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Department of Surgery, Universidad de La Laguna, Tenerife, Spain
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University of Basel, Basel, Switzerland
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Department of Orthopedic and Rehabilitation, University of Iowa, Iowa, USA
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Department of Surgery, Universidad de La Laguna, Tenerife, Spain
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Department of Surgery, Universidad de Sevilla, Sevilla, Spain
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Ankle osteoarthritis (OA) is much less frequent than knee or hip OA, but it can be equally disabling, greatly affecting the quality of life of the patients.
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Approximately 80% of ankle OA is post-traumatic, mainly secondary to malleolar fractures, being another of the main causes untreated in chronic instability. The average age of the patient affected by ankle OA is around 50 years, being therefore active patients and in working age who seek to maintain mobility and remain active.
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The authors conducted a comprehensive review of the conservative, medical, and surgical treatment of ankle OA.
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Initial conservative treatment is effective and should be attempted in any stage of OA. From a pharmacological point of view, non-steroidal anti-inflammatory drugs (NSAIDs) and intra-articular infiltrations can produce temporary relief of symptoms.
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After the failure of conservative-medical treatment, two large groups of surgical treatment have been described: joint-preserving and joint-sacrificing procedures.
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In the early stages, only periarticular osteotomies have enough evidence to recommend in ankle OA with malalignment. Both ankle arthrodesis and ankle replacement can produce satisfactory functional results if correctly indicated in the final stages of the disease.
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Finally, the authors propose a global treatment algorithm that can aid in the decision-making process.
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discussed in a multidisciplinary team meeting with at least two surgeons and a specialised radiologist in order to plan a complete resection and a reconstruction aiming to achieve a sufficient functional result. 7 , 8 When a complete resection with a
Hospital Base de Valdivia, Valdivia, Chile
AO Foundation, LEGEC Expert Group, Davos, Switzerland
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Hospital Base de Valdivia, Valdivia, Chile
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Clínica Puerto Montt, Puerto Montt, Chile
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Hospital Base de Valdivia, Valdivia, Chile
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offers good functional results, good rates of patient satisfaction, and a low rate of complications ( 11 ). One-stage elongation has certain limitations. In cases with shortening of >15 mm, elongation may lead to vasospasm and stretching of the nerve
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rehabilitation) have evolved considerably from non-surgical treatment to open reconstruction to minimally invasive techniques. The transition to surgical treatment was predominantly driven by lower re-rupture rates and better functional results but at the cost of
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foot complex to optimise compensatory motion, resulting in a more physiological gait pattern. 7 , 8 , 12 Ankle arthrodesis has been demonstrated to result in significant pain alleviation and good functional results. 9 , 10 , 13 , 14 In recent
Department of Orthopaedics and Trauma Surgery, Klinik Gut, St. Moritz, Switzerland
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AO Research Institute Davos, Davos Switzerland
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fractures of the posterior malleolar fragment should be treated surgically as insufficient reduction and/or incongruence of the ankle joint correlate with poor functional results ( 43 ). Timing of definitive surgery is dependent on the soft tissue
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results of a prospective randomized controlled trial (RCT) from Canada comparing operative and non-operative treatment of DIACFs suggested that without stratification of the groups, the functional results were equivalent in both groups. However, after
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an anatomical reduction and, subsequently, an optimal clinical and functional result. Three-dimensional (3D) pre-operative imaging (CT scans with two-dimensional (2D) and 3D reconstructions) is essential to fully understand the fracture morphology
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’ immobilisation boot. 40 Casting, however, has been shown to yield inferior functional results by many authors compared with orthosis and early weight-bearing. 63 Though many patients prefer cast immobilisation, we suggest starting physiotherapy as
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-up Consensus Practitioners agree that after surgery patients will need physiotherapy to accelerate recovery and improve functional results. The return to normal activity, including sport activities, may occur around four months post
