Emerging Research on Gutter Impingement Following Total Ankle Arthroplasty
Gutter impingement remains a clinically relevant complication following total ankle arthroplasty (TAA), often contributing to persistent pain and reduced postoperative function. A systematic review, presented in an abstract at the American College of Foot and Ankle Surgeons' Annual Scientific Conference, aimed to evaluate the surgical management strategies and outcomes associated with treating gutter impingement post-TAA, providing insights for foot and ankle surgeons seeking to optimize patient care.The researchers conducted a comprehensive literature search across PubMed/Medline, Cochrane, and Scopus databases using terms related to TAA and impingement. Eight studies they identified met the inclusion criteria, encompassing a total of 1,456 patients who underwent total ankle replacement. Of these, the studies identified gutter impingement in 130 ankles, reflecting an overall incidence of 8.93%.1
The surgical approaches used varied across the studies, and outcome assessments commonly utilized the American Orthopaedic Foot & Ankle Society (AOFAS) score to measure improvements. Across all reported approaches, postoperative improvements in AOFAS scores were observed, suggesting that surgical intervention for gutter impingement can yield meaningful clinical benefit.1
However, significant heterogeneity in surgical techniques, follow-up durations, and outcome reporting limited the ability to determine the superiority of one approach over another. The current body of evidence is constrained by small sample sizes and the absence of standardized protocols, underscoring the need for higher-quality, prospective studies, they reported.
In conclusion, while the authors did find tht surgical management of gutter impingement following TAA demonstrated favorable outcomes in terms of pain relief and functional improvement, the lack of consensus on optimal technique warrants further investigation. Considerations such as individual patient anatomy, implant positioning, and symptomatology may play into selecting a surgical approach. The contend that future research efforts prioritizing standardized outcome measures and larger multicenter cohorts to better guide treatment strategies would be beneficial.
Reference
1. Badillo KJ, Tolin J, Manway J. Gutter impingement following total ankle arthroplasty: a systematic review of management and surgical approaches. Abstract presented at the American College of Foot and Ankle Surgeons Annual Scientific Conference, March 26-28, 2025, Phoenix, AZ.
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