ABSTRACT
Nonunion is known to be a relatively common complication following ankle arthrodesis.
Various fixation techniques have been introduced to enhance the stability and to improve
fusion rate. With the use of anterior plate supplementation, postoperative wound problems
have been frequently reported despite better fusion rate. This study was performed
to determine the effects of tibialis anterior (TA) tenotomy on wound complications
and functional outcomes after anterior fusion plating for severe ankle arthritis.
Forty-six patients who underwent ankle arthrodesis using anterior fusion plate were
followed for more than 2 years. TA tenotomy was performed prior to wound closure in
all patients. As a control group, 38 patients who underwent arthrodesis without TA
tenotomy were analyzed. Functional outcomes were evaluated with Ankle Osteoarthritis
Scale and Foot and Ankle Ability Measure. Wound complication rate, time to fusion,
fusion rate, time to pain relief were evaluated. Mean Ankle Osteoarthritis Scale and
Foot and Ankle Ability Measure scores significantly improved to 32.6 and 69.4 points
at final follow-up, respectively. As compared to control group (33.8 and 67.7 points),
there were no significant differences in functional outcomes. As postoperative wound
complications, there were 1 case of wound dehiscence and 1 case of superficial wound
infection. TA tenotomy group showed a significantly lower wound complication rate
(4.3%) than control group (23.7%) (p < .001). While there were no significant differences in fusion rate, time to fusion,
and time to pain relief between both groups, control group needed higher rate of implant
removal. Ankle arthrodesis using anterior fusion plate in conjunction with TA tenotomy
appears to be an effective surgical option for end-stage ankle arthritis, with excellent
fusion rate and less wound complication rate. Although there were no specific functional
deficits related to absence of TA tendon, further studies are needed to determine
long-term effects of TA tenotomy in patients with a fused ankle.
Level of Clinical Evidence
Keywords
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References
- Intermediate and long-term outcomes of total ankle arthroplasty and ankle arthrodesis. A systematic review of the literature.J Bone Joint Surg Am. 2007; 89: 1899-1905
- Comparison of reoperation rates following ankle arthrodesis and total ankle arthroplasty.J Bone Joint Surg Am. 2007; 89: 2143-2149
- Surgeon type and outcomes after inpatient ankle arthrodesis and total ankle arthroplasty: a retrospective cohort study using the nationwide premier healthcare claims database.J Bone Joint Surg Am. 2019; 101: 127-135
- Trends in complication rates following ankle arthrodesis and total ankle replacement.J Bone Joint Surg Am. 2016; 98: 1453-1458
- Ankle arthrodesis using an anterior titanium dual locked plating construct.J Foot Ankle Surg. 2017; 56: 304-308
- Ankle arthrodesis using anatomically contoured anterior plate.Foot Ankle Int. 2010; 31: 492-498
- Anatomically contoured anterior plating for isolated tibiotalar arthrodesis: a systematic review.Foot Ankle Spec. 2017; 10: 352-358
- Ankle arthrodesis through an anterior approach.J Orthop Trauma. 2020; 34: S42-S43
- Comparison of ankle fusion rates with and without anterior plate augmentation.Foot Ankle Int. 2017; 38: 419-423
- Anterior double plating for rigid fixation of isolated tibiotalar arthrodesis.Foot Ankle Int. 2009; 30: 631-639
- Use of a small bilateral external fixator for ankle fusion.J Foot Ankle Surg. 2009; 48: 89-92
- High union rates and function scores at midterm follow-up with ankle arthrodesis using a four screw technique.Clin Orthop Relat Res. 2010; 468: 958-968
- Primary stability and stiffness in ankle arthrodes-crossed screws versus anterior plating.Foot Ankle Surg. 2013; 19: 168-172
- A biomechanical comparison of internal fixation techniques for ankle arthrodesis.J Foot Ankle Surg. 2015; 54: 188-191
- A biomechanical evaluation of three forms of internal fixation used in ankle arthrodesis.Foot Ankle Int. 1994; 15: 297-300
- A biomechanical analysis of two anterior ankle arthrodesis systems.Foot Ankle Int. 2013; 34: 1006-1011
- Anterior plate supplementation increases ankle arthrodesis construct rigidity.Foot Ankle Int. 2007; 28: 219-223
- Ankle arthrodesis with an anterior tension plate.Clin Orthop Relat Res. 1991; 268: 70-77
- The anatomic compression arthrodesis technique with anterior plate augmentation for ankle arthrodesis.Foot Ankle Clin. 2011; 16: 91-101
- Management of ankle arthritis after severe ankle trauma.J Orthop Trauma. 2020; 34: S26-S31
- Comparative study of ankle arthrodesis using cross screw fixation versus anterior contoured plate plus cross screw fixation.Acta Orthop Belg. 2006; 72: 716-721
- Ankle arthrodesis: a retrospective analysis comparing single column, locked anterior plating to crossed lag screw technique.J Foot Ankle Surg. 2017; 56: 453-456
- Ankle arthrodesis with anterior plate fixation in patients at high risk for nonunion.Foot Ankle Spec. 2020; 13: 211-218
- Ankle joint fusion with an anatomically preshaped anterior locking plate.J Foot Ankle Surg. 2016; 55: 414-417
- A review of ankle arthrodesis: predisposing factors to nonunion.Foot Ankle Int. 1994; 15: 581-584
- Factors affecting the outcomes of uncomplicated primary open ankle arthrodesis.Foot Ankle Int. 2015; 36: 1170-1179
- Arthroscopic ankle arthrodesis: factors influencing union in 39 consecutive patients.Foot Ankle Int. 2006; 27: 1079-1085
- Ankle fusion in a high risk population: an assessment of nonunion risk factors.Foot Ankle Int. 1999; 20: 491-496
- Nonunion risk assessment in foot and ankle surgery: proposing a predictive risk assessment model.Foot Ankle Int. 2015; 36: 901-907
- Comparison of posterior approach with intramedullary nailing versus lateral transfibular approach with fixed-angle plating for tibiotalocalcaneal arthrodesis.Foot Ankle Int. 2017; 38: 1343-1351
- Ankle arthrodesis through a fibular-sparing anterior approach.Foot Ankle Int. 2020; 41: 1480-1486
- Anterior ankle incision wound complications between total ankle replacement and ankle arthrodesis: a matched cohort study.J Foot Ankle Surg. 2021; 60: 47-50
- Angiosomes of the foot and ankle and clinical implications for limb salvage: reconstruction, incisions, and revascularization.Plast Reconstr Surg. 2006; 117: S261-S293
- Open posterior approach for tibiotalar arthrodesis.Foot Ankle Clin. 2011; 16: 103-114
Article info
Publication history
Published online: July 05, 2022
Footnotes
Financial Disclosure: None reported.
Conflict of Interest: None reported.
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