CME OnDemand: 2022 AOFAS Annual Meeting-Radiographic Outcomes of Proximal vs. Distal Syndesmotic Low Tibial Osteotomy

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The study conducted by Jun Young Choi and Jin Soo Suh compared the radiographic outcomes of proximal syndesmotic (PS) tibial osteotomy versus distal syndesmotic (DS) tibial osteotomy. The study aimed to determine the effectiveness of DS tibial osteotomy combined with fibular osteotomy for correcting extra- and intra-articular deformities in varus ankle arthritis. <br /><br />The authors performed a retrospective study on patients who underwent tibial osteotomy from January 2009 to January 2019, with a minimum follow-up of 24 months. They excluded patients with simultaneous foot operations, lower extremity alignment-altering trauma history, and postoperative complications. Radiographic parameters such as talar tilt, talo-crural angle, and talar center migration were measured, along with clinical parameters and scores.<br /><br />The results showed that DS tibial osteotomy resulted in more significant improvements in talar tilt and talo-crural angle compared to PS tibial osteotomy, especially in patients with a large talar tilt and those with medial malleolar erosion. The authors also suggest that DS tibial osteotomy combined with fibular osteotomy is a favorable option for varus ankle arthritis, even without medial malleolar erosion.<br /><br />They recommend a lateral closed wedge shortening valgization fibular osteotomy after DS tibial osteotomy to determine the position and rotation of the talus. However, it is important to note that the study had limitations such as a small sample size, retrospective design, and a high number of excluded patients.<br /><br />Overall, the study suggests that DS tibial osteotomy combined with fibular osteotomy is an effective surgical option for correcting deformities in varus ankle arthritis, providing greater correction than PS tibial osteotomy.

Asset Subtitle

Jun Young Choi, M.D, Ph.D.,JinSoo Suh, M.D., Ph.D.

Keywords

proximal syndesmotic tibial osteotomy

distal syndesmotic tibial osteotomy

radiographic outcomes

varus ankle arthritis

extra-articular deformities

intra-articular deformities

talar tilt

talo-crural angle

talar center migration

fibular osteotomy