2023, Vol. 27 ›› Issue (13): 2124-2132

Advantage of supramalleolar osteotomy for asymmetric ankle arthritis: a system evaluation

Shang Wei, Fu Panfeng, Kang Zhe, Zhu Shaobo   

Abstract: OBJECTIVE: For asymmetric ankle arthritis with varus and valgus deformity, supramalleolar osteotomy can correct the negative gravity line, restore the coordination of the joint, and regulate the pressure in the ankle joint. This study was designed to evaluate supramalleolar osteotomy in treating asymmetric ankle arthritis by evidence-based medicine.  
METHODS: Databases of Wanfang Data, China National Knowledge Infrastructure (CNKI), PubMed, EMbase and Medline were searched from their establishment to December 30, 2021 to collect the randomized controlled trials and non-randomized controlled trials about supramalleolar osteotomy for the treatment of the asymmetric ankle arthritis. The established inclusion and exclusion criteria were strictly followed to screen articles that met the inclusion criteria and extract data. Data were meta-analyzed using Stata 12.0 software.
RESULTS:   A total of 14 studies (884 patients) were included. Among them, there were 546 patients with varus deformity and 338 patients with valgus deformity. Meta-analysis results showed: (1) in 884 patients, American Foot and Ankle Surgeons ankle and hindfoot score, visual analogue scale pain score, talus inclination angle, tibial lateral articular surface angle, and Takakura rank score were better after operation than those before operation (P < 0.05). The distal tibial articular surface angle was not significantly different before and after operation (P > 0.05). (2) American Foot and Ankle Surgeons ankle and hindfoot score, visual analogue scale pain score, talus inclination angle, tibial lateral articular surface angle, and Takakura rank were better after operation than those before operation in the varus group (P < 0.05). American Foot and Ankle Surgeons ankle and hindfoot score, visual analogue scale pain score, distal tibial articular surface angle, and Takakura rank were better after operation than those before operation in the valgus group (P < 0.05). (3) There was no significant difference in American Foot and Ankle Surgeons ankle and hindfoot score, visual analogue scale pain score, and tibial lateral articular surface angle between the varus group and the valgus group after surgery (P > 0.05), but there were significant differences in distal tibial articular surface angle, talus inclination angle, and Takakura rank (P < 0.05).  
CONCLUSION: The American Foot and Ankle Surgeons ankle and hindfoot score, distal tibial articular surface angle, and Takakura rank were improved by supramalleolar osteotomy in the treatment of asymmetric ankle arthritis. The tibial lateral articular surface angle and talus inclination angle for varus deformity were improved. There is no significant improvement in tibial lateral articular surface angle and talus inclination angle for valgus deformity. The need for combined fibular osteotomy is still lack of more subgroup evidence to support.
Key words: ankle arthritis, supramalleolar osteotomy, varus deformity, valgus deformity, meta-analysis