Biomechanical analysis of the impact of fibular osteotomies at tibiotalar joint: A cadaveric study

Abstract

Background:Osteotomy of the fibula is a common orthopedic procedure performed for various indications, including harvesting fibula for grafting purposes. The effect of fibular osteotomy and need for tibiofibular syndesmotic fixation fusion at different levels on tibiotalar joint is matter of debate. We performed a biomechanical analysis of the impact of fibular osteotomies at different levels and whether the fixation of distal tibiofibular joint mitigates instability caused by the osteotomy.Materials and Methods:Six lower limb specimens from fresh adult cadavers were used to prepare leg-foot models. The specimens were assigned to six status according to the level of osteotomy and whether fixation of distal tibiofibular joint was performed or not. Each specimen was then loaded axially to 700 N by the material testing machine, and the tibiotalar joint contact area and peak pressure were measured using an electronic pressure sensor.Results:The contact area and the pressure of tibiotalar joint showed significant changes when compared to the normal specimen. All osteotomy specimens had a decreased tibiotalar contact area and an increased peak pressure. This positively correlated with proximity of level of osteotomy to the lateral malleolus.Conclusions:Through this study, we found that fibular osteotomy had an adverse effect in terms of decreasing the contact surface of tibiotalar joint that led to increased peak pressure in the joint. However, bone fusion and screw fixation of the distal tibiofibular joint reduced these adverse effects.

Ankle Joint Contact Loads and Displacement With Progressive Syndesmotic Injury

“…It is important to note that the fibula plays a likely role in tibiotalar contact mechanics even with intact ligaments. 24,31 Yang et al performed suprasyndesmotic fibular osteotomies and found significant reductions in tibiotalar contact area measured using a K-Scan pressure sensor (Tekscan), even though the syndesmotic ligaments (but not the IOM) remained intact. Restoring and fixing the bone and stabilizing the syndesmosis normalized contact area in their study.…”

“…Restoring and fixing the bone and stabilizing the syndesmosis normalized contact area in their study. 31 Given the apparent relationship between tibiotalar contact area and the position of the talus and fibula relative to the tibia (linear and rotational), the importance of syndesmotic stability for protecting the joint from injury becomes more evident. Alterations in the magnitude and location of intra-articular pressure found in our study after disruption of the IOL and PITFL could explain both acute and longterm joint conditions.…”

Anterolateral Tibial Osteotomy for Accessing Osteochondral Lesions of the Talus in Autologous Osteochondral Transplantation

“…14 However, there is concern that operative disruption of the syndesmosis may result in morbidity, including rotational instability. 3,6,7,19,22,25 The results from our study demonstrate that the anterolateral tibial osteotomy is a reasonable alternative for accessing lateral or posterior lesions for AOT with limited morbidity associated with the osteotomy, strong evidence of adequate osteotomy healing, and good clinical outcomes.…”

Regeneration of the Fibula with Unidirectional Porous Hydroxyapatite

“…Reconstruction of the fibula defect after harvesting might not be necessary, because the fibula and interosseous membrane carry only 6% to 16% of the load applied to the lower extremity [10, 11] and spontaneous regeneration of the fibula has been reported previously, especially in children [12]. However, incomplete regeneration or nonunion following fibula harvesting has also been described [1, 13], and the loss of the fibula after its removal sometimes results in significant donor site morbidity, such as surgical scar pain, weaknesses of plantar flexion of the ankle [14], valgus deformity of the ankle [1], ankle instability [15], and tibial fracture [2]. Our case demonstrated slight proximal migration of the remaining distal fibula without ankle valgus deformity, which could be avoided by using temporary syndesmotic screw fixation.…”