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Arthroscopic ankle arthrodesis effective for treatment of degenerative ankle disease
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Arthroscopic ankle arthrodesis was effective for the treatment of degenerative ankle disease, including in patients with moderate tibiotalar coronal deformity, according to a recently published study.
The study comprised 97 patients who underwent arthroscopic ankle arthrodesis, and mean follow-up was 86 months. Investigators assessed patients with the American Orthopaedic Foot and Ankle Society ankle and hindfoot scale, Ankle Osteoarthritis Scale and the Foot and Ankle Outcome Score. Patients also underwent clinical and radiographic examinations.
Results showed that 94.6% of patients achieved ankle fusions. The mean AOFAS score was 83.3 and the mean FAOS score was 87.4. Investigators observed 75% good/excellent results with the AOS scoring system. The Kellgren-Lawrence score and van Dijk osteoarthritis grading scale showed that 85% and 69% of patients had no change in talonavicular or subtalar grade of osteoarthritis, respectively. Researchers observed no cases of deep infection or other serious adverse events. After arthroscopic ankle arthrodesis, all patients but four patients were able to return to work. – by Monica Jaramillo
Disclosures : Please see the full study for a list of all authors relevant financial disclosures.
Perspective
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Gregory C. Berlet, MD, FRCS(C), FAOA
Jones, Wong, Applegate and Ferkel are to be commended on collating a large sample size to look at midterm arthroscopic ankle fusion results with a mean follow up of 7.1 years. Their data are encouraging with most ankle fusion patients returning to work and 75% satisfied with their surgery.
The conclusions on adjacent joint disease are likely a bit optimistic. Coester and colleagues showed that adjacent joint arthritis is present in nearly all patients with ankle fusion compared with the contralateral control at 20 years post-surgery. Kozanek and colleagues presented data proposing the mechanism of adjacent joint arthritis is a breakdown in the normal hindfoot motion coupling. They showed that in stance phase of gait the subtalar, coronal and transverse rotational planes tend to occur in an opposite direction of a stiff ankle compared with normal controls. This would lead us to conclude that regardless of the surgical technique (open vs arthroscopic) that adjacent joint disease is a real problem.
This same cohort followed over 20 years will lead to valuable information on adjacent joint disease and the need for future surgery.
References:
Coester et al. J Bone Joint Surg Am. 2001; 83-A(2):219-228.
Kozanek et al. Foot Ankle Int. 2009;doi:10.3113/FAI.2009.0734.
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