Posttraumatic ankle osteoarthritis: How initial cartilage lesions, the deltoid ligament and hindfoot alignment affect the outcome of operatively treated ankle fractures

The vast majority (70-78%) of ankle osteoarthritis is of posttraumatic origin. The quality of the reduction of intra-articular fractures is of paramount importance for a satisfactory outcome in all joints. Accordingly, the most important aspect of conservative or surgical treatment of ankle fractures, is achieving anatomical reduction, thereby restoring the congruity of the mortise. It remains to be answered, why a significant part of the operatively - anatomically - reduced ankle fractures still result in posttraumatic osteoarthritis. Not yet fully recognized is the possibly adverse effect of intra-articular cartilage lesions that are often seen after ankle fractures. In this thesis we address the role of these intra-articular cartilage lesions. In addition the role of the deltoid ligament in ankle fractures, and the role of the alignment of the hindfoot on tibiotalar pressure distribution are clarified