Clinical Outcome of Tibiotalar Arthrodesis Utilizing the Chevron Technique

Abstract

Tibiotalar arthrodesis remains the gold standard reconstructive procedure for the treatment of disabling ankle arthritis. The purpose of this study was to review the clinical results of tibiotalar arthrodesis utilizing the chevron fusion technique. The results of 46 consecutive patients who underwent ankle arthrodesis utilizing the chevron technique were reviewed. The etiology of the tibiotalar arthritis was posttraumatic in 29 of 46 patients. Of the remaining 17 patients, seven had osteoarthritis, five had talar osteonecrosis, two had rheumatoid arthritis, one had hemophilic arthropathy, one had gouty arthropathy, and one had unrecognized chronic osteomyelitis. Three patients had prior hindfoot arthrodeses, and two patients had bilateral ankle fusions at last follow-up. All patients were followed for a minimum of 2 years. Of the 46 patients, 41 were available for review, with an average follow-up of 7.3 years (range, 2-20 years). Twelve patients had greater than 10-year follow-up. The Mazur ankle score was calculated for all 41 patients. The average Mazur ankle score for the 41 patients available for review was 72.8, out of a maximum possible score of 90. Eighteen patients had excellent results, 11 patients had good results, five patients had fair results, and seven patients had poor results. The most common reasons for fair or poor results were symptomatic subtalar arthritis and multiple medical comorbidities. All patients with postoperative symptomatic subtalar arthritis had preoperative radiographic evidence of subtalar arthrosis. Of the 12 patients with greater than 10-year follow-up, nine had excellent or good results, and an average Mazur ankle score of 76.6. All patients with either prior hindfoot arthrodeses or bilateral ankle fusions had excellent or good results. Of the 41 arthrodeses included in the study, 38 (38/41, 93%) went on to clinical and radiographic union. The chevron technique provides a predictable method to obtain fusion of the tibiotalar joint. Most patients can expect excellent or good results. In the current study, 90% (37/41) of patients were satisfied with the outcome of their surgery and would undergo the same operation again under similar circumstances.

High Union Rates and Function Scores at Midterm Followup With Ankle Arthrodesis Using a Four Screw Technique

“…Our observations confirm those of Sheridan et al [43] who reported a high percentage (96%) of subtalar and midfoot arthritis was preexisting due to ankle malfunction in end-stage arthritis. Progression of preexisting arthritis has been reported in between 0 and 70% [5,27,30,48]. Several long-term studies have reported high overall rates of subtalar arthritis of between 47% and 100% [4,6,11,17].…”

Treatment of distal tibial shaft fractures by three different surgical methods: a randomized, prospective study

“…Anterior knee pain, fracture site pain and ankle pain were noted. Ankle function was measured using Mazur ankle score [22]. The maximum score was 100 points.…”

Arthrodèse talocrurale. Technique opératoire et retentissement sur les articulations sous-jacentes. À propos de 11 cas

“…La technique du chevron s'en rapproche [15]. Pilette [24] sur une étude de 21 chevilles cadavériques remarque que sur le plan de la stabilité biomécanique la fixation interne est préférable à la fixation externe et que, dans ce même ordre d'idée la plaque en T est supérieure au montage par des vis.…”