Perioperative axial loading computed tomography findings in varus ankle osteoarthritis: Effect of supramalleolar osteotomy on abnormal internal rotation of the talus

BackgroundWe used axial loading computed tomography (AL CT) to evaluate preoperative and postoperative talocrural joints of patients who underwent supramalleolar osteotomy (SMO) to treat varus ankle osteoarthritis.MethodsWe performed retrospective analyses of 16 patients (18 feet) who underwent SMO including fibular osteotomy. Radiographic assessment was performed with weightbearing radiographs and AL CT. Clinical outcomes were assessed based on American Orthopedic Foot & Ankle Society (AOFAS) scale, visual analog scale (VAS) for pain, and Foot and Ankle Ability Measure (FAAM).ResultsThe mean 2-year follow-up tibial-ankle surface angle, talar tilt angle, Takakura stage, and tibial-lateral surface angle were all significantly different relative to preoperative parameters (P < .05). The mean 6-month follow-up talus rotation ratio was significantly corrected compared to the preoperative value (P = .001). The mean 2-year follow-up AOFAS, VAS at gait, and FAAM scores were all significantly improved relative to preoperative measurements (P = .001).ConclusionsAbnormal internal rotation of the talus in mild to moderate varus ankle osteoarthritis found on AL CT was significantly corrected after SMO.Level of evidenceTherapeutic Level IV     

Muscle strength and ankle mobility for the gait parameters in diabetic neuropathies

AimsTo evaluate the spatio-temporal variables of gait and the isometric muscle strength component of the ankle in patients with peripheral diabetic neuropathy. Also, verify the relationship between these variables and gait parameters.MethodsThis study involved 25 diabetic peripheral neuropathy (DPN) participants (62.4 ± 8.36 years) and 27 age-matched healthy control individuals (64.48 ± 6.21 years). The assessment of the spatio-temporal parameters of gait was performed using an electronic baropodometry treadmill. Prior to the collection data, each participant was instructed to walk on the treadmill in her/his habitual self-selected speed.ResultsDiabetic neuropathy group showed impairment of gait, with a smaller stride and length speed of the cycle, and increased duration of support time. Restricted dorsiflexion mobility and increased plantarflexion mobility were found, with a decrease in muscle strength of the dorsiflexors and plantiflexors. There was a significant relationship between plantiflexor muscle strength and the length and speed of the gait cycle. Also the muscle strengths of the plantiflexors and dorsiflexors, and the range of motion of dorsiflexion were predictors of gait performance.ConclusionsThe ankle, muscle strength and ankle mobility variables could explain changes in gait speed and range of motion in patients with DPN, allowing for the application of preventive strategies.     

Factors associated with patient satisfaction with foot and ankle surgery in a large prospective study

BackgroundThere is minimal published research on outcomes and satisfaction with foot and ankle surgery.ObjectiveTo investigate patient-reported outcomes and satisfaction, and investigate which factors influence satisfaction at 9 months following foot or ankle surgery.MethodsProspective study of 671 adult patients having foot or ankle surgery. Pre-and post-surgery, patients self-completed MOXFQ, SF-36 and EQ-5D questionnaires. Using ratings to a satisfaction item, patients who were ‘very pleased’ with the outcome were compared with everyone else, using multiple logistic regression, regarding their pre-, peri- and post-operative characteristics.ResultsOf 628 eligible patients, 491 (73%) completed pre-and post-operative questionnaires. Following adjustment, satisfaction with surgery was influenced by patients’ perceptions of their foot/ankle's appearance (OR 0.12, 95% CIs 0.06–0.23, p < 0.001); wearable range of shoes (OR 0.36, 95% CIs 0.17–0.79, p = 0.01); continued foot/ankle pain (OR 0.06, 95% CIs 0.03–0.14, p < 0.001); impairment in Social-Interaction (MOXFQ SI scale) (OR 0.98, 95% CIs 0.96–0.99, p = 0.009). The final explanatory model explained 67% of the variance in patient satisfaction.ConclusionsFoot appearance, wearable shoe range, the (full) alleviation of pain and the ability/confidence to interact socially are crucial to peoples’ satisfaction with their foot or ankle surgery.     

