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Changes in ankle joint alignment after proximal fibular osteotomy.

ABSTRACT: The purpose of this study was to assess the effect of proximal fibular osteotomy (PFO) on ankle joint. 49 patients or 53 lower limbs were included and followed-up with a minimum of one year in the study prospectively. Patients were evaluated radiographically and clinically. The questionnaires of the American Knee Society Score (KSS), the Ankle-Hindfoot Scale of the American Orthopedic Foot and Ankle Society (AOFAS), Visual Analogue Scale/Score (VAS) were used to assess the patients clinically. Radiographic evaluations were measured by the hip-knee-ankle angle (HKA), the femoro-tibial angle (FTA), tibial inclination (TI), distal tibial articural surface (TAS), talar tilt (TT), length of fibular (FL), and hind foot alignment such as hindfoot alignment view angle (HAVA), hindfoot alignment ratio (HAR), and hindfoot moment arm (HMA). Of the 53 subjects, no significant differences were exhibited in AOFAS, VAS scores and FL in ankle joint, but a significant differences were demonstrated in KSS score, HKA, FTA, TI, TT, HAVA, HAR and HMA after PFO. Due to the structural improvements of ankle joint, PFO not only improves joint function but also the alignment of ankle joint radiographically, and is still recommended as a safe surgery in treating medial compartment osteoarthritis of knee.

SUBMITTER: Guo J

PROVIDER: S-EPMC6430369 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Changes in ankle joint alignment after proximal fibular osteotomy.

Guo Jialiang J Zhang Li L Qin Di D Chen Wei W Dong Weichong W Hou Zhiyong Z Zhang Yingze Y

PloS one 20190322 3

The purpose of this study was to assess the effect of proximal fibular osteotomy (PFO) on ankle joint. 49 patients or 53 lower limbs were included and followed-up with a minimum of one year in the study prospectively. Patients were evaluated radiographically and clinically. The questionnaires of the American Knee Society Score (KSS), the Ankle-Hindfoot Scale of the American Orthopedic Foot and Ankle Society (AOFAS), Visual Analogue Scale/Score (VAS) were used to assess the patients clinically. R ...[more]

PMID: 30901350

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Project description:BackgroundOsteoarthritis of knee is one of the important causes of knee pain in elderly patients and is a debilitating disease. It often leads to varus deformity of knee. Many treatment options are available for this progressive knee joint disorder. Proximal fibular osteotomy (PFO) is a novel yet simple procedure used to alleviate the symptoms of medial compartment knee osteoarthritis. The present study was undertaken to evaluate whether this procedure improves the symptoms, functions and limb alignment in patients with medial compartment knee osteoarthritis.MethodsFollowing approval by the Institutional Review Board, this prospective study included 42 cases (56 knees) with Kellgren-Lawrence grade II and III medial compartment knee osteoarthritis and underwent proximal fibular osteotomy. Clinical assessment was done by visual analogue scale (VAS) score and The Western Ontario and McMaster universities osteoarthritis Index (WOMAC) score pre-operatively and at 3, 6 and 12 months follow-up for pain and functional improvement. Radiological assessment was done by measuring femoro-tibial angles (FTA) pre-operatively and at 1 year follow-up.ResultsThe mean age was 58.30 years. There were 30 females and 12 males. The preoperative mean WOMAC score was 87.3, at 3 months follow-up it was 29.4 this was significantly better (p < 0.05) but the improvement was not significant at subsequent follow-up visits. Similarly the VAS scores also showed significant improvement at 3 months, but not at 6 and 12 months follow-up. There was no significant improvement in the femoro-tibial angle (FTA) at 1 year follow-up.ConclusionThe study highlights that both the VAS scores and WOMAC scores were significantly better at 3 months after surgery. However these did not show any significant improvement at 6 and 12 months. It does not change the alignment of knee at one year follow-up. The authors conclude that proximal fibular osteotomy provides only short-term relief in patients of medial compartment knee osteo-arthritis.

Project description:BackgroundStrengthening of hip and trunk muscles can modify pelvis and hip movements. However, the varus alignment of the foot-ankle complex (FAC) may influence the effects of muscle strengthening, due to the relationship of FAC alignment with pelvic and hip kinematics. This study evaluated the effects of hip and trunk muscle strengthening on pelvis and hip kinematics during walking, in subgroups with larger and smaller values of FAC varus alignment. In addition, this study evaluated the effects of hip and trunk muscle strengthening on hip passive and active properties, in the same subgroups.MethodsFifty-three women, who were divided into intervention and control groups, participated in this nonrandomized controlled trial. Each group was split into two subgroups with larger and smaller values of FAC varus alignment. Hip and trunk muscle strengthening was performed three times a week for two months, with a load of 70% to 80% of one repetition maximum. Before and after strengthening, we evaluated (1) pelvis and hip excursions in the frontal and transverse planes during walking, (2) isokinetic hip passive external rotator torque, and (3) isokinetic concentric and eccentric peak torques of the hip external rotator muscles. Mixed analyses of variance (ANOVAs) were carried out for each dependent variable related to walking kinematics and isokinetic measurements (α = 0.05).ResultsThe subgroup with smaller varus alignment, of the intervention group, presented a reduction in pelvic drop after strengthening (P = 0.03). The subgroup with larger varus alignment increased pelvic drop after strengthening, with a marginal significance (P = 0.06). The other kinematic excursions did not change (pelvic anterior rotation P = 0.30, hip internal rotation P = 0.54, and hip adduction P = 0.43). The intervention group showed increases in passive torque (P = 0.002), peak concentric torque (P < 0.001), and peak eccentric torque (P < 0.001), independently of FAC alignment. These results suggest that FAC varus alignment influences the effects of strengthening and should be considered when hip and trunk muscle strengthening is used to reduce pelvic drop during walking.

