title: Effect of ankle arthritis on clinical outcome of lateral ankle ligament reconstruction in cavovarus feet.
abstract: BACKGROUND
  Patients with idiopathic cavovarus deformity and lateral ankle ligament instability often present with varying degrees of ankle arthritis. The purpose of this study was to determine whether the severity of degenerative change would impact the clinical outcome in patients treated operatively for both cavovarus deformity and lateral ankle ligament instability.
  
  
  METHODS
  Twenty-two patients were treated with lateral ankle ligament reconstruction and realignment foot osteotomy. American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, Karlsson and Peterson (KP) scoring scale, Visual Analog Scale (VAS) for pain, and level of satisfaction were obtained. Preoperative and postoperative ankle radiographs were reviewed and graded using the van Dijk score. Patients with Grade 0 and I arthritis preoperatively were grouped together as ``no to minimal arthritis'' (Group 1) and those with Grade II and III arthritis preoperatively as ``moderate to severe arthritis'' (Group 2). There were 14 ankles in Group 1 and eight ankles in Group 2. Mean followup was 60.4 months.
  
  
  RESULTS
  Mean AOFAS and KP scores were significantly improved in Group 1 compared to Group 2 at latest followup, while VAS pain scale trended lower in Group 1. There were 12 excellent/good results, one fair result, and one poor result in Group 1. Patients in Group 2 had three excellent/good results, two fair results, and three poor results. One of 14 patients in Group 1 had progression of arthritis, while five of eight patients in Group 2 either had progression of arthritis or required an ankle fusion.
  
  
  CONCLUSIONS
  Patients treated with lateral ankle ligament reconstruction and cavovarus realignment osteotomy with no to minimal preoperative tibiotalar arthritis have higher clinical scores and increased satisfaction compared to patients with more advanced preoperative tibiotalar arthritis. A cautious and realistic approach should be followed when recommending surgical treatment for this patient population.
authors.affiliation: Department of Orthopaedic Surgery, University of Michigan, 2098 S. Main St., Ann Arbor, MI 48103-5827, USA. tirwin@med.umich.edu
authors.forename: Todd A
authors.initials: TA
authors.lastname: Irwin
authors.forename: Robert B
authors.initials: RB
authors.lastname: Anderson
authors.forename: W Hodges
authors.initials: WH
authors.lastname: Davis
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Cohen
mesh_terms: D001168:Arthritis / Q000000981:diagnostic imaging / Q000453:epidemiology*; D002111:Calcaneus / Q000601:surgery; D018450:Disease Progression; D005260:Female; D005530:Foot Deformities / Q000453:epidemiology* / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D017844:Lateral Ligament, Ankle / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010027:Osteotomy; D010147:Pain Measurement; D017060:Patient Satisfaction; D011859:Radiography; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D016896:Treatment Outcome