Total ankle arthroplasty results using fixed bearing CT-guided patient specific implants in posttraumatic versus nontraumatic arthritis

BackgroundPatients who undergo total ankle arthroplasty (TAA) for end-stage posttraumatic ankle osteoarthritis have previously reported more complications and lower satisfaction than those with non-traumatic etiologies. The purpose of this study was to evaluate clinical and radiographic outcomes in these two patient groups after TAA using a newer generation implant.MethodsPatients underwent TAA with a third generation implant using CT-based patient-specific cutting guides. Patients were evaluated clinically using the Foot and Ankle Ability Measure (FAAM) and radiographically at a mean follow up of 32, and 24 months respectively.ResultsForty-one patients were studied (26 posttraumatic, 15 nontraumatic). There were no significant differences between the two study groups in FAAM scores (p = 0.3423) and radiographic measurements.ConclusionWe were able to show comparable results in terms of patient satisfaction, short term clinical and radiographic results between traumatic and nontraumatic patients using newer patient specific implant systems.     

Bone mass and anthropometry in patients with osteoarthritis of the foot and ankle

BackgroundPatients with hip and knee osteoarthritis (OA) have high bone mineral density (BMD) and high BMI. If the same accounts for patients with foot or ankle OA is unknown.MethodsWe measured BMD and femoral neck (FN) width by dual-energy X-ray absorptiometry in 42 women and 19 men with idiopathic OA in the foot or ankle, and in 99 women and 82 men as controls.ResultsWomen with OA had significant higher BMI than controls. Women with OA had higher BMI-adjusted BMD (p < 0.01) and smaller BMI-adjusted FN width (p < 0.01) than controls. Men with OA had higher BMI adjusted-BMD (p < 0.05) and smaller BMI-adjusted FN width (p < 0.01) than controls.ConclusionPatients with OA in the foot or ankle have higher BMD and smaller bone size than being expected by their BMI. This phenotype may provide unfavourable forces across the joint and is hypothetically important for development of OA.     

Assessment of perioperative total blood loss during total ankle arthroplasty

BackgroundAlthough many authors have discussed total blood loss after arthroplasty of the knee, hip, and shoulder, reports on perioperative blood loss after total ankle arthroplasty (TAA) are rare. The purpose of this study was to assess total blood loss after TAA and to identify correlated factors.MethodsA total of 103 cases (99 patients) of TAA for end-stage ankle osteoarthritis were enrolled in this study. Perioperative total blood loss was divided into intraoperative and postoperative blood loss. The patient-related variables evaluated for total blood loss were age, sex, body mass index, American Society of Anesthesiologists Classification score, comorbidities, history of previous ankle surgery, preoperative use of anticoagulants, platelet count and prothrombin time/international normalized ratio. Operation-related variables including type of anesthesia, operation time, TAA implant, and procedures performed in addition to TAA (if any) were evaluated to analyze correlations with total blood loss. In addition, the rate of transfusions after surgery was identified, and risk factors for transfusion were statistically analyzed.ResultsThe total blood loss was mean 795.5 ± 351.1 mL, which included 462.2 ± 248.5 mL of intraoperative blood loss and 333.2 ± 228.6 mL of postoperative blood loss. Sex, TAA implant, and additional bony procedures performed along with TAA were significantly correlated with total blood loss (p = 0.039, 0.024, 0.024, respectively) but the other variables were not significant (p > 0.05). Transfusions were administered for 4 cases (3.8%) but no risk factors for transfusion could be identified.ConclusionThe total blood loss after TAA was 795.5 mL and the rate of transfusions was 3.8%. This study demonstrated that male sex, use of TAA implants with a larger cutting surface, and bony procedures performed in addition to TAA were associated with an increase in total blood loss after TAA. The findings of this study will help surgeons to better predict blood loss and make optimal surgical plans accordingly.Level of evidenceLevel IV, retrospective case series.     

Factors Influencing patient experience and satisfaction following surgical management of ankle fractures

BackgroundPatient feedback is increasingly important to inform and develop effective healthcare within the United Kingdom. In order to optimise patient experience of ankle fracture care in our unit, we sought to identify elements of practice associated with poor patient experience and low levels of satisfaction.MethodsAdult patients with closed ankle fractures requiring fixation over a ten month period were prospectively identified. Prior to discharge all patients completed the Picker Patient Experience Questionnaire (PPE-15), satisfaction visual analogue scale (VAS: 0–10) and a demographic questionnaire. Operative delay and cancellation episodes were similarly noted. PPE-15 and satisfaction VAS data were collected concurrently from a control group of elective hip and knee arthroplasty patients.Results52 patients (23 males) of average age 47 years (17–86) underwent ankle fracture fixation. Median pre-operative length of stay (LOS) was 3 days (IQR 1–6). Ankle fracture patients had significantly worse experiences compared to arthroplasty patients (p < 0.05 across all 15 PPE domains). Once pre-operative length of stay exceeded 3 days patients reported more areas of concerns (6 of 15) than those waiting 3 days or less (4 of 15) (p = 0.02). Cancelled patients reported significantly worse experiences, with satisfaction VAS of 7 (versus 9 in those not cancelled [p = 0.005]), and median of 6 PPE-15 domains of concern (versus 3.5 [p = 0.03]).ConclusionsEfforts to improve the healthcare experience of patients with ankle fractures should be focused on improving processes that minimise cancellation of surgery and the communication around delay management.     

