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

  • kshepherd72
  • Jun 11, 2025
  • 1 min read

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.

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