Indications for mosaicplasty with a plug transfer from the knee to the talus must be considered carefully, as at midterm, moderate outcome and considerable donor-site morbidity may be found.

In patients with asymmetric (varus or valgus) ankle osteoarthritis, realignment surgery is an alternative treatment to fusion or total ankle replacement in selected cases. To determine whether realignment surgery in asymmetric ankle osteoarthritis relieved pain and improved function, we clinically and radiographically followed 35 consecutive patients with posttraumatic ankle osteoarthritis treated with lower leg and hindfoot realignment surgery. We further questioned if outcome correlated with achieved alignment. The average patient age was 43 years (range, 26-68 years). We used a standardized clinical and radiographic protocol. Besides distal tibial osteotomies, additional bony and soft tissue procedures were performed in 32 patients (91%). At mean followup of 5 years (range, 3-10.5 years), pain decreased by an average of 4 points on a visual analog scale; range of ankle motion increased by an average of 5 degrees . Walking ability and the functional parts of the American Foot and Ankle Society score increased by an average of 10 and 21 points, respectively, and correlated with achieved reversal of tibiotalar tilt and the score of Takakura et al. Revision surgery was performed in 10 ankles (29%), of which three ankles (9%) were converted to total ankle replacement. We believe the data support realignment surgery for patients with asymmetric ankle osteoarthritis.

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