The demand incidence of symptomatic ankle osteoarthritis presenting to foot & ankle surgeons in the United Kingdom

BackgroundAnkle arthritis is a cause of major disability; however reports in the literature on the incidence of ankle osteoarthritis are rare.ObjectivesTo explore the methodological challenges in obtaining an incidence of ankle osteoarthritis and to estimate the incidence of symptomatic osteoarthritis presenting to Foot & Ankle specialists in the UK.MethodsWe searched available national diagnosis databases and also sent out a questionnaire-based survey to all Consultant members of the British Orthopaedic Foot & Ankle Society (n = 180).Results123 completed survey questionnaires were returned (68%) with each surgeon seeing on average 160 cases of symptomatic ankle arthritis and performing on average 20 definitive procedures for end-stage ankle osteoarthritis per year. There are no internationally agreed diagnostic or treatment codes specific for ankle osteoarthritis.ConclusionThere are an estimated 29,000 cases of symptomatic ankle osteoarthritis being referred to specialists in the UK, representing a demand incidence of 47.7 per 100,000. 3000 definitive operations to treat end stage ankle osteoarthritis take place in the UK annually. We recommend that specific codes pertaining to ankle arthritis and its treatment be included in any future revisions of the WHO International Classification of Diseases (ICD) and operative procedure coding systems.     

The effect of preoperative foot and ankle physiotherapy group on reducing inpatient stay and improving patient care

BackgroundBenefits of day case foot and ankle surgery include reduced hospital stay, cost savings, high patient satisfaction, quicker recovery with no increased complications. The preoperative foot and ankle group was set up in 2007 to reduce inpatient hospital stays and increase the rate of day case procedures.MethodsWe evaluated length of stay and physiotherapy intervention for all our patients during the first three months of 2007–2011.ResultsMedian length of stay was statistically significant (p < 0.05) in all groups apart from the ankle group. Day case surgery rates increased in all groups apart from hindfoot group but the result was only significant for forefoot and midfoot groups.ConclusionThe results show that the setting up our group has resulted in reduced inpatient stay, increase in day case surgery rates with significant cost savings.     

Individual didactic sessions or group lectures for teaching the foot and ankle to orthopaedic residents

BackgroundThe relative efficacy of individual didactic sessions or group lectures in teaching the foot and ankle to orthopaedic residents is unknown.MethodTen fourth year (R4) orthopaedic residents received individual didactic teaching sessions during a 1-month foot and ankle rotation, and 12 fifth year (R5) orthopaedic residents who had no foot and ankle rotation received a series of group lectures. Foot and ankle knowledge level was evaluated before and after the teaching programs with multiple choice tests.ResultsThe average test score for all residents was significantly improved from before to after the teaching programs (all residents: pre-test, 51 ± 11%; post-test, 66 ± 8%; P < 0.0001). There was no difference between the R4 and R5 resident groups in average pre-test score or post-test score. The improvement in test scores from the pre-test to the post-test was similar for the R4 and R5 resident groups.ConclusionsIndividual didactic sessions and group lectures were equally effective in encouraging learning and improving knowledge level of the foot and ankle. The key factors in significantly improving knowledge of the foot and ankle were the presence of a formal teaching program to stimulate learning and the availability of an active Foot and Ankle Service with dedicated attending foot and ankle subspecialist surgeons.     

