Rodríguez-Merchán E Carlos, Ribbans William J, Olmo-Jiménez José M, Delgado-Martínez Alberto D
EFORT Open Rev. 2025 May 5;10(5):213-223. doi: 10.1530/EOR-2023-0100.
Arthroscopic ankle arthrodesis (AAA) has been performed for 40 years for end-stage ankle osteoarthritis. Along with open ankle arthrodesis (OAA) and total ankle replacement (TAR), it forms one arm of the triumvirate of commonly performed procedures for this condition. The aim of this article is to review the state of the art for AAA and compare outcomes with OAA and TAR. This narrative review of the literature traces the development of this technique through case series and systematic reviews. Traditional OAA techniques carry a nonunion rate of 11%, necessitating revision surgery in most cases. As individual and communal experience of AAA has grown, the range of pathology and deformity successfully corrected by this technique has developed. There is evidence that AAA offers greater and more rapid union rates, with reduced hospital stay and better long-term outcomes. However, the technique requires mature surgical skills and still carries a significant complication rate. No single procedure is suitable for all patients. AAA can be seen as the new gold standard for patients with isolated ankle osteoarthritis and no/minimal deformity, either within the talocrural joint or hindfoot or patients with systemic and/or local comorbidities that would benefit from minimal disturbance to the soft-tissue envelope. However, in older patients, the presence of concomitant hindfoot osteoarthritis or significant deformity, TAR and OAA remain valuable procedures in the foot and ankle surgeon's armamentarium.
关节镜下踝关节融合术（AAA）用于治疗终末期踝关节骨关节炎已有40年历史。它与开放踝关节融合术（OAA）和全踝关节置换术（TAR）一起，构成了针对该病症的三种常见手术方式之一。本文旨在回顾AAA的技术现状，并将其结果与OAA和TAR进行比较。本文通过病例系列和系统评价对该技术的发展进行了叙述性综述。传统的OAA技术骨不连发生率为11%，在大多数情况下需要进行翻修手术。随着对AAA个人经验和集体经验的增加，该技术成功矫正的病理和畸形范围也在不断发展。有证据表明，AAA能实现更高、更快的骨愈合率，缩短住院时间，并带来更好的长期效果。然而，该技术需要成熟的手术技巧，且并发症发生率仍然较高。没有一种手术适用于所有患者。对于单纯踝关节骨关节炎且距小腿关节、后足无畸形或畸形轻微的患者，或者患有全身性和/或局部合并症且软组织包膜受干扰最小有益的患者，AAA可被视为新的金标准。然而，对于老年患者，若存在合并的后足骨关节炎或严重畸形，TAR和OAA在足踝外科医生的手术方法中仍具有重要价值。
