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BMC Musculoskelet Disord. 2017 Sep 9;18(1):389. doi: 10.1186/s12891-017-1749-0.

Changes in ankle joint motion after Supramalleolar osteotomy: a cadaveric model.

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Department of Orthopedic Surgery, Guro Hospital, Korea University College of Medicine, 80 Gurodong, Gurogu, Seoul, 152-703, South Korea.
Department of Orthopedic Surgery, Veterans Health Service Medical Center, 53, Jinhwangdo-ro 61-gil, Gangdong-gu, Seoul, 134-791, South Korea.
Department of Anatomy, Korea University College of Medicine University, 73 Inchon-ro, Seongbuk-gu, Seoul, South Korea.
Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, Seoul, 136-705, South Korea.
Department of Biomedical Engineering, College of Medical Science, Catholic University of Daegu, 330, Geumrak, Hayang-eup, Gyeongsan-si, Gyeongbuk, 712-702, South Korea.
Department of Orthopaedic Surgery,Bucheon Hospital, College of Medicine, Soonchunhyang University, 1174 Jung-1-dong, Wonmi-gu, Bucheon-si, Gyunggi-do, 420-767, Republic of Korea.



Malalignment of the ankle joint has been found after trauma, by neurological disorders, genetic predisposition and other unidentified factors, and results in asymmetrical joint loading. For a medial open wedge supramalleolar osteotomy(SMO), there are some debates as to whether concurrent fibular osteotomy should be performed. We assessed the changes in motion of ankle joint and plantar pressure after supramalleolar osteotomy without fibular osteotomy.


Ten lower leg specimens below the knee were prepared from fresh-frozen human cadavers. They were harvested from five males (10 ankles)whose average age was 70 years. We assessed the motion of ankle joint as well as plantar pressure for SS(supra-syndesmotic) SMO and IS(intra-syndesmotic) SMO. After the osteotomy, each specimen was subjected to axial compression from 20 N preload to 350 N representing half-body weight. For the measurement of the motion of ankle joint, the changes in gap and point, angles in ankle joint were measured. The plantar pressure were also recorded using TekScan sensors.


The changes in the various gap, point, and angles movements on SS-SMO and IS-SMO showed no statistically significant differences between the two groups. Regarding the shift of plantar center of force (COF) were noted in the anterolateral direction, but not statistically significant.


SS-SMO and IS-SMO with intact fibula showed similar biomechanical effect on the ankle joint. We propose that IS-SMO should be considered carefully for the treatment of osteoarthrosis when fibular osteotomy is not performed because lateral cortex fracture was less likely using the intrasyndesmosis plane because of soft tissue support.


Ankle; Osteoarthritis; Supramalleolar osteotomy

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