Project description:BackgroundFibular hemimelia is a congenital disorder that is characterized by the absence of the fibula that could be either partial or complete. Successful management aims to restore normal weight bearing and normal limb length. The introduction of the Ilizarov method of limb lengthening has provided an attractive alternative to amputation. During lengthening, the tight posterolateral soft-tissue structures, the thick fibrous fibular band, and the shortened Achilles tendon become tighter and transfer a valgus force to the talus and calcaneus, further aggravating the deformity.Questions/purposesWe have developed a strategy to address this in patients with Paley type III fibular hemimelia via ankle reconstruction that provides posterolateral stability and buttressing of the ankle and hind foot by reconstructing the lateral buttress. This is achieved through excision of the fibrous fibular anlage, centralization of the ankle, restoring talocalcaneal coronal alignment, and reconstruction of the lateral malleolus by transplanting the cartilaginous remnant of the lateral malleolus or by crafting a bone block autograft taken from the iliac crest or tibia.MethodsA prospective non-randomized clinical trial included ten ankles in eight patients with fibular hemimelia Paley type III (two patients had bilateral deformity). The patients' ages ranged from 7 to 36 months.ResultsAfter a follow-up ranging from 48 to 96 months, a stable plantigrade foot was achieved in nine ankles; one ankle had residual equinus, five ankles had residual valgus heel, and eight ankles had complete range of motion of the ankle, whereas one patient lost 5° of dorsiflexion. One ankle had equinus deformity.ConclusionsTo achieve satisfactory results, a stable plantigrade foot and ankle is necessary in patients with fibular hemimelia before attempting to equalize limb length discrepancy. It is important to reconstruct the ankle through an extra-articular soft tissue release, anlage resection, osteotomies, and restoring the abnormal talocalcaneal relationship before any attempt to equalize LLD.

Project description:High tibial osteotomy is a common procedure to address unicompartment knee osteoarthritis and other conditions. Regarding the specific surgical methods, medial open wedge osteotomy and lateral close wedge osteotomy are the most used. Both methods have a common disadvantage in that they are not so suitable to correct a severe deformity. Thus, we would like to introduce an anterior proximal-to-posterior distal oblique proximal tibial osteotomy technique, which is especially suitable to correct severe tibial deformity. The most critical point of this technique is to create an osteotomy plane from the most proximal posterior site of the tibial tubercle posteriorly and distally to the posterior cortex of the tibia, with each horizontal osteotomy maneuver in the coronal plane. Combined fibular osteotomy is always needed, and better results can be obtained when it is combined with arthroscopic debridement of the knee. We consider the introduction of this technique will provide a useful option when tibial osteotomy is needed to preserve the knee, especially for a great deformity correction. Technique Video Video 1 Anterior proximal-to-posterior distal oblique proximal tibial osteotomy. This procedure is performed in the right knee. Arthroscopy is performed to confirm the osteoarthritis status of the medial compartment and the healthier status of the lateral compartment. Debridement and other indicated arthroscopic procedures are performed. A K-wire is drilled in the coronal plane from the medial to the lateral side of the tibia at a level approximately 1 cm distal to the joint line, parallels the joint line as far as possible, and is used as a proximal reference wire. Another K-wire is drilled into the tibia also in the coronal plane at a level in the distal one third of the leg and used as a distal reference wire. The angle between the 2 reference wires is controlled being equal to the to-be-corrected angle of the tibia as far as possible. A longitudinal incision is made over the midline of the medial surface of the tibia. The pes anserinus is peeled off from its tibial insertion. A K-wire is placed at the most proximal and posterior site of the tibial tubercle and an osteotomy line is marked posterodistally to the posteromedial ridge of the tibia with 30° angulation to the tibial axis. The posterior osteofascial compartments are opened at the distal end of the osteotomy line. A 2.5-mm K-wire is used to drill through the medial tibial cortex along the osteotomy line to make a line of holes with approximately 5 mm distance between the neighboring holes. An osteotome is used to cut the bone and connect the holes along the osteotomy line at the medial side of the tibia. The lateral tibial cortex is drilled through the medial tibial fissure with each drilling maneuver along the coronal plane, to create a line of holes on the lateral side of the tibia. The osteotome is put into the fissure at the medial side of the tibia to connect the holes on the lateral side of the tibia to create an osteotomy plane. The distal posterior tibial cortex is cut along the osteotomy plane. A K-wire is drilled perpendicular to the coronal plane through the middle of the osteotomy plane. A fibula osteotomy is performed at its middle point with a wire saw. Valgus stress is applied to correct the varus deformity of the tibia till the 2 reference wires parallel to each other. Two additional K-wires are placed across the osteotomy plane for temporary fixation of the fracture. A tibial condyle plate is placed at the medial side of the tibia. Four self-locking screws are placed in respectively at the proximal and distal segments of the tibia for fracture fixation. The K wires for temporary fixation and correction reference are removed. A suction drainage tube is placed to the osteotomy site. The wounds are closed.

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Changes in ankle joint alignment after proximal fibular osteotomy.

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Changes in ankle joint alignment after proximal fibular osteotomy.

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