2025 AOFAS Annual Meeting-Paper Session 2A

Video Transcription

Video Summary

The session featured presentations from leading researchers on ankle osteoarthritis (OA), its traumatic origins, pathology, bone quality, treatment options, and surgical outcomes. Bopa Kriya’s multicenter study revealed that 73% of end-stage ankle OA cases requiring surgery stem from prior trauma, especially rotational ankle fractures and recurrent sprains, with an average 18-20 year gap from injury to surgery. This highlights the prolonged degenerative timeline post-injury.<br /><br />Dr. Matias’ transcriptomic analysis showed distinct synovial gene expression profiles between post-traumatic OA (PTOA), non-traumatic OA (NTOA), and post-fracture cases. Crucially, PTOA synovium resembled fracture tissue decades after injury, with elevated Wnt7b and IL-11 pathways, indicating these may link acute injury to chronic degeneration, suggesting new therapeutic targets.<br /><br />Dr. Henry's preliminary work focused on bone quality in ankle OA, demonstrating abnormal bone microarchitecture and similar serum biomarkers in both post-traumatic and chronic instability OA. Imaging and micro-CT analyses showed decreased bone density and quality in arthritic ankles, correlating with worse patient outcomes, implying a common bone pathology pathway in ankle OA.<br /><br />Medical student Avi Dewar compared outcomes of recombinant PDGF (RHPDGF) versus autograft in complex hindfoot fusions (TTC, pantalar, triple arthrodesis). RHPDGF use was associated with significantly lower nonunion and opioid use rates versus autograft, though with a non-significant increase in wound disruption, indicating it as a promising alternative to autograft.<br /><br />Dr. Jensen’s cadaveric study demonstrated that stemmed tibial implants had significantly less micromotion than low-profile implants in total ankle arthroplasty, explaining better early implant survivorship with stemmed components and influencing implant selection.<br /><br />Cole George’s analysis found that non-tobacco nicotine use, like vaping, similarly increases medical and surgical complications following ankle fracture surgery as traditional tobacco, emphasizing the need for clinical nicotine use screening.<br /><br />Panel discussions debated treatment strategies for young patients with post-traumatic ankle OA, weighing fusion versus replacement, implant choice, the role of systemic and local factors (bone quality, inflammatory pathways), and the potential for early intervention post-injury. The importance of a multidisciplinary approach involving biomechanics, biology, and patient-specific factors was emphasized to optimize ankle arthritis management and surgical outcomes.

Keywords

ankle osteoarthritis

post-traumatic osteoarthritis

rotational ankle fractures

synovial gene expression

Wnt7b pathway

bone microarchitecture

recombinant PDGF

total ankle arthroplasty

nicotine use complications

fusion versus replacement