Is there an optimal degree of correction for ankle varus deformity after supramalleolar osteotomy? A systematic review.

BACKGROUND: There is no consensus on the angle targeted for in varus ankle deformity after supramalleolar osteotomy (SMOT). The aim of this study was to investigate which obtained correction has the best clinical outcome after valgus SMOT. METHODS: A systematic review according PRISMA guidelines was conducted with studies being eligible for inclusion when published in English, German or Dutch, patients older than 18 years at study entrance, primary or posttraumatic varus ankle osteoarthritis, using any valgus SMOT technique, describing radiological alignment and clinical outcome at baseline and after at least 12 months follow-up. Risk of bias was assessed using the McMaster University Occupational Therapy Evidence-Based Practice Research Group quality assessment tool. The electronical databases PubMed, EMBASE and Cinahl were used as data sources. Included cohorts were categorized according to the mean obtained medial distal tibia angle (MDTA; ranged between 87° and 100°). A linear mixed effect model was used for individual patient data to assess the association between the MDTA and the (difference in) clinical outcome. RESULTS: Thirty studies including 33 patient cohorts with 922 ankles were identified. At a mean follow-up of 4 years no differences in clinical outcome between correction categories were found. Individual data of 34 ankles showed no relationship between obtained MDTA and clinical outcome either. CONCLUSION: This review could not demonstrate an optimal degree of correction after valgus SMOT. Results were hampered by biased low quality studies and the widespread use of unreliable 2D alignment measures such as the MDTA.

Sacroiliac joint fusion in patients with Ehlers Danlos Syndrome: A case series.

BACKGROUND: Sacroiliac joint dysfunction (SJD) is a known cause of lower back pain. SJD might be due to hypermobility in the Sacroiliac joint (SIJ) in patients with Ehlers Danlos Syndrome (EDS). Stabilization of the SIJ can be a highly successful treatment for lower back pain. No previous literature about EDS and SIJ fusion is available. The purpose of this study was to assess our mid-term results of SIJ fusion surgery in EDS patients suffering from SIJ dysfunction. METHODS: A case series of patients who underwent SIJ fusion for SIJ dysfunction due to EDS between January 2012 and December 2018 were analyzed in retrospect. Patients underwent surgery and the SIJ was stabilized with triangular implants bridging the joint. Pain and functional outcomes were assessed in nine agree/disagree questions and a satisfaction performance scale. Clinical data has been extracted from the patient files and in addition, we reassessed the position of the implants on the CT scans. RESULTS: A total of 16 patients with EDS completed the questionnaire and were available for analysis. The mean satisfaction score is 78.1 out of 100 and seven patients reported a 100% satisfaction score. CONCLUSION: SIJ fusion is a safe and useful procedure to reduce pain and function levels in EDS patients with lower back pain due to SIJ dysfunction.