Computer-assisted surgery (CAS) based correction of posttraumatic ankle and hindfoot deformities—Preliminary results

The first clinical experiences with a computer assisted surgery based (CAS) guided correction arthrodeses at ankle, hindfoot and midfoot were evaluated.MethodsTime spent, accuracy, surgeons’ rating (Visual Analogue Scale [VAS], 0–10 points) were analyzed. The accuracy was assessed by ISO-C 3D (Siremobile™, Siemens, Germany).Results10 patients were included (ankle, n = 3; subtalar joint, n = 6; ankle and subtalar joint, n = 2; Lisfranc joint, n = 1). Time needed for preparation was 500 s (400–900). The correction process took 45 s (30–60). All angles/translations were achieved as planned before surgery (≤ ±1°/±1 mm). The ratings of the three involved surgeons were: feasibility, 9.5 (9–10); accuracy 9.8 (9.5–10); clinical benefit 9 (8–10).ConclusionsCAS guided correction of posttraumatic deformities of the ankle and hindfoot region provides very high accuracy and a fast correction process. The significance of the introduced method may be high in those cases, because the improved accuracy may lead to an improved clinical outcome.     

Radiological evaluation of ankle arthrodesis with Ilizarov fixation compared to internal fixation

IntroductionWe asked whether the type of ankle joint arthrodesis stabilization will affect: (1) rate of union, (2) rate of adjacted-joint arthritis, (3) malalignment of the ankle joint.Material and methodsWe retrospectively radiological studied 62 patients who underwent ankle arthrodesis with Ilizarov external fixator stabilization (group 1,n = 29) or internal stabilization (group 2,n = 33) from 2006 to 2015. Radiologic outcomes were mesure by: (1) rate of union, (2) rate of adjacent-joint arthritis, (3) malalignment of the ankle joint. The Levene’s test,Mann–Whitney U test and Students t-test were used to the statistical analyses.ResultsAnkle fusion was achieved in 100% of patients treated with external fixation and in 88% with internal stabilization. Desired frontal plane alignment was achieved in 100% of patients with external fixation and 76% with internal stabilization. Desired sagittal plane alignment was achieved in 100% of external fixation and 85% of internal stabilization. A total of 14 (48.3%) patients from group 1 showed a radiographic evidence of pre-existing adjacent-joint OA. The radiographic evidence of pre-existing adjacent-joint OA was also found in 27(81.8%) subjects from group 2. Alterations of adjacent joints were also found on postoperative radiograms of 19 (65.5%) patients subjected to Ilizarov fixation and in all 33 patients from group 2.DiscusionIlizarov fixation of ankle arthrodesis is associated with lower prevalence of adjacent-joint OA and ankle joint misalignment,and with higher fusion rates than after internal fixation.Although achieving a complex ankle fusion is generally challenging,radiological outcomes after fixation with the Ilizarov apparatus are better than after internal stabilization.     

Kinematic analysis of ankle stiffness in subjects with and without flat foot

BackgroundAlthough the magnitude of ankle motion is influenced by joint congruence and ligament elasticity, there is a lack of understanding on ankle stiffness between subjects with and without flat foot.ObjectiveThis study investigated a quantified ankle stiffness difference between subjects with and without flat foot.MethodsThere were forty-five age- and gender-matched subjects who participated in the study. Each subject was seated upright with the tested foot held firmly onto a footplate that was attached to a torque sensor by the joint-driving device.ResultsThe flat foot group (mean ± standard deviation) demonstrated increased stiffness during ankle dorsiflexion (0.37 ± 0.16 for flat foot group, 0.28 ± 0.10 for control group; t = −2.11, p = 0.04). However, there was no significant group difference during plantar flexion (0.35 ± 0.15 for flat foot group, 0.33 ± 0.07 for control group; t = 0.64, p = 0.06).ConclusionThe results of this study indicated that the flat foot group demonstrated increased ankle stiffness during dorsiflexion regardless of demographic factors. This study highlights the need for kinematic analyses and joint stiffness measures during ankle dorsiflexion in subjects with flat foot.     

The feasibility of point-of-care ankle ultrasound examination in patients with recurrent ankle sprain and chronic ankle instability: Comparison with magnetic resonance imaging

