Choi Jun Young, Kim Jin Hwan, Kim Byeong Gon, Suh Jin Soo
Inje University Ilsan Paik Hospital, Goyang-si, Republic of Korea.
Arch Orthop Trauma Surg. 2025 Feb 4;145(1):156. doi: 10.1007/s00402-025-05761-8.
Relative fibular shortening compared to the tibia and syndesmotic widening are recognized contributors to the valgus tilt of the talus. This study aimed to assess: (1) the impact of fibular shortening relative to the tibia; and (2) the influence of syndesmotic widening, in correcting a large varus talar tilt (TT) associated with advanced ankle osteoarthritis through medial opening wedge valgization supramalleolar osteotomy (SMO).
We retrospectively reviewed the clinico-radiographic findings of 41 patients with a preoperative TT of 8 degrees or more who underwent SMO for varus ankle osteoarthritis, with a minimum follow-up of more than two years. We compared several clinico-radiographic parameters between the three groups based on postoperative TT changes (decreased TT by 2 degrees or more, no TT changes [TT change between - 2 and 2 degrees], and increased TT by 2 degrees or more).
In total, 18, 16, and 7 patients were included in the groups with postoperative decreased TT, no TT changes, and postoperative increased TT, respectively. The postoperative talocrural angle was greater in the postoperative increased TT group than in the postoperative decreased TT group (P =.036). The postoperative tibiofibular clear space was greatest in the postoperative decreased TT group (P =.037), whereas the other two groups were not significantly different (P =.260). In the postoperative increased TT group, postoperative tibial plafond inclination was the lowest among the three groups (P =.048 and 0.023, respectively), indicating the greatest plafond valgus inclination to the ground. All postoperative clinical parameters were significantly lower in the postoperative increased TT group (P <.05).
When performing SMO for varus ankle osteoarthritis, TT correction might be associated with the relative length of the fibula to the tibia and the role of the syndesmosis, implying the need for fibular shortening/valgization and syndesmotic widening. Additionally, excessive correction during SMO that places the tibial plafond in a valgus position relative to the ground floor can paradoxically increase TT and exacerbate ankle osteoarthritis.
Level III.
与胫骨相比，腓骨相对缩短以及下胫腓联合增宽被认为是距骨外翻倾斜的成因。本研究旨在评估：（1）腓骨相对于胫骨缩短的影响；以及（2）下胫腓联合增宽在通过内侧开放楔形上踝外翻截骨术（SMO）矫正与晚期踝关节骨关节炎相关的严重内翻距骨倾斜（TT）中的作用。
我们回顾性分析了41例术前TT≥8°、因内翻踝关节骨关节炎接受SMO治疗且随访至少两年的患者的临床影像学资料。我们根据术后TT变化（TT降低≥2°、TT无变化[TT变化在-2°至2°之间]、TT升高≥2°）将患者分为三组，并比较了几组临床影像学参数。
术后TT降低组、TT无变化组和术后TT升高组分别纳入18例、16例和7例患者。术后TT升高组的术后胫距关节角大于术后TT降低组（P = 0.036）。术后TT降低组的术后胫腓间隙最大（P = 0.037），而其他两组差异无统计学意义（P = 0.260）。在术后TT升高组中，术后胫骨平台倾斜度在三组中最低（分别为P = 0.048和0.023），表明平台相对于地面的外翻倾斜度最大。术后TT升高组的所有术后临床参数均显著更低（P < 0.05）。
在对内翻踝关节骨关节炎进行SMO时，TT矫正可能与腓骨相对于胫骨的相对长度以及下胫腓联合的作用有关，这意味着需要进行腓骨缩短/外翻和下胫腓联合增宽。此外，SMO过程中过度矫正使胫骨平台相对于地面处于外翻位置可能会适得其反地增加TT并加重踝关节骨关节炎。
III级。
