Cutting Down on Medial Gutter Impingement in Total Ankle Arthroplasty (TAA)

by Vince Vacketta

The problem: Medial gutter impingement following TAA results in pain and restricted movement, despite the implant being well aligned.

The study: Retrospective case-control study comparing patients with and without postoperative gutter impingement. 

The culprits of impingement

• Implant positioning: Varus malposition, excessive medialization or internal rotation of the talar implant

• Soft tissue: Inadequate debridement, residual soft tissue impingement

• Sizing: Use of an oversized talar component

Takeaways



• Avoidance of medial gutter impingement requires a careful balance of surgeon technique and implant sizing. 

• Ensure precise implant positioning and thorough debridement of gutters.

• Don't be afraid to downsize the talar component; downsizing has been associated with an 82% reduction in the probability of medial gutter impingement.