Distraction arthroplasty compared to other cartilage preservation procedures in patients with post-traumatic arthritis: a systematic review

Abstract

Post-traumatic arthritis (PTA) is characterized by the deterioration of articular cartilage temporally associated with an articular injury. With a paucity of literature comparing joint preservation techniques, we performed a systematic review of the literature intending to describe and summarize the results of ankle distraction arthroplasty as it compares with studies on tibio-talar microfracture, allograft, and autograft for ankle joint preservation in the post-traumatic population under 50 years of age. Research databases were searched and abstracts screened for relevance on our topic of interest. Abstracts meeting screening criteria with high interobserver reliability underwent full-manuscript review and coding for pertinent citation, study level, treatment, and outcome variables. Outcome variables for patient-reported pain scales, validated outcome measurement tools, radiographic progression, reoperation/re-treatment rates, and complication rates were recorded. Out of 105 unique citations, 10 publications were included. The distraction arthroplasty studies had 36 out of 181 patients requiring reoperation for complications (19.9%), while other joint-preserving procedures studies had 40 out of 177 patients requiring reoperations for complications (22.6%). Clinical outcome scores at mean follow-up time ranging from 2 to 10 years between studies were similar. Reported results for a variety of cartilage preservation procedures, including distraction arthroplasty, are satisfactory and reoperation rates for complication are similar. Limitations in available data and underlying study quality affect synthesis of the results therein. While distraction arthroplasty is an option for cartilage preservation in patients with PTA of the ankle, the technique is highly specialized which may affect the external validity.Level of evidence: III.

Ligament stabilization improved clinical and radiographic outcomes for individuals with chronic ankle instability and medial ankle osteoarthritis

“…1, 3). BMSP seemed ineffective in alleviating the pain related to medial compartment OA because the eburnated, brittle cortical bone may be difficult to remodel with fibrocartilage after a microfracture, and this finding was similar to those found in previous reports [3, 16, 20, 26]. Lateral ligament reconstruction procedures were found to play a crucial role in alleviating the ankle OA pain and significantly improving the ankle functional score by stabilizing the unstable ankles, considering that the BMSP group (55.6%) and non‐BMSP group showed similar results.…”

Supramalleolar osteotomy with medial distraction arthroplasty for ankle osteoarthritis with talar tilt

“…Ankle joint distraction arthroplasty was first reported in 1995 by van Valburg and his colleagues [18] and has evolved as an option for cartilage preservation in patients with osteoarthritis [19, 20]. Although distraction arthroplasty cannot correct the bony deformities, it may shift the force from the hindfoot to the valgus at the joint level and give the medial structure a distraction.…”

Ankle distraction arthroplasty (ADA): A brief review and technical pearls

“…The results of this procedure have been variable in multiple meta-analyses, but the consensus is that ankle distraction arthroplasty has a role in the treatment of post traumatic ankle arthritis with the understanding that the benefits will wear off over time. [24,29,30] (Table 1).…”