicine, 120-1 Neungdong-ro (Hwayang-dong), Gwangjin-gu, 05030, Seoul, Republic of Korea

    Sung Jin Kang, Je-Min Im, Sae Him Kwon & Hong-Geun Jung

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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by SJK, J-MI, and SHK. The first draft of the manuscript was written by J-WL, and H-GJ, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. J-WL: data curation, formal analysis, investigation, methodology, validation, writing — original draft. SJK: data curation, investigation, project administration, resources. J-MI: data curation, formal analysis, investigation, resources, visualization. SHK: project administration, resources, software. H-GJ: conceptualization, formal analysis, methodology, project administration, supervision, writing — original draft, writing — review and editing.

Corresponding author

Correspondence to Hong-Geun Jung.

Ethics declarations

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Institutional Review Boards of Konkuk University Medical Centre (IRB No. KUMC2020-02–049).

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

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Patients signed informed consent regarding publishing their data.

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The authors declare no competing interests.

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Level of evidence: Level III, therapeutic study

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Lim, JW., Kang, S.J., Im, JM. et al. Evaluation of clinico-radiological outcome of fibular valgization osteotomy with supra-malleolar osteotomy in patients with ankle osteoarthritis. International Orthopaedics (SICOT) 47, 2013–2021 (2023). https://doi.org/10.1007/s00264-023-05822-w

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