ObjectiveTo evaluate the feasibility of point-of-care ankle ultrasound compared with magnetic resonance imaging (MRI) for diagnosing major ligaments and Achilles tendon injuries in patients with recurrent ankle sprain and chronic instability, and to evaluate inter-observer reliability between an emergency physician and a musculoskeletal radiology fellow.Material and methodsA prospective cross-sectional study was conducted in an emergency department. Patients with recurrent ankle sprain and chronic instability were recruited. An emergency physician and a musculoskeletal radiology fellow independently evaluated the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), distal anterior tibiofibular ligament (ATiFL), deltoid ligament, and Achilles tendon using point-of-care ankle ultrasound. Findings were classified normal, partial tear, and complete tear. MRI was used as the reference standard. We calculated diagnostic values for point-of-care ankle ultrasound for both reviewers and compared them using DeLong's test. Intra-class correlation coefficients (ICCs) were calculated for agreement between each reviewer and the reference standard, and between the two reviewers.ResultsEighty-five patients were enrolled. Point-of-care ankle ultrasound showed acceptable sensitivity (96.4–100%), specificity (95.0–100%), and accuracy (96.5–100%); these performance markers did not differ significantly between reviewers. Agreement between each reviewer and the reference standard was excellent (emergency physician, ICC = 0.846–1.000; musculoskeletal radiology fellow, ICC = 0.930–1.000), as was inter-observer agreement (ICC = 0.873–1.000).ConclusionPoint-of-care ankle ultrasound is as precise as MRI for detecting major ankle ligament and Achilles tendon injuries; it could be used for immediate diagnosis and further pre-operative imaging. Moreover, it may reduce the interval from emergency department admission to admission for surgical intervention, and may save costs.     

3D optical scanning as an objective and reliable tool for volumetry of the foot and ankle region

BackgroundEdema development of the foot and ankle region should be evaluated by an objective measurement. We hypothesized, that 3D optical scanning of this region can serve as an alternative to clinically established measurement techniques.MethodsTwo investigators determined the volume by 3D optical scanning and the figure-of-eight method in a random order at 2 separate time points. Plots were created and ICCs were calculated for determination of reliability. The Pearson correlation coefficient served as a measure of the association between both measures.Results40 healthy volunteers with mean age of 28.3 ± 9.9 years underwent four sequences of measurements. The inter- and intraobserver reliability of both methods was excellent with high intraclass correlation coefficients (ICC 3,1). A strong correlation (r = 0.96, P < 0.001) between measured ankle volumes was noted.Conclusion3D optical scanning turned out to be more reliable than the figure-of-eight method in a preclinical set-up. A clinical use should be aimed at.     

Splinting vs temporary external fixation in the initial treatment of ankle fracture-dislocations

BackgroundTo compare the efficacy, functional outcome, and complication frequency of splinting and external fixation in the initial treatment of ankle fracture-dislocations.MethodAnkles with poor soft tissue conditions who underwent temporary stabilization due to using a splint or external fixator due to an ankle fracture-dislocation between 2012 and 2019 were retrospectively evaluated. Ankles were divided into two groups as the splint (n = 69) and external fixator (n = 48). The time between the injury to definitive surgery, reduction loss, operation time, functional outcome, pain, and soft-tissue complication frequency before and after definitive surgery were compared.ResultsThe frequency of reduction loss (25% vs. 4%, p = 0.019) and skin necrosis (22% vs. 6%, p = 0.028) were significantly higher in the splint group. Posterior malleolar fracture fragment ratio was calculated by dividing the fracture fragment axial length by the total axial length of the articular surface on computed tomography. Posterior malleolar fracture fragment ratio was found to be significantly higher in ankles with reduction loss in both the splint (25% vs 75%, p = 0.032) and fixator groups (4% vs 96%, p = 0.021). The mean time period between injury and definitive surgery was significantly shorter in the external fixator group (11 ± 5 vs 7 ± 4 days, p = 0.033). Before definitive treatment, pin tract infection was observed in two ankles in the fixator group.ConclusionSplint immobilization of ankle fracture-dislocations may predispose to reduction loss, soft tissue complications, and a longer time period between injury and definitive fixation. The risk of these potential complications can be reduced with the use of an external fixator.     

Impact of fibular torsion and rotation on chronic ankle instability

BackgroundThe fibula is known not to involve in transmission of weight but known simply as an ankle stabilizer. However, its main function in stabilizing the ankle remains obscure. Since the fibula has an impact on torsion and rotation of the ankle, its effect on lateral ankle instability should be investigated.Materials and methodsTwenty patients with lateral ankle instability (Group 1) and 19 healthy volunteers (Group 2) were included in the study. The tibiofibular and talofibular relationships were evaluated using MRI images. Fibular torsion and rotation angles were calculated using a new method. Range of motion of the ankle joint was investigated while the knee was at flexion (90°) and extension (0°). The comparisons performed between the 2 groups and independent from the groups were statistically evaluated and, the p value of <0.05 was considered as statistically significant.ResultsA significant difference was found between the two groups for age (p < 0.05). There were no statistically significant differences between the right and left sides for all measurements in the group 1 and 2 (p > 0.05). There was a statistically significant difference between the two groups in dorsal flexion when the knee is at flexion (90°) and extension (0°) position. There was also a statistically significant difference between the two groups in plantar flexion which was measured while the knee was at extension (0°) position. No statistically significant difference was found between both groups in terms of fibular torsion and rotation. However, independent from the groups when the patients were divided into 2 groups according to whether the fibula localized posteriorly or not, in patients with posteriorly localized fibula it was demonstrated that the fibular torsion and rotation was increased significantly.ConclusionWe did not detect any relationship between fibular torsion and rotation and ankle instability. However, independent from the groups when the patients were divided into 2 groups according to whether the fibula localized posteriorly or not, we realized that in patients with posteriorly localized fibula, fibular torsion and rotation significantly increased. This finding did not explain the cause of instability. However, it may gain significance with new further studies regarding ankle instability.     

