• Ankle
• Arthrodesis
• Fibular graft
• Fusion
• Screws
• Union

The Ankle Spacer was developed as a joint-sparing alternative to invasive end-stage surgeries. Currently, there are no clinical studies on the Ankle Spacer.

To describe the operative technique and the clinical efficacy of the Ankle Spacer for the treatment of multiple, cystic osteochondral lesions of the talus in patients with failed prior operative treatment.

This is a prospective study during which patients were assessed preoperatively, at 2- and 6 wk, and at 3, 6, 12 and 24 mo postoperatively. Patients with multiple, cystic or large (≥ 15 mm) osteochondral lesions of the talus after failed prior surgery were included. The primary outcome measure was the numeric rating scale (NRS) for pain during walking at 2 years postoperatively. Secondary outcome measures included the NRS in rest and during stair climbing, the American Orthopaedic Foot and Ankle Society Hindfoot Score, the Foot and Ankle Outcome Score, the Short- Form 36 physical and mental component scale, and the Range of Motion (ROM). Radiographic evaluations were conducted to evaluate prosthetic loosening and subsidence. Revision rates and complications were also assessed.

Two patients underwent an Ankle Spacer implantation on the talus. The NRS during walking improved from 6 and 7 preoperatively to 2 and 2 points postoperatively at 2 years, in patient 1 and 2, respectively. The other patient-reported outcome measures also improved substantially. There were no re-operations nor complications. Radiological imaging showed no loosening of the implant and no change of implant position.

The Ankle Spacer showed clinically relevant pain reduction during walking, improvement in clinical outcomes as assessed with PROMs, and no complications or re-operations. This treatment option may evolve as a joint-sparing alternative to invasive end-stage surgeries.

• Hemi-arthroplasty
• Ankle Spacer
• Talar surface implant
• Osteochondral lesions of the talus
• End-stage

• ankle
• arthrodesis
• arthroplasty
• early career
• training
• use

• anterior approach
• fusion
• outcomes
• tibiotalar

• ankle arthritis
• ankle arthrodesis
• return to sport
• total ankle replacement

Arthroscopic ankle arthrodesis (AAA) is a standard surgical method for the treatment of advanced traumatic ankle arthritis and has become more popular due to its advantages. To fix the tibiotalar joint, the use of three percutaneous screws is considered to have better mechanical stability than the use of two screws. However, it is sometimes difficult to insert three screws because they might block each other due to the small area of the tibiotalar joint surface and the large diameter of the screws; few articles illustrate how to insert three screws without the screws disturbing each other. The purpose of this study is to explore possible screw configurations of tripod fixation in arthroscopic ankle arthrodesis that avoid the collision of screws and yield better biomechanical performance.

We used the finite element method to examine the impact of different screw positions and orientations on the biomechanical characteristics of a three-dimensional (3D) ankle model. Maximum and average micromotion, pressure on the articular surface, and von Mises stress values of the tibia and the talus were used to evaluate the initial stability of the ankle.

Five kinds of three-screw configurations were identified, and finite element analysis results suggested that configurations with the posteromedial home-run screw presented lower micromotion (maximum, 17.96 ± 7.49 μm versus 22.52 ± 12.8 μm; mean, 4.88 ± 1.89 μm versus 5.19 ± 1.92 μm) (especially configuration 3) and better screw distributions on the articular surface than those with the posterolateral home-run screw.

Screw configurations with the posteromedial home-run screw avoid collision and are more biomechanically stable than those with the posterolateral home-run screw. Thus, inserting the home-run screw through the posteromedial approach is recommended for clinical practice.

• Arthroscopic ankle arthrodesis
• Biomechanics
• Finite element method
• Screw configuration

A great deal of research suggests that arthroscopic ankle fusion (AAF) has advantages over open ankle fusion (OAF), but these outcomes would be imprecise because of a selection bias. The purpose of this study is to verify which is better for ankle fusion, AAF or OAF. We regrouped the OAF group into two subgroups according to whether the osseous operation type is the same as AAF group. The goal is to minimize the impact of disease severity, thereby reducing selection bias to some extent.

We retrospectively analyzed the data of ankle fusion in our hospital between July 2015 and October 2018. Forty-three patients were enrolled and divided into AAF group (n = 17) and OAF group (n = 26). In order to eliminate selection bias, we divided OAF group into complex osseous operation subgroup (COO subgroup) (n = 15) and simple osseous operation subgroup (SOO subgroup) (n = 11). The osseous operation type of SOO subgroup is the same as AAF group. Then, we compared the differences between these groups. All patients were followed up at least 1 year after operation. We analyzed data, including etiology composition, surgical time, intra-op blood loss, reduction of albumin, total hospital stays, union time, fusion situation, complications, radiological examination, functional score, and questionnaire survey. Then we performed statistical analyses.

We found that the etiological components of AAF group and OAF group were different; the etiological components of AAF group and SOO subgroup were similar. We found that AAF group has advantages over OAF group and COO subgroup in general. However, except in terms of surgical trauma, hospital stays, and short-term complications occurred, the AAF group has not obvious advantages over SOO subgroup, including intra-op blood loss, fusion condition, postoperative function score, and postoperative patient satisfaction; and AAF group need more surgical time than the SOO subgroup.

The arthroscopic ankle fusion can bring a good curative effect; however, if the osseous operation type is the same, the arthroscopic ankle fusion only has a limited advantage over the traditional open operation in perioperative soft tissue protection and enhanced recovery after surgery.

• Arthroscopic ankle fusion
• Follow-up
• Open ankle fusion
• Questionnaire survey
• Selection bias

Ankle arthritis is a major source of morbidity impacting a younger working age population than hip and knee arthritis. Unlike the hip and knee, more than 70% of ankle arthritis cases are post-traumatic, with the remainder being inflammatory or primary arthritis. Nonoperative treatment begins with lifestyle and shoe-wear modifications and progresses to bracing, physical therapy, anti-inflammatory medications, and intra-articular injections. Ankle arthrodesis and total ankle arthroplasty are the 2 main surgical options for end-stage ankle arthritis, with debridement, realignment osteotomy, and distraction arthroplasty being appropriate for limited indications.

• Anatomy
• Ankle
• Arthrodesis
• Arthroscopy

• Ankle Injuries/complications
• Ankle Injuries/therapy
• Humans
• Orthopedic Procedures
• Sprains and Strains/complications
• Sprains and Strains/therapy