title: Arthroscopic evaluation of persistent pain following supramalleolar osteotomy for varus ankle osteoarthritis.
abstract: OBJECTIVE
  The purposes of this study were to investigate pain experienced by patients after supramalleolar osteotomy for varus ankle osteoarthritis and to analyse correlations between this pain and arthroscopic findings.
  
  
  METHODS
  Twenty-nine patients (31 ankles) who underwent arthroscopic evaluation after supramalleolar osteotomy were reviewed retrospectively. The visual analog scale (VAS) was used to assess pain, and the patients were instructed to record the time point, location, and character of the pain. The tibial-ankle surface angle, talar tilt, and tibial-lateral surface angle were measured on radiographs.
  
  
  RESULTS
  The location, time point, and character of the pain experienced by the patients changed after supramalleolar osteotomy. The mean VAS score was significantly improved after supramalleolar osteotomy at the time of the arthroscopic evaluation (P < 0.001) and improved further after the arthroscopic procedures (P = 0.026). During arthroscopy, pathologic lesions such as adhesions, synovitis, and soft-tissue impingement were identified. A significant correlation was found between adhesions and dull pain and pain at rest (P = 0.016 and P = 0.005, respectively). In addition, soft-tissue impingement in the lateral gutter was significantly correlated with dull pain, pain at rest, and clicking pain (P = 0.001, P = 0.035, and P = 0.042, respectively). No significant correlations were found between post-operative radiographic measurements and development of pathologic lesions.
  
  
  CONCLUSIONS
  With the use of arthroscopy, persistent pain experienced after supramalleolar osteotomy was found to be associated with adhesions, synovitis, and soft-tissue impingement in medial and lateral gutters of the ankle. Arthroscopy can be helpful in identifying and treating painful lesions commonly seen after supramalleolar osteotomy. An understanding of these painful lesions will help patients have more realistic expectations regarding the supramalleolar osteotomy.
  
  
  METHODS
  Case series study, Level IV.
authors: Department of Orthopaedic Surgery, Center for Stem Cell and Arthritis Research, Yonsei Sarang Hospital, 478-3, Bangbae-dong, Seocho-gu, Seoul, Korea. yskimos@gmail.com.
authors: Yong Sang
authors: YS
authors: Kim
authors: Department of Orthopaedic Surgery, Bala Hospital, Daegu, Korea.
authors: Hyun Kook
authors: HK
authors: Youn
authors: Department of Orthopaedic Surgery, Inha University Graduate School of Medicine, Incheon, Korea.
authors: Bom Soo
authors: BS
authors: Kim
authors: Department of Orthopaedic Surgery, Center for Stem Cell and Arthritis Research, Yonsei Sarang Hospital, 478-3, Bangbae-dong, Seocho-gu, Seoul, Korea.
authors: Yun Jin
authors: YJ
authors: Choi
authors: Department of Orthopaedic Surgery, Center for Stem Cell and Arthritis Research, Yonsei Sarang Hospital, 478-3, Bangbae-dong, Seocho-gu, Seoul, Korea.
authors: Yong Gon
authors: YG
authors: Koh
mesh_terms: D000328:Adult; D000842:Ankle; D000843:Ankle Joint / Q000601:surgery*; D018771:Arthralgia / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D001182:Arthroscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000601:surgery*; D010027:Osteotomy / Q000379:methods*; D010146:Pain / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D011859:Radiography; D012189:Retrospective Studies; D013585:Synovitis / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D013628:Talus / Q000601:surgery; D013977:Tibia / Q000601:surgery; D000267:Tissue Adhesions / Q000150:complications / Q000175:diagnosis* / Q000601:surgery
keywords: Arthroscopy; Pain; Supramalleolar osteotomy; Varus ankle osteoarthritis