Patient reported outcomes and ankle plantarflexor muscle performance following gastrocnemius recession for Achilles tendinopathy: A prospective case-control study

BackgroundProspective studies to guide the application of a gastrocnemius recession for Achilles tendinopathy are limited. Our aim was to prospectively evaluate patient reported outcomes and muscle performance.MethodsPatients with unilateral recalcitrant Achilles tendinopathy who received an isolated gastrocnemius recession (n = 8) and a healthy control group (n = 8) were included. Patient reported outcomes, ankle power during walking and stair ascent, and the heel rise limb symmetry index (total work) were collected.ResultsImprovements in pain and self-reported function were observed (six months and two years). Sport participation scores reached 92% by two years. Patients demonstrated lower ankle power during stair ascent and decreased limb symmetry during heel rise six months following treatment (p ≤ .02).ConclusionsStudy findings regarding long-term improvements in patient pain, self-reported function and sport participation, and early preservation of ankle function during walking, can help refine patient selection, anticipated outcomes, and rehabilitation strategies.     

Short-term and mid-term outcome of total ankle replacement in haemophilic patients

BackgroundAnkle arthropathy is very frequent in haemophilic patients. Prostheses are valuable alternatives to arthrodesis in non-haemophilic patients. We report the experience of a single centre in France on the use of prostheses in haemophilic patients.MethodsRetrospective study of 21 patients with haemarthropathy who underwent ankle arthroplasty (32 ankles), with additional surgery, if needed, from July 2002 to September 2009 (mean follow-up 4.4 ± 1.7 years). The American Orthopaedic Foot and Ankle Society (AOFAS) ankle–hindfoot scale was used to evaluate pain, function, ankle mobility and alignment.ResultsThe overall AOFAS score improved from 40.2 ± 19.4 (pre-surgery) to 85.3 ± 11.4 (post-surgery). The function score increased from 23.6 ± 7.7 to 35.9 ± 6.7 and dorsiflexion from 0.3° ± 5.0° to 10.3° ± 4.4°. Two patients underwent further ankle arthrodesis. On X-ray, both tibial and talar components were stable and correctly placed in all ankles. Alignment was good.ConclusionAnkle arthroplasty is a promising alternative to arthrodesis in haemophilic patients.     

Bipolar fresh total osteochondral allograft in the ankle: Is it a successful long-term solution?

IntroductionSevere post-traumatic ankle arthritis poses a reconstructive challenge in young and active patients. Although technically demanding and despite unsolved immunological issues, bipolar fresh total osteochondral allograft (BFTOA) represent an intriguing option to arthrodesis and prosthetic replacement. The purpose of this paper is to evaluate the outcomes of a series of 48 ankle BFTOA at 10 years follow up and to investigate the rate of survival long term.Methods58 patients underwent BFTOA, of these 48 were available for follow up. The allograft was prepared with the help of specifically designed jigs and the surgery was performed using either a lateral or a direct anterior approach. Patients were evaluated clinically and radiographically preoperatively, and at a mean 121 ± 18 months of follow-up.ResultsThe AOFAS score improved from 31 ± 11 pre operatively, to 65 ± 25 at the last (p < 0.0005). Fourteen failures occurred, with 70.8% allograft rate of survival. All the surviving allografts showed a reduction of the ankle joint movement, still associated with a satisfactory clinical result.ConclusionThe use of BFTOA represents an intriguing option to arthrodesis or arthroplasty. A satisfactory clinical result associated to a good movement of the transplanted joint is to be expected up to short-mid-term, overtime. Long term, the range of motion (ROM) is progressively decreased up to spontaneous arthrodesis in some cases, still the joint results pain free and patient’s perception is of a well functioning ankle. A deeper knowledge of the immunological behavior of transplanted cartilage is needed in order to improve the durability of this fascinating technique.