Effect of ankle arthritis on clinical outcome of lateral ankle ligament reconstruction in cavovarus feet
Patients with idiopathic cavovarus deformity and lateral ankle ligament instability often present with varying degrees of ankle arthritis. The purpose of this study was to determine whether the severity of degenerative change would impact the clinical outcome in patients treated operatively for both cavovarus deformity and lateral ankle ligament instability.
Twenty-two patients were treated with lateral ankle ligament reconstruction and realignment foot osteotomy. American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, Karlsson and Peterson (KP) scoring scale, Visual Analog Scale (VAS) for pain, and level of satisfaction were obtained. Preoperative and postoperative ankle radiographs were reviewed and graded using the van Dijk score. Patients with Grade 0 and I arthritis preoperatively were grouped together as “no to minimal arthritis” (Group 1) and those with Grade II and III arthritis preoperatively as “moderate to severe arthritis” (Group 2). There were 14 ankles in Group 1 and eight ankles in Group 2. Mean followup was 60.4 months.
Mean AOFAS and KP scores were significantly improved in Group 1 compared to Group 2 at latest followup, while VAS pain scale trended lower in Group 1. There were 12 excellent/good results, one fair result, and one poor result in Group 1. Patients in Group 2 had three excellent/good results, two fair results, and three poor results. One of 14 patients in Group 1 had progression of arthritis, while five of eight patients in Group 2 either had progression of arthritis or required an ankle fusion.
Patients treated with lateral ankle ligament reconstruction and cavovarus realignment osteotomy with no to minimal preoperative tibiotalar arthritis have higher clinical scores and increased satisfaction compared to patients with more advanced preoperative tibiotalar arthritis. A cautious and realistic approach should be followed when recommending surgical treatment for this patient population.
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