Ankle Arthrodesis Through a Fibular-Sparing Anterior Approach.
BACKGROUND
The open anterior approach to ankle arthrodesis offers a technique that provides several advantages for surgeons, such as easier visualization of the joint for deformity correction and preservation of the malleoli for potential future conversion to total ankle arthroplasty. The purpose of this study was to evaluate clinical, radiographic, and functional outcomes in a large series of patients undergoing open ankle arthrodesis via a fibular-sparing anterior approach.


METHODS
A retrospective review was performed of patients undergoing primary ankle arthrodesis with a single fellowship-trained foot and ankle orthopedic surgeon between 2009 and 2017. Patients were excluded if an approach other than anterior was performed. Patient-reported outcome measures (Foot and Ankle Ability Measure-Activities of Daily Living [FAAM-ADL], Short-Form 12 [SF-12], and visual analog scale [VAS] pain) were subsequently collected at a minimum of 24 months (2 years) following index surgery, along with outcome satisfaction and likelihood to repeat surgery. Fusion of the tibiotalar joint at the time of last radiographic follow-up was also assessed. Paired t tests were performed to assess change in pre- to postoperative outcomes, while linear regression analysis was performed to identify any patient factors associated with outcomes. Eighty-one patients, including 31 women and 50 men, with a mean age of 51.5 years and a mean follow-up of 58.9 (range, 24-104) months, were included.


RESULTS
Sixty-two patients reported significant improvement in mean FAAM-ADL (P < .0001), SF-12 Physical Composite Scale (P < .0001), and VAS pain (P < .0001), while the SF-12 Mental Composite Scale also improved, though not significantly (P = .2854). Twelve patients (14.8%) experienced complications following their arthrodesis procedure. Seventy-nine patients (97.5%) achieved fusion at their last radiographic follow-up. Multiple linear regression analysis revealed age (B = 0.071 [0.004, 0.128]; P = .0373) to have a positive association with postoperative VAS pain.


CONCLUSION
Ankle arthrodesis utilizing a fibular-sparing anterior approach combined with the transarticular screw fixation technique offers surgeons several advantages, along with a low postoperative complication rate, high rate of radiographic evidence of joint fusion, and substantially large improvement in pain and functional levels.


LEVEL OF EVIDENCE
Level IV, retrospective case series.
['Rogero|Ryan G|RG|https://orcid.org/0000-0002-7316-3172', 'Fuchs|Daniel J|DJ|https://orcid.org/0000-0001-7469-9596', 'Corr|Daniel|D|', 'Shakked|Rachel J|RJ|', 'Raikin|Steven M|SM|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D000843:Ankle Joint D001174:Arthrodesis D001863:Bone Screws D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D010147:Pain Measurement D000071066:Patient Reported Outcome Measures D012189:Retrospective Studies D055815:Young Adult
anterior approach outcomes fusion tibiotalar