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Research article
Koji Nozaka
Akita University Graduate School of Medicine
Corresponding Author
ORCiD: https://orcid.org/0000-0003-0238-8929
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Background Advanced to end-stage ankle osteoarthritis in highly active older individuals has traditionally been treated using tibiotalar arthrodesis. Tibiotalar arthrodesis is possible to have high levels of pain-free function, however there is loss of ankle joint movement and a risk of arthrosis of adjacent joints in the future. Distraction arthroplasty is a simple method with a possibility of the joint cartilage repair but current results are mixed with reports of patients with better pain scores and some without any improvement. Distal tibial osteotomy (DTO) without fibular osteotomy, a type of joint preservation surgery, has garnered attention in recent years, However, as far as we know, there are no reports on DTO with joint distraction using a circular external fixator. The purpose of this study was to examine the effect of DTO with joint distraction using a circular external fixator on ankle osteoarthritis.
Materials and Methods A total of 21 patients with medial ankle arthritis were examined. Arthroscopic synovectomy and a microfracture procedure were performed. Then angled osteotomy and correction of the distal tibia were performed. After ankle conditions improved, the stabilization of the ankle joint was performed. An external fixator was used in all patients. In addition, joint distraction of about 5.8 mm was performed. All patients were allowed full weight-bearing walking immediately after surgery.
Results Antero-posterior mortise angle during weight-bearing, lateral mortise angle during weight-bearing, and talar tilt angle and anterior translation of the talus in ankle stress radiography significantly improved (P < 0.05). In addition, signal changes in magnetic resonance imaging (MRI) improved in all patients. Visual Analogue Scale (VAS ) and The American Orthopaedic Foot & Ankle Society (AOFAS) scores also improved significantly (P < 0.05). No severe complications were observed.
Conclusion DTO with joint distraction may be useful for older patients with a high physical activity level as joint preserving surgery for medial ankle osteoarthritis.
Keywords
distal tibial osteotomy, medial ankle arthritis, joint distraction, circular external fixator
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View the published article at BMC Musculoskeletal Disorders.
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Editorial decision: Minor revision
On 17 Dec, 2019
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On 05 Dec, 2019
Review #2 received
Received 05 Dec, 2019
Reviewers invited
Invitations sent on 04 Dec, 2019
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On 04 Dec, 2019
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On 02 Dec, 2019
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Editor invited
On 01 Dec, 2019
Version 1
Posted 11 Nov, 2019
No comments provided
Editorial decision: Minor revision
On 20 Nov, 2019
Review #1 received
Received 17 Nov, 2019
Reviewer #2 agreed
On 15 Nov, 2019
Review #2 received
Received 15 Nov, 2019
Reviewers invited
Invitations sent on 14 Nov, 2019
Reviewer #1 agreed
On 14 Nov, 2019
Editor assigned
On 29 Oct, 2019
First submitted
On 28 Oct, 2019
Submission checks complete
On 28 Oct, 2019
Editor invited
On 28 Oct, 2019
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Subject Areas
Orthopedic Surgery
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See the published version of this preprint at BMC Musculoskeletal Disorders.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Koji Nozaka
Akita University Graduate School of Medicine
Corresponding Author
ORCiD: https://orcid.org/0000-0003-0238-8929
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Musculoskeletal Disorders.
No community comments so far
Reviewer #1 agreed
On 06 Jan, 2020
Review #1 received
Received 06 Jan, 2020
Reviewers invited
Invitations sent on 05 Jan, 2020
Editor assigned
On 02 Jan, 2020
Submission checks complete
On 01 Jan, 2020
Editor invited
On 01 Jan, 2020
No comments provided
Editorial decision: Minor revision
On 17 Dec, 2019
Review #1 received
Received 17 Dec, 2019
Reviewer #2 agreed
On 05 Dec, 2019
Review #2 received
Received 05 Dec, 2019
Reviewers invited
Invitations sent on 04 Dec, 2019
Reviewer #1 agreed
On 04 Dec, 2019
Editor assigned
On 02 Dec, 2019
Submission checks complete
On 01 Dec, 2019
Editor invited
On 01 Dec, 2019
Version 1
Posted 11 Nov, 2019
No comments provided
Editorial decision: Minor revision
On 20 Nov, 2019
Review #1 received
Received 17 Nov, 2019
Reviewer #2 agreed
On 15 Nov, 2019
Review #2 received
Received 15 Nov, 2019
Reviewers invited
Invitations sent on 14 Nov, 2019
Reviewer #1 agreed
On 14 Nov, 2019
Editor assigned
On 29 Oct, 2019
First submitted
On 28 Oct, 2019
Submission checks complete
On 28 Oct, 2019
Editor invited
On 28 Oct, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Orthopedic Surgery
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Musculoskeletal Disorders.
Background Advanced to end-stage ankle osteoarthritis in highly active older individuals has traditionally been treated using tibiotalar arthrodesis. Tibiotalar arthrodesis is possible to have high levels of pain-free function, however there is loss of ankle joint movement and a risk of arthrosis of adjacent joints in the future. Distraction arthroplasty is a simple method with a possibility of the joint cartilage repair but current results are mixed with reports of patients with better pain scores and some without any improvement. Distal tibial osteotomy (DTO) without fibular osteotomy, a type of joint preservation surgery, has garnered attention in recent years, However, as far as we know, there are no reports on DTO with joint distraction using a circular external fixator. The purpose of this study was to examine the effect of DTO with joint distraction using a circular external fixator on ankle osteoarthritis.
Materials and Methods A total of 21 patients with medial ankle arthritis were examined. Arthroscopic synovectomy and a microfracture procedure were performed. Then angled osteotomy and correction of the distal tibia were performed. After ankle conditions improved, the stabilization of the ankle joint was performed. An external fixator was used in all patients. In addition, joint distraction of about 5.8 mm was performed. All patients were allowed full weight-bearing walking immediately after surgery.
Results Antero-posterior mortise angle during weight-bearing, lateral mortise angle during weight-bearing, and talar tilt angle and anterior translation of the talus in ankle stress radiography significantly improved (P < 0.05). In addition, signal changes in magnetic resonance imaging (MRI) improved in all patients. Visual Analogue Scale (VAS ) and The American Orthopaedic Foot & Ankle Society (AOFAS) scores also improved significantly (P < 0.05). No severe complications were observed.
Conclusion DTO with joint distraction may be useful for older patients with a high physical activity level as joint preserving surgery for medial ankle osteoarthritis.
Figure 1
Figure 2
Figure 3
Figure 4
This is a list of supplementary files associated with this preprint. Click to download.
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