Realignment Using Supramalleolar Osteotomy Is Associated With Improved Tibiotalar Congruity Without Fibular or Syndesmotic Reconstruction in Chronic Post-Traumatic Ankle Deformity With Tibiofibular Incongruity

Background: Post-traumatic ankle deformity associated with tibiofibular incongruity has traditionally been managed with anatomical reconstruction of the fibula and syndesmosis to restore talar position. However, such reconstruction is often not feasible in chronic deformities with distorted anatomy. We hypothesized that realignment using supramalleolar osteotomy (SMO), without fibular or syndesmotic reconstruction, would improve tibiotalar congruity. Methods: A retrospective study included 11 patients (11 ankles) who underwent SMO for chronic post-traumatic ankle deformity with tibiofibular incongruity. Patients were included if they had persistent symptoms refractory to nonoperative treatment and underwent SMO as the primary realignment procedure. Anatomical reconstruction of the fibula or syndesmosis was not attempted. Radiographic outcomes included whole limb and distal tibial alignment, tibiotalar congruity, and hindfoot alignment. Clinical outcomes were assessed using the visual analog scale (VAS) and the Foot Function Index (FFI). All cases achieved union and no patient required conversion to ankle arthrodesis or total ankle arthroplasty. Conclusion: In selected patients with chronic post-traumatic ankle deformity associated with tibiofibular incongruity in whom anatomical fibular or syndesmotic reconstruction is not feasible, realignment using supramalleolar osteotomy was associated with improved tibiotalar alignment and congruity, with favorable clinical outcomes. This realignment-based strategy represents a viable joint-preserving alternative in complex chronic ankle deformities with tibiofibular incongruity. Level of Evidence: Level IV, prognostic.