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Basic Science Behind the Development of Posttraumatic Osteoarthritis of the Ankle

Liles, Jordan L., MD; Steele, John R., MD; Chen, Fengyu, BS; Nettles, Dana L., PhD; Adams, Samuel B. Jr, MD

Techniques in Foot & Ankle Surgery: December 2018 - Volume 17 - Issue 4 - p 169–174
doi: 10.1097/BTF.0000000000000212
Special Focus: Advances in Ankle Fracture Management
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As the diagnosis of ankle osteoarthritis (OA) increases over time due to the use of new imaging modalities, including both direct visualization through arthroscopy and indirect imaging modalities such as magnetic resonance imaging and computed tomography, our understanding of the cause and progression of this disease is also growing. Unlike many other causes of end-stage OA in the body (knee, hip, shoulder), a majority of the causes of end-stage OA in the ankle is related to trauma. This unique difference between these major joints offers clinicians the ability to not only identify a specific timepoint which serves as the starting point for development of posttraumatic osteoarthritis (PTOA) in the ankle, but also serves as a possible initial timepoint for intervention to prevent further progression of the disease. In this article, we will review the biomechanical differences between the ankle and other weight-bearing joints, as well as changes in the cartilaginous cellular composition between the ankle joint and other weight-bearing joints at baseline and following trauma. In addition, the development of PTOA in the ankle is commonly explained using 2 different models of arthritis development: a mechanical model and an inflammatory model. This article outlines the basic science behind the mechanical and inflammatory model of development of PTOA of the ankle. The purpose of this article is to review the state of literature and understanding of ankle PTOA and serve as a foundation for future research aimed at reducing severity and progression of PTOA.

Level of Evidence: Diagnostic Level V. See Instructions for Authors for a complete description of levels of evidence.

Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC

The authors declare no conflict of interest.

Address correspondence and reprint requests to Jordan L. Liles, MD, Duke University Hospital, Durham, NC 27713. E-mail: jordan.liles@duke.edu.

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