Surgical Correction of Large Talar Tilt in Varus Ankle Osteoarthritis: Lessons from Clinical Experience and a Review of the Literature
Abstract
:1. Introduction
2. Preoperative Considerations
2.1. Fundamental Radiographic Parameters
2.2. Definition of Large Varus Talar Tilt and Surgical Limits
2.3. Type of Varus Ankle Osteoarthritis
2.4. Radiographic Correction Goals
2.5. Age Limitation in Varus Talar Tilt Correction
3. Intraoperative Considerations: Supramalleolar Osteotomy
3.1. Osteotomy Type and Location
3.2. Fibular Osteotomy
3.3. Bone Marrow Stimulation of the Medial Talar Dome
3.4. Effects and Prevention of Hinge Fracture
4. Intraoperative Considerations: Inframalleolar Correction
4.1. Calcaneal Osteotomy
4.2. Soft Tissue Procedure on the Medial Aspect
4.3. Soft Tissue Procedure on the Lateral Aspect
4.4. Additional Procedures
5. Surgical Sequence
- Calcaneal osteotomy and internal fixation
- Fibular osteotomy
- Preemptive Kirschner wire fixation at the anticipated tibial hinge site
- Deltoid ligament release from the medial malleolus, multiple drilling on the medial talar dome, and PTT Z-shaped cut
- Distal syndesmotic SMO
- Opening of the tibial osteotomy site, followed by plate fixation with a metal wedge or tricortical bone graft
- Fibular fixation using two Kirschner wires
- PTT repair with lengthening
- ATFL and CFL repair or reconstruction as needed
6. Postoperative Management
7. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Parameters | Clinical Implications | Reference Range |
---|---|---|
TAS | A quantitative measure of correction | 88–93° |
TT | Aim of correction | ≤4° |
TMMA | A quantitative measure of medial malleolar erosion | 20–25° |
TCA | Relative fibular length measurement | 8–15° |
TPI | Tibial plafond coronal alignment relative to the ground (a supplementary aim of correction) | N/A |
TLS | Sagittal alignment parameter of the distal fragment after correction (anterior/posterior angulation) | 79–83° |
HMA | A parameter assessing hindfoot alignment | Neutral alignment when the tibial bisecting line intersects the lowest point of the calcaneus |
HAR | A parameter assessing hindfoot alignment | 0.3–0.5 |
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Choi, J.Y.; Suh, J.S. Surgical Correction of Large Talar Tilt in Varus Ankle Osteoarthritis: Lessons from Clinical Experience and a Review of the Literature. J. Clin. Med. 2025, 14, 2781. https://doi.org/10.3390/jcm14082781
Choi JY, Suh JS. Surgical Correction of Large Talar Tilt in Varus Ankle Osteoarthritis: Lessons from Clinical Experience and a Review of the Literature. Journal of Clinical Medicine. 2025; 14(8):2781. https://doi.org/10.3390/jcm14082781
Chicago/Turabian StyleChoi, Jun Young, and Jin Soo Suh. 2025. "Surgical Correction of Large Talar Tilt in Varus Ankle Osteoarthritis: Lessons from Clinical Experience and a Review of the Literature" Journal of Clinical Medicine 14, no. 8: 2781. https://doi.org/10.3390/jcm14082781
APA StyleChoi, J. Y., & Suh, J. S. (2025). Surgical Correction of Large Talar Tilt in Varus Ankle Osteoarthritis: Lessons from Clinical Experience and a Review of the Literature. Journal of Clinical Medicine, 14(8), 2781. https://doi.org/10.3390/jcm14082781