Rate of Malunion Following Bi-plane Chevron Medial Malleolar Osteotomy

Bull, Patrick E.; Berlet, Gregory C.; Canini, Cameron; Hyer, Christopher F.

doi:10.1177/1071100716628912

Cited by 31 publications

(35 citation statements)

References 18 publications

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“…In our series, no cases had an uneven articular surface of the tibial plafond at the malleolar osteotomy site visually, and the measured results were much lower than those reported by Bull and colleagues. 3 Also, all ankles in the current study achieved union at 7.3 ± 1.5 weeks, which is similar to the union time of chevron-type medial malleolar osteotomy. 13 The type of fixation plays an important role in the prevention of osteotomy displacement.…”

Section: Discussionsupporting

confidence: 81%

“…The more recent biplane chevron and step-cut osteotomy techniques provide wider exposure, a broad cancellous surface for healing, and greater intrinsic theoretical stability. 9 , 18 However, Bull et al 3 showed that biplane chevron medial malleolar osteotomy fixed with 2 lag screws had a 30% malunion rate, with an average of 2 mm of incongruence on final follow-up radiographs. Displacement after osteotomy can lead to advanced ankle osteoarthritis.…”

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confidence: 99%

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A Novel Medial Malleolar Osteotomy Technique for the Treatment of Osteochondral Lesions of the Talus

Cheng

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: The current techniques for medial malleolar osteotomy may lead to posterior tibial tendon injury and have a high rate of malunion. Purpose: To describe a novel partial step-cut medial malleolar osteotomy technique and evaluate its technical feasibility and its advantages compared with traditional methods. Study Design: Case series; Level of evidence, 4. Methods: The novel technique consisted of osteotomy of the anterior one-third to two-thirds of the medial malleolus. A total of 19 ankles (18 patients) with osteochondral lesions of the talus underwent the novel osteotomy technique before osteochondral reconstruction. All patients were evaluated for more than 2 years. Radiographs were analyzed for postoperative displacement and malunion, and postoperative ankle function was evaluated according to the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale and the visual analog scale (VAS) for pain. Results: The partial step-cut osteotomy technique was able to provide adequate intra-articular exposure without disturbing the posterior tibial tendon. The 19 ankles healed at a mean of 7.3 ± 1.5 weeks (range, 6-12 weeks). There was slight incongruence in 4 ankles, with a displacement of 1.0 ± 0.1 mm proximally and 0.3 ± 0.1 mm medially. The mean postoperative AOFAS and VAS scores improved compared with preoperatively, from 54.2 ± 12.1 to 84.6 ± 6.6 and from 6.4 ± 1.0 to 1.8 ± 1.3, respectively ( P < .001 for both). No intraoperative tendon injuries were observed. Conclusion: Results indicated that partial step-cut osteotomy is a reliable and effective method for providing enough exposure, avoiding displacement after reduction, and not disturbing the anatomic structures behind the medial malleolus.

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Section: Discussionsupporting

confidence: 81%

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confidence: 99%

A Novel Medial Malleolar Osteotomy Technique for the Treatment of Osteochondral Lesions of the Talus

Cheng

et al. 2021

Orthopaedic Journal of Sports Medicine

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“…Ein wesentlicher Nachteil ist, dass trotz aller Maßnahmen, wie Vorbohren der Schraubenlöcher für die spätere Ostsynthese vor der eigentlichen Osteotomie, Einsatz einer zusätz-lichen Schraube parallel zum Gelenksspalt, Durchtrennen des Knochens mit dem Meißel oder auch einer domför-migen Osteotomie, häufig kleine Stufen verbleiben, die als Risikofaktor für eine spätere Arthroseentwicklung angesehen werden. Dies wird umso deutlicher, je häufiger Schnittbildverfahren im weiteren Krankheitsverlauf angefertigt werden [5,18].…”

Section: Operativer Zugang Mit Innenknöchelosteotomieunclassified

Autologe matrixinduzierte Chondrogenese am Sprunggelenk

et al. 2017

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“…In a study of 50 biplane medial malleolar osteotomies, 30.0% of cases had a malunion with a mean incongruency of 2 mm. 4 However, for fixation of OLT, unlike the exposure required for autologous osteochondral transplantation and allografting, the entire lesion does not have to be exposed and malleolar osteotomy is not always required. In a cadaveric study, 33% of the talus in the anteroposterior length and 30% of its mediolateral length could be reached by posteromedial arthrotomy without malleolar osteotomy.…”

Section: Discussionmentioning

confidence: 99%

“…11,33 Even for adults, malleolar osteotomy entails some complications. 4 However, unlike the exposure required for autologous osteochondral transplantation and allografting for the placement of large osteochondral plugs or an allograft block, for fragment fixation, the entire lesion does not have to be exposed and a malleolar osteotomy is not always required. We developed a method to approach the lesion without malleolar osteotomy.…”

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confidence: 99%

Internal Fixation of Osteochondral Lesion of the Talus Involving a Large Bone Fragment

Choi

Kim

et al. 2021

Am J Sports Med

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Background: Internal fixation of an osteochondral lesion of the talus (OLT) can restore the congruency of the talus and maintain the subchondral bone and innate hyaline cartilage. However, OLT that is indicated for fixation is rarely encountered; hence, not many studies report on the results after the procedure. Purpose: To evaluate the clinical and radiological outcomes after internal fixation of chronic OLT involving a large bone fragment of at least 10 mm in diameter and 3 mm in depth on computed tomography (CT). Study Design: Case series; Level of evidence, 4. Methods: We retrospectively reviewed the data of 26 patients with OLT treated with internal fixation between August 2014 and April 2018. Of the patients, 15 were male and 11 were female, with a mean age of 16 years (range, 11-29 years). The primary radiological outcome measurement was bone union assessed on the 6-month postoperative CT scan. Clinical outcomes were assessed at a mean of 27.7 months postoperatively. Results: Twenty patients (77%) achieved bone union on postoperative CT scan. The mean 100-mm visual analog scale (VAS) improved from 30.5 ± 8.5 preoperatively to 13.4 ± 9.7 postoperatively ( P < .001). The mean Foot Function Index (FFI) improved from 30.5 ± 6.7 preoperatively to 13.7 ± 9.8 postoperatively ( P < .001). A malleolar osteotomy was not necessary to approach the lesion in 88% of patients. A bone fragment with an irregular margin and low density on the preoperative CT scan was significantly associated with nonunion (odds ratio: 7.67, 95% confidence interval: 2.67 to 22.02, P = .008). The difference in clinical outcomes between patients with skeletally immature ankles and those with skeletally mature ankles was not statistically significant. Patient age did not correlate with postoperative 100-mm VAS (Pearson correlation coefficient, r = −0.07, P = 0.72) or the postoperative FFI (Pearson correlation coefficient, r = –0.05, P = .80). Conclusion: Internal fixation of an OLT involving a large bone fragment resulted in satisfactory clinical and radiologic outcomes. We found that patients with skeletally immature and mature ankles attained healing at comparable rates after the internal fixation of OLT.

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Rate of Malunion Following Bi-plane Chevron Medial Malleolar Osteotomy

Abstract: Level IV, retrospective case series.

Cited by 31 publications

References 18 publications

A Novel Medial Malleolar Osteotomy Technique for the Treatment of Osteochondral Lesions of the Talus

A Novel Medial Malleolar Osteotomy Technique for the Treatment of Osteochondral Lesions of the Talus

Autologe matrixinduzierte Chondrogenese am Sprunggelenk

Internal Fixation of Osteochondral Lesion of the Talus Involving a Large Bone Fragment

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