Comparison of weight-bearing restriction periods using a patellar tendon-bearing brace after arthroscopic and open ankle arthrodesis.

Abstract

After ankle arthrodesis (AA), a postoperative non-weight-bearing period is generally required. A patellar tendon-bearing (PTB) brace allows ambulation while reducing load transmission to the ankle joint; however, its role in supporting early postoperative weight-bearing (within 6 weeks) after AA remains unclear. To determine whether early weight-bearing after AA using a PTB brace is feasible in patients with end-stage ankle osteoarthritis by comparing clinical outcomes and bone union between 6-week and 8-week non-weight-bearing protocols. Retrospective comparative cohort study. Sixty-seven patients with end-stage ankle osteoarthritis who underwent arthroscopic (n = 41) or open (n = 26) AA were retrospectively reviewed. All patients used a PTB brace postoperatively to allow ambulation with reduced ankle loading. Thirty-six patients followed a 6-week non-weight-bearing protocol, and 31 followed an 8-week protocol. Clinical outcomes were assessed using the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) preoperatively and at final follow-up. Complications, including bony nonunion, were evaluated. Outcomes were compared between groups and by surgical approach. Both groups showed significant postoperative improvement in all SAFE-Q domains compared with preoperative scores (all P < 0.001). The 8-week group demonstrated significantly higher SAFE-Q scores and a higher bone union rate than the 6-week group (both P = 0.04). No significant differences in complication rates, including bony nonunion, were observed between arthroscopic and open AA. Ambulation with ankle load reduction using a PTB brace resulted in favorable clinical outcomes; however, early weight-bearing after AA may not be optimal for all patients and should be considered individually.