Ankle arthrodesis with arthroscopic fibular osteotomy for varus ankle arthritis

Abstract

Objectives: The aim of this study was to assess the clinical outcomes of a novel, single-stage arthroscopic ankle arthrodesis employing complete arthroscopic fibular osteotomy in patients exhibiting significant varus malalignment (≥10°) and severe osteoarthritis (OA) and to compare these results with those of patients undergoing arthroscopic ankle arthrodesis with mild deformity.

Patients and methods: Between August 2018 and May 2023, a total of 49 patients (23 males, 26 females; mean age: 50.00±14.72 years; range, 21 to 71 years) who underwent arthroscopic ankle arthrodesis for tibiotalar arthrosis with a minimum postoperative follow-up of two years were retrospectively analyzed. The patients were divided into two groups: Group A (n=20) consisted of end-stage tibiotalar OA patients with ≥10° varus alignment and Group B (n=29) consisted of those with <10° varus alignment. An arthroscopic fibular osteotomy at the level of ankle joint was performed using an osteotome introduced through the anteromedial portal in Group A, resulting in fibula shortening equivalent to the thickness of the osteotome. Fixation in both groups was achieved using two or three 6.5-mm cannulated screws. Outcomes were evaluated utilizing the Visual Analog Scale (VAS) for pain, the 36-item Short Form Survey (SF-36), and the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Score (AOFAS) at baseline and at three, six, 12, and 24 months postoperatively.

Results: There was no statistically significant difference between the groups in terms of age, sex, or the affected sides between the groups (p=0.210, p=0.348, and p=0.906, respectively). All the patients had Takakura Stage IIIB and IV ankle OA with a trauma-related etiology. The mean duration of the operation was 85.50±9.72 min in Group A which included arthroscopic fibular osteotomy and 57.59±5.61 min in Group B, indicating a statistically significant difference (p<0.001). The mean fusion times and complication rates were comparable between the groups (p=0.064 and p=1.000, respectively). All patients demonstrated significant and consistent improvements in VAS, AOFAS, and SF-36 scores, compared to baseline (p<0.001). At three months, the VAS scores in Group A were significantly higher (p=0.020); however, later evaluations showed comparable scores between the groups. Group B exhibited significantly higher AOFAS scores at three, six, and 24 months. The SF-36 scores indicated no significant differences between the groups in any time points in the postoperative period.

Conclusion: This study provides the novel, initial clinical evidence for a single-stage arthroscopic procedure which incorporates complete arthroscopic ankle arthrodesis and arthroscopic fibular osteotomy in severe varus deformities. It can be effectively used with similar fusion and recovery times, by eliminating mechanical obstruction caused by the fibula in varus OA without necessitating additional surgical incisions.

Citation: Akkurt MO, Bahadir B, Mantı N. Ankle arthrodesis with arthroscopic fibular osteotomy for varus ankle arthritis. Jt Dis Relat Surg 2026;37(x):i-xii. doi: 10.52312/jdrs.2026.2680.