Intra-Articular Opening Medial Tibial Wedge Osteotomy (Plafond-Plasty) for the Treatment of Intra-Articular Varus Ankle Arthritis and Instability

Abstract

These results demonstrate that plafond-plasty osteotomy associated with lateral ligament reconstruction may be a suitable for patients presenting with intra-articular varus ankle osteoarthritis associated with ankle instability, providing pain relief and better function and stability in most patients.

Single-Stage Supramalleolar Osteotomy for Coronal Plane Deformity

“…In all 4 patients, the indication for joint-sacrificing conversion was progressive pain, in 2 patients with ankle arthrodesis substantial progression of ankle osteoarthritis. The majority of all patients (15 ankles) were either satisfied or very satisfied with functional outcome of this procedure [68].…”

“…Mann et al [68] described a novel surgical technique of intraarticular medial opening-wedge osteotomy for the treatment of intraarticular varus ankle osteoarthritis with concomitant instability-so called plafond-plasty. The surgical technique includes an osteotomy, which is performed not above, as the supramalleolar osteotomy, nor below the ankle, as the inframalleolar calcaneus osteotomies, but intraarticular at the level of the deformity with regard to the center of rotation and angulation (CORA).…”

Osteotomies for Managing Varus and Valgus Malalignment with Total Ankle Replacement

“…Several articles have described the surgical techniques [10][11][12][13][14][15][16][17][18] and others reported on clinical outcomes of TAR in deformed ankles. 8,9,[19][20][21][22][23][24][25][26] One cannot isolate many studies reporting on outcomes of TARs combined with osteotomies, as these procedures are part of the whole spectrum of surgery performed for ankles with greater than 10 coronal plane deformity.…”

“…[3][4][5][6][7][8][9] Some surgeons have, however, expanded the indications of TAR to include ankles with preoperative deformity of 15 or more, performing adjunctive procedures to correct coronal plane alignment and stability (eg, subtalar or triple arthrodesis, osteotomies, soft tissue releases, and ligament reconstructions). [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] We present the rationale, surgical techniques, and outcomes of re-alignment osteotomies that have been described (ie, medial malleolus, fibula, distal or proximal tibia, calcaneus, first metatarsal) as adjunctive procedures performing TAR for deformed ankles. This article focuses on coronal plane deformities, but one has to bear in mind that ankle deformity rarely occurs in one plane only.…”

Return to Play Following Ankle Sprain and Lateral Ligament Reconstruction

“…59 Patients who have lateral ankle instability in the setting of moderate-severe varus malalignment may benefit from supramalleolar or lateralizing calcaneal osteotomies, in addition to a more robust and augmented soft tissue reconstruction. 60 Unstable syndesmotic injuries have traditionally been treated with rigid internal stabilization to achieve and maintain anatomic alignment, thus allowing for proper healing while preventing further injury. There has been controversy surrounding the type, size, and extent of screw fixation.…”