Anterior ankle arthroplasty

Osteophytic proliferation at the anterior ankle joint level occurs secondary to repeated direct trauma to the talus and tibia during extreme dorsiflexion of the ankle. This syndrome occurs frequently, especially in athletes. As the exostosis increases in size, ankle joint motion decreases. With increased activity, patients will complain of pain at the anterior aspect of the ankle joint, secondary to the osseous impingement occurring at the tibiotalar joint. If surgical resection is planned, the following should be considered: (1) Proper planning of the incision should give optimal exposure to the tibiotalar joint. (2) Meticulous dissection should be used to identify and carefully retract the superficial and deep neurovascular structures. (3) Adequate repair of the inferior and superior bands of the extensor retinaculum is critical in order to prevent postoperative bowstringing of the anterior tendons. (4) A postoperative course of 3 weeks nonweight bearing is required to help avoid hypertrophic scar formation and allow adequate healing of the extensor retinaculum. (5) Passive range of motion may be started after suture removal at 10 to 14 days. (6) Active range of motion should begin with the initiation of weight bearing at the start of the fourth week. Rewarding results from anterior ankle arthroplasty resection have been seen in those patients presenting with the classical symptoms, as discussed previously, and radiographic evidence of exostosis formation and impingement of the anterior tibiotalar joint.