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Arthroscopic Ankle Arthrodesis: A Long-Term Follow-up Study

      Introduction

      Despite advances in arthroplasty techniques, ankle arthrodesis remains the gold standard for the treatment of degenerative ankle disease. Following tibiotalar fusion, there is concern of development of arthritis in the adjacent hindfoot joints as well as deterioration in functional outcomes secondary to a loss of motion at the ankle joint. We performed a long-term study to address these concerns.

      Methods

      Between 1993 and 2013, 116 patients (120 ankles) underwent arthroscopic ankle arthrodesis (AAA). Mean age at surgery was 61.1 years with a mean follow-up of 86 months. Patients were assessed according to the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle and Hindfoot scale, Ankle Osteoarthritis Scale (AOS) and Foot and Ankle Outcome Score (FAOS). Patients also underwent a comprehensive clinical and radiographic (pre and postoperative x-ray/CT) examination.

      Results

      Radiographic evidence of ankle fusion was achieved in 95% of patients. The mean AOFAS score was 83.3 (SD 13.2). The mean modified FAOS score was 87.4 (SD 10.4). There were 75% good/excellent results according to the modified AOS scoring system. According to the Kellgren-Lawrence score and van Dijk osteoarthritis grading scale 85% and 69% of patients had no change in talonavicular or subtalar grade of osteoarthritis, respectively. There were no cases of deep infection or other serious adverse events. All but 4 patients were able to return to work following AAA.

      Conclusion

      Arthroscopic ankle arthrodesis is an effective operation for treating degenerative ankle disease, even in cases of moderate tibiotalar coronal deformity. It resulted in good/excellent functional outcomes at a mean of 86 months post-operatively in nearly three-quarters of our patient cohort. Arthritis found in the adjacent hindfoot joints at the time of tibiotalar fusion appears to be a function of preexisting arthritic change and not directly caused by the tibiotalar fusion.