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Stolarz K, Osiowski A, Preinl M, Osiowski M, Jasiewicz B, Taterra D. The prevalence and anatomy of accessory navicular bone: a meta-analysis. Surg Radiol Anat 2024; 46:1731-1743. [PMID: 39136746 PMCID: PMC11405447 DOI: 10.1007/s00276-024-03459-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2024] [Accepted: 08/05/2024] [Indexed: 09/18/2024]
Abstract
PURPOSE There have been over 40 descriptions of the common developmental variants of the accessory ossicles of the feet. Although predominantly asymptomatic, they sometimes may be linked to painful conditions. One of the most common accessory ossicles in the foot is the accessory navicular bone (AN), located on the medial side of the foot. Our research provides a first meta-analysis on this topic that establishes its frequency by contrasting 39 studies from across the globe. METHODS Up to February 2024, PubMed and Embase databases were thoroughly searched for research on the AN. Eligible data regarding AN prevalence was extracted. This study strictly adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS A total of 39 studies, 11,015 patients, and 36,837 feet were analyzed in our study. The pooled prevalence estimate (PPE) of AN was found to be 17.5% (95%CI: 11.5-25.7) and 12.6% (95%CI: 10.1-15.5) in patients and feet analyses, respectively. Accessory navicular occurred bilaterally in 50.0% of patients, with similar distribution in gender-based groups (21.1% of males and 22.0% of females were confirmed with AN). Accessory navicular was most prevalent in the East Asian population (38.4%) and least prevalent in North Americans (8.0%). No significant differences in AN prevalence were found when comparing different imaging modalities (X-ray and cadaver dissection). CONCLUSION Accessory navicular is a common finding in imaging studies. Its prevalence depends on the population covered by the study but is not affected by the patient's gender or the imaging modality utilized for AN assessment.
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Affiliation(s)
- Kacper Stolarz
- Faculty of Medicine, Jagiellonian University Medical College, św. Anny 12, Krakow, 31-008, Poland
- Ortho and Spine Research Group, Zakopane, Poland
| | - Aleksander Osiowski
- Faculty of Medicine, Jagiellonian University Medical College, św. Anny 12, Krakow, 31-008, Poland
- Ortho and Spine Research Group, Zakopane, Poland
| | - Maciej Preinl
- Faculty of Medicine, Jagiellonian University Medical College, św. Anny 12, Krakow, 31-008, Poland
- Ortho and Spine Research Group, Zakopane, Poland
| | - Maksymilian Osiowski
- Faculty of Medicine, Jagiellonian University Medical College, św. Anny 12, Krakow, 31-008, Poland
- Ortho and Spine Research Group, Zakopane, Poland
| | - Barbara Jasiewicz
- Department of Orthopedics and Rehabilitation, Jagiellonian University Medical College, Balzera 15, Zakopane, 34-500, Poland
| | - Dominik Taterra
- Ortho and Spine Research Group, Zakopane, Poland.
- Department of Orthopedics and Rehabilitation, Jagiellonian University Medical College, Balzera 15, Zakopane, 34-500, Poland.
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Belair JA, Jung J, Desai V, Morrison WB, DeLuca PF, Zoga AC. Bone bruise vs. non-displaced fracture on MRI: a novel grading system for predicting return-to-play. Skeletal Radiol 2024; 53:947-955. [PMID: 37993556 DOI: 10.1007/s00256-023-04504-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/18/2023] [Accepted: 10/28/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVE To devise an MRI grading scheme for osseous contusion patterns in elite hockey players for predicting return-to-play (RTP). METHODS A retrospective review was performed to identify traumatic lower extremity osseous injuries in professional hockey players. A total of 28 injuries (17 players) were identified over a 10-year period. All had MRIs acquired at ≥ 1.5 T within a mean interval of 2 days from initial injury. MRIs were retrospectively reviewed by 3 musculoskeletal radiologists