Search Results (3)

Background and Objectives: Conventional supramalleolar osteotomy (SMO) often involves a concomitant fibular osteotomy (FO), which carries risks, such as nonunion and nerve injury. We evaluated the clinical and radiological outcomes of a fibula-preserving SMO (FP-SMO) combined with arthroscopic modified Broström operation (MBO) in patients with medial compartment varus ankle osteoarthritis and chronic lateral ankle instability. Materials and Methods: We retrospectively reviewed 22 patients who underwent medial opening wedge FP-SMO and arthroscopic MBO between 2014 and 2019. Clinical outcomes were assessed using the Visual Analog Scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score, and Foot and Ankle Outcome Score (FAOS). Radiological evaluation included the anterior drawer test (ADT), talar tilt angle, tibiotalar surface (TTS) angle, medial distal tibial angle (MDTA), tibial lateral surface (TLS) angle, Takakura stage, and International Cartilage Regeneration and Joint Preservation Society (ICRS) grade assessed during second-look arthroscopy. Results: At a mean follow-up of 17.22 months, the mean VAS, AOFAS, and FAOS scores improved significantly (p < 0.001). Radiologically, the mean ADT decreased from 5.98 mm to 4.70 mm (p = 0.015), and the mean talar tilt angle decreased from 9.85° to 6.09° (p < 0.001). The mean TTS angle increased from 80.46° to 84.86° (p = 0.021), and the mean MDTA increased from 85.03° to 91.26° (p < 0.001). The TLS angle showed no significant change from 81.17° to 81.54° (p = 0.238). Takakura stage and ICRS grade improved or remained stable in all patients. No major complications, including nonunion, were observed. Conclusions: FP-SMO combined with arthroscopic MBO demonstrated favorable short-term clinical and radiological outcomes in selected patients with medial compartment varus ankle osteoarthritis and chronic lateral ankle instability. This combined approach may be a feasible joint-preserving option that addresses coronal malalignment and lateral ankle instability without requiring FO; however, longer-term comparative studies are needed to confirm its durability and clinical utility. Full article

Medial opening-wedge supramalleolar osteotomy (MOWSMO) is a joint-preserving surgical option for varus ankle osteoarthritis (OA); however, its ability to correct large varus talar tilt (TT), particularly in advanced diseases like Takakura stage IIIB, remains limited. Varus TT represents a complex three-dimensional deformity characterized by coronal malalignment and internal rotation, which cannot be reliably corrected by isolated supramalleolar realignment. Building on our previous work, we propose a new treatment algorithm for large varus TT based on preoperative tibial plafond inclination (TPI) and arthritis type, categorized as translational and rotational. While MOWSMO primarily addresses TPI, effective correction of talar inclination requires a balanced, multilevel approach. This includes using an oblique sliding fibular osteotomy to facilitate rotational realignment with fibular shortening and, critically, prioritizing inframalleolar correction (IMC). IMC is implemented through an “all-in-one” strategy involving lateral ligament repair, deltoid ligament release, calcaneal osteotomy, and posterior tibial tendon lengthening. Furthermore, we discuss critical intraoperative considerations, such as avoiding excessive TPI valgization to prevent a “paradoxical increase” in TT. Collectively, this framework provides clinically relevant insights and a reproducible algorithm for achieving satisfactory outcomes in the joint-preserving management of severe varus ankle OA. Full article

Of the five nerves that innervate the foot, the one in which anesthetic blocking presents the greatest difficulty is the tibial nerve. The aim of this clinical trial was to establish a protocol for two tibial nerve block anesthetic techniques to later compare the anesthetic efficiency of retromalleolar blocking and supramalleolar blocking in order to ascertain whether the supramalleolar approach achieved a higher effective blocking rate. A total of 110 tibial nerve blocks were performed. Location of the injection site was based on a prior ultrasound assessment of the tibial nerve. The block administered was 3 mL of 2% mepivacaine. The two anesthetic techniques under study provided very similar clinical results. The tibial nerve success rate was 81.8% for the retromalleolar technique and 78.2% for the supramalleolar technique. No significant differences in absolute latency time (p = 0.287), percentage of effective nerve blocks (p = 0.634), anesthetic block duration (p = 0.895), or pain level during puncture (p = 0.847) were found between the two techniques. The greater ease in locating the tibial nerve at the retromalleolar approach could suggest that this is the technique of choice for tibial nerve blocking, especially in the case of professionals new to the field. The supramalleolar technique could be worth considering for those more experienced professionals. Full article