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Related Concept Videos

Ankle Joint01:10

Ankle Joint

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The ankle is formed by the talocrural joint (crural = leg). It consists of the articulations between the talus bone of the foot and the distal ends of the tibia and fibula of the leg. The superior aspect of the talus bone is square-shaped and has three areas of articulation. The top of the talus articulates with the inferior tibia. This is the portion of the ankle joint that carries the body weight between the leg and foot. The sides of the talus are firmly held in position by the articulations...
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The knee joint is the most complicated joint in the body. It consists of three articulations– two tibiofemoral and one patellofemoral. As is characteristic of synovial joints, the knee joint has a thin articular capsule that partially surrounds this joint cavity. Additionally, several ligaments, muscles, and cartilaginous structures support the movement of the knee.
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Treatment of Ankle Osteoarthritis with Total Ankle Replacement Through a Lateral Transfibular Approach
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Syndesmotic Overload in 3-Component Total Ankle Replacement.

Roxa Ruiz1, Roman Susdorf1, Nicola Krähenbühl1

  • 1Department of Orthopaedics, Kantonsspital Baselland, Liestal, Switzerland.

Foot & Ankle International
|December 18, 2019
PubMed
Summary

Syndesmotic overload negatively impacts outcomes in mobile-bearing total ankle replacement (TAR). Tibiofibular fusion can effectively restore function and relieve pain in revision cases.

Keywords:
3-component total anklesyndesmotic overloadtibiofibular fusiontotal ankle replacement

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Area of Science:

  • Orthopedic surgery
  • Biomechanical engineering
  • Radiology

Background:

  • Mobile-bearing total ankle replacement (TAR) allows motion at the tibial implant-polyethylene insert interface.
  • This mobility may lead to periarticular ligament overload and talar translation.
  • Syndesmotic overload is a potential complication affecting TAR outcomes.

Purpose of the Study:

  • To evaluate the impact of syndesmotic overload on clinical and radiographic outcomes after mobile-bearing TAR.
  • To assess the efficacy of tibiofibular fusion as a treatment for syndesmotic overload in TAR.

Main Methods:

  • Retrospective analysis of 31 patients undergoing revision surgery for syndesmotic overload post-TAR.
  • Assessment of clinical and radiographic outcomes at multiple time points.
  • Analysis of computed tomography scans to evaluate implant position and syndesmotic integrity.

Main Results:

  • Lateral talar translation correlated with valgus tibial implant position (P = .003).
  • Increased tibiofibular distance was linked to a larger hindfoot moment arm (P = .025).
  • Polyethylene insert height decrease (32%) and fracture (13%) were observed; talar cysts occurred in 39% of cases.

Conclusions:

  • Syndesmotic overload significantly impairs outcomes following mobile-bearing TAR.
  • Tibiofibular fusion proved effective for functional restoration and pain relief in revision surgery.
  • Optimizing implant positioning and considering realignment procedures may prevent soft tissue overload.