Gutter impingement following total ankle arthroplasty: A systematic review of management and surgical approaches,

Total ankle arthroplasty (TAA) has become an increasingly common surgical option for patients with end stage ankle arthritis. Gutter impingement is a common yet largely underreported complication following total ankle arthroplasty (TAA). As the use of TAA exponentially increases, an understanding of how to both recognize and manage gutter impingement is vital to the optimization of post-operative care. Narrowing of the medial and lateral ankle gutters can arise from a variety of causes, including implant malalignment, scar tissue formation and hypertrophic bone formation, ultimately leading to residual pain following surgery. The incidence of this pathology and its respective management varies greatly within the available literature. The purpose of this study is to review the incidence, treatment approaches and outcomes of gutter impingement following TAA. Eight studies were analyzed which included 1456 patients, of which 130 were treated for gutter impingement at an average of 18 months following index TAA. The mean age of patients across all studies was 62.9 years, with an average follow up period of 40.6 ± 23.1 months. Open debridement was noted to be the most common surgical approach (50.8 %) followed by arthroscopic debridement (37.7 %). Conservative treatment was only used in 9.2 % of cases. This review demonstrates the underreporting of gutter impingement following total ankle arthroplasty and highlights the of lack of standardized treatment. Future prospective studies are warranted in efforts to optimize patient outcomes in the management of gutter impingement.

Level of Evidence

Level III Systematic Review