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March 22, 2026Open Access

Functional and Radiological Benefits of Adding Fibular Osteotomy to Supramalleolar Osteotomy in Ankle Osteoarthritis

Key Points

This study aims to evaluate the benefits of adding fibular osteotomy to supramalleolar osteotomy in ankle osteoarthritis patients.
Conducted a retrospective analysis of 65 patients with mid-stage ankle osteoarthritis.
Patients categorized into two groups: SMOT (34 patients) and SMOT+FO (31 patients).
Outcomes assessed using VAS for pain, AOFAS scores, range of motion, and complication rates.
Radiographic parameters were compared, including various angular measurements of the tibia and talus.
Both treatment groups showed significant improvement in AOFAS scores and VAS scores post-surgery (P<0.001).
No significant improvement was noted in range of motion between groups.
The SMOT+FO group exhibited superior outcomes in AOFAS scores and improved radiographic angles compared to SMOT (P<0.001).
Postoperative complications were lower in the SMOT group compared to SMOT+FO group (2.9% vs 6.4%); however, this was not statistically significant (P=0.500).

Abstract

Ankle arthritis is a chronic degenerative disease; its typical symptom is pain in the ankle joint.This retrospective study of 65 patients with mid-stage ankle osteoarthritis aimed to compare clinical outcomes from supramalleolar osteotomy (SMOT) and supramalleolar osteotomy combined with fibular osteotomy (SMOT+FO). Material/Methods:Based on whether fibular osteotomy was performed during the procedure, the patients were categorized into the SMOT group (n=34) or the SMOT+FO group (n=31).Surgical outcomes were systematically assessed using the Visual Analogue Scale (VAS) for pain, American Orthopaedic Foot and Ankle Society (AOFAS) score, range of motion (ROM), and complication rates.Radiographic parameters were compared between the 2 groups, including the distal tibial articular surface angle, talar tilt angle, tibiocrural angle, and tibial lateral surface angle. Results:The AOFAS scores, VAS scores, and imaging indicators in both patient groups showed significant improvement compared with preoperative levels (P<0.001).However, no statistically significant improvement was observed in the ROM.Compared to SMOT, the addition of fibular osteotomy demonstrated superior outcomes in terms of AOFAS scores and greater improvement in both the talar tilt and tibiocrural angles (P<0.001).The overall incidence of postoperative complications in the SMOT group was lower than that in the SMOT+FO group (2.9% vs 6.4%; OR, 0.44; 95% CI, 0.04 to 5.10).However, the difference did not reach statistical significance (P=0.500). Conclusions:Combining fibular osteotomy with SMOT not only significantly enhances ankle joint function but also exhibits notable advantages in improving radiological parameters, so as to provide long-term clinical benefits for patients.

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