Enhancement of syndesmotic fusion rates in total ankle arthroplasty with the use of autologous platelet concentrate

Background: One of the challenges of total ankle arthroplasty continues to be achieving a solid distal fusion of the tibiofibular joint. Delayed union rates of 29% to 38% and the nonunion rates of 9% to 18% for syndesmotic fusion have been documented. The risk of tibial component migration has been reported to increase 8.5 times if a solid syndesmotic fusion is absent. Growth factors have been shown to accelerate bone healing and may enhance the fusion of the syndesmosis and, thereby, decrease the frequency of nonunion and subsequent tibial component migration. Methods: An autologous platelet concentrate was used to increase the amount of growth factors at the site of the distal tibiofibular joint fusion in 20 total ankle arthroplasties. Results: Our 6-month fusion rate was 100%. When compared to historical controls (6-month fusion rate of 62%) the difference was statistically significant (p < 0.0001). Conclusion: The improved rate of distal tibiofibular fusion may be attributable to the increased presence of growth factors provided by an autologous platelet concentrate.