Strategies in Trauma and Limb Reconstruction

Register      Login

VOLUME 13 , ISSUE 1 ( April, 2018 ) > List of Articles


The Teramoto distal tibial oblique osteotomy (DTOO): surgical technique and applicability for ankle osteoarthritis with varus deformity

Tsukasa Teramoto, Shota Harada, Motoyuki Takaki, Tomohiko Asahara, Narutaka Kato, Nobuyuki Takenaka, Takasi Matsushita, Yosiaki Makino, Kouitiro Tasiro, Ootuka Kazutaka, Yukinobu Nishi, Kiyoto Kinugsa

Keywords : Ankle, Tibia, Deformity, Distal tibial oblique osteotomy, Varus, Ankle osteoarthritis

Citation Information : Teramoto T, Harada S, Takaki M, Asahara T, Kato N, Takenaka N, Matsushita T, Makino Y, Tasiro K, Kazutaka O, Nishi Y, Kinugsa K. The Teramoto distal tibial oblique osteotomy (DTOO): surgical technique and applicability for ankle osteoarthritis with varus deformity. 2018; 13 (1):43-49.

DOI: 10.1007/s11751-018-0307-0

License: CC BY-NC-SA 4.0

Published Online: 01-06-2016

Copyright Statement:  Copyright © 2018; The Author(s).


We have devised a medial peri-articular osteotomy, the distal tibial oblique osteotomy (DTOO), and have used this technique since 1994 for ankle osteoarthritis of advanced and late stages associated with varus inclination. This report describes the surgical technique and its applicability. DTOO can be used for cases of varus ankle osteoarthritis with a range of the ankle joint movement of at least 10° or more. The osteotomy is obliquely directed cut across the distal tibia from proximal-medial to distal lateral and is of an opening-wedge type with the centre of rotation coincident with the centre of the tibiofibular joint. A laminar spreader instrument is inserted in the osteotomy to open the wedge until the lateral surface of the talar body is seen on X-ray to be in contact and congruent with medial articular surface of the lateral malleolus. Common obstacles which may prevent this contact and congruency are bony spurs present on the anterior side of fibula or on the lateral side of the tibia; these require removal. The opening-wedge osteotomy is held in position by an Ilizarov external fixator or internally fixed with a plate. Bone graft is taken from the iliac crest and inserted into the open wedge. If, after completion of the osteotomy, the dorsiflexion angle of the ankle joint does not exceed 0°, a Z-lengthening is performed of the Achilles tendon. In the DTOO for ankle osteoarthritis, the contact area of the ankle joint increases and decreases the load pressure per unit area. Furthermore, as the width of the ankle mortice is restored through the realignment of the body of the talus, instability at the ankle joint decreases. There is additional improvement with restoration of the inclination of the distal tibial articular surface as this directs the hindfoot valgus and corrects the alignment of the foot, with consequent improvement of ankle pain.

PDF Share
  1. Boobbyer GN (1981) The long-term results of ankle arthrodesis. Acta Orthop Scand 52(1):107-110
  2. Chalayon O, Wang B, Blankenhorn B, Javckson JB 3rd, Beals T, Nickisch F, Saltzman CL (2015) Factors affecting the outcomes of uncomplicated primary open ankle arthrodesis. Foot Ankle Int 36(10):1170-1179
  3. Ebalard M, Le henaff G, Sigonney G, Lopes R, Kerhousse G, Brilhault J, Huten D (2014) Risk of osteoarthritis secondary to partial or total arthrodesis of the subtalar and midtarsal joint after a minimum follow-up of 10 years. Ortho Traumatol Surg Res 100(4):231-237
  4. Osti L, Del Buono A, Maffulli N (2016) Arthroscopic debridement of the ankle for mild to moderate osteoarthritis: a midterm follow-up study in former professional soccer players. J Orthop Surg Res 11:37
  5. Nguyen MP, Pedersen DR, Gao Y, Saltzman CL, Amendola A (2015) Intermediate-term follow up after ankle distraction for treatment of end-stage osteoarthritis. J Bone Joint Surg Am 97(7):590-596
  6. Pagenstert G, Barg A (2015) Knee and ankle arthroplasty—What results can be expected? Ther Umsch 72(8):495-503
  7. Popelk S, Sosna A (2016) Eleven-year experience with total ankle arthroplasty. Acta Clin Orthop Traumatol Cech 83(2):74-83
  8. Takao M, Komatsu F, Naito K, Uchio Y, Ochi M (2016) Reconstruction of lateral ligament with arthroscopic drilling for treatment of early-stage osteoarthritis in unstable ankle. Arthroscopy 22(10):1119-1125
  9. Teramoto T, Tasiro K, Ootsuka K, Takaki M, Makino Y, Asahara T (2009) The changes in the instability of the ankle joint after distal tibial oblique osteotomy performed for the treatment of osteoarthritis of the ankle joint. J Jpn Assoc Extern Fixat Limb Length 20:119-126
  10. Teramoto T, Harada S, Takaki M, Takenaka N, Watanabe Y, Matsushita T, Makino Y, Asahara T, Tasiro K, Ootsuka K, Matida H (2014) Operative Methods Of Arthroplasty Used By Intra-Articular Osteotomy Of The Knee Joint And Ankle Joint. J Jpn Assoc Extern Fixat Limb Length 25:169-176
  11. Teramoto T, Nakamura S, Makino Y, Iwasaki K (1996) The application of ilizarov external fixator for the osteotomy of tibia. J Jpn Soc Extern Fixat 7:29-32
  12. Takakura Y, Tanaka Y, Kumai T, Tamai S (1995) Low tibial osteotomy for osteoarthritis of the ankle. J Bone Joint Surg (Br) 77-B:50-54
  13. Tanaka Y, Takakura Y, Hayasi K, Taniguti A, Kumai K, Sugimoto K (2006) Low tibial osteotomy for varus-type osteoarthritis of the ankle. J Bone Joint Surg (Br) 88-B:909-913
  14. Tanaka Y, Takakura Y, Kumai T, Narikawa K, Shinohara Y, Kosugi S (2008) Low tibial osteotomy for varus-type osteoarthritis of the ankle. Orthop Surg 53:121-124
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.