Supramalleolar osteotomy combined with lateral ligament reconstruction and talofibular immobilization for varus ankle osteoarthritis with excessive talar tilt angle

Background Although supramalleolar osteotomy is the main joint-preserving method for the treatment of varus ankle osteoarthritis, it tends to be ineffective when ankle osteoarthritis presents in combination with an excessive talar tilt angle. The purpose of this study was to present a new surgical technique, supramalleolar osteotomy combined with lateral ligament reconstruction and talofibular immobilization, for the treatment of varus ankle osteoarthritis with an excessive talus tilt angle and to evaluate the clinical and radiological results. Methods From January 2013 to October 2016, a total of 17 patients with 17 cases of varus ankle arthritis with excessive talar tilt angles (larger than 7.3[degrees]) underwent surgical treatment using our new technique. The American Orthopaedic Foot and Ankle Society (AOFAS) clinical ankle-hindfoot scale and a visual analogue scale (VAS) were used to evaluate ankle function and pain before surgery and at the last follow-up. The medial distal tibial angle (MDTA), anterior distal tibial angle (ADTA), talar tilt angle (TTA), and hindfoot moment arm values (HMAVs) were evaluated on weight-bearing radiographs acquired preoperatively and at the last follow-up. Results The AOFAS score improved significantly from 45.8 [+ or -] 2.1 before surgery to 84.8 [+ or -] 1.8 after surgery (p < 0.001), and the VAS score decreased from 4.9 [+ or -] 0.4 to 1.1 [+ or -] 0.2 (p < 0.001). The MDTA, TTA, and HMAV changed from 80.9[degrees] [+ or -] 0.4[degrees] to 90.1[degrees] [+ or -] 0.4[degrees], 11.7[degrees] [+ or -] 0.6[degrees] to 1.4[degrees] [+ or -] 0.3[degrees], and 12.6 mm [+ or -] 0.8 mm to 4.2 mm [+ or -] 0.6 mm, respectively (each p < 0.001). The ADTA showed no obvious change (p = 0.370). The staging of 11 cases (65%) improved. Intramuscular vein thrombosis of the lower limbs occurred in 1 patient 1 week after surgery, and superficial infection occurred in 1 patient. Conclusions Supramalleolar osteotomy combined with lateral ligament reconstruction and talofibular immobilization can correct the load of the weight-bearing ankle and effectively improve the ankle function. As the talar tilt angle can be significantly improved after surgery, this technique can be used for the treatment of varus ankle osteoarthritis with an excessive TTA. Keywords: Varus ankle osteoarthritis, Excessive talar tilt angle, Supramalleolar osteotomy, Lateral ligament reconstruction, Talofibular immobilization