Improvement in clinical outcome and quality of life after arthroscopic ankle arthrodesis in paralytic foot drop

Abstract

Background: Paralytic foot-drop is a disabling deformity that results from nerve or direct muscle injuries. Palliative surgeries such as tendon transfer and ankle arthrodesis are reserved for permanent deformity, with the arthroscopic technique had not been widely studied before. This study aims to evaluate the clinical outcome and quality of life after arthroscopic ankle fusion of paralytic foot-drop deformity.

Materials and methods: The patients who were retrospectively enrolled in this study underwent arthroscopic ankle fusion for paralytic foot-drop deformity between March 2017 and December 2021. The American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and Cumberland Ankle Instability Tool (CAIT) were the measures used for clinical assessment. To judge the union, serial plain radiographs of the ankle were obtained. The preoperative and postoperative means were analyzed utilizing a two-tailed paired t-test, with a p value of less than 0.05 indicating statistical significance.

Results: This study included 21 consecutive patients with a mean follow-up of 35.09 ± 4.5 months and a mean age of 41.5 ± 6.1 years. Highly significant improvements were observed between the preoperative and final follow-up means of the AOFAS score (from 57.6 ± 4.6 to 88.3 ± 2.7) and CAIT (from 12.1 ± 2.2 to 28.9 ± 1.01; p ˂ 0.00001 for both). All patients attained radiographic union and resumed their previous occupations without reporting serious adverse effects.

Conclusions: Arthroscopic ankle fusion is an effective, minimally invasive palliative surgery for patients suffering from permanent paralytic foot-drop deformity. This technique was shown to provide good functional and radiologic outcomes without significant complications.

Level of evidence: Retrospective cohort; level of evidence (IV).

Keywords: Ankle; Arthroscopic arthrodesis; Foot-drop; Paralytic.

Fig. 1

Patient position and portals for arthroscopic ankle fusion

Fig. 2

Arthroscopic view showing the removal of articular cartilage from superior surface of the talar dome with a small curette

Fig. 3

Arthroscopic view after complete removal of articular cartilage from the distal tibia and body of the talus. P; plafond, and T; talar dome

Fig. 4

Intraoperative fluoroscopic imaging to check the final position of the construct fixing and compressing the arthrodesis site. a Anteroposterior, and b Lateral views

Fig. 5

Plain radiographs show radiographic union at 5 months postoperatively in the anteroposterior (a) and lateral views (b), and the CT images demonstrate full consolidation at 9 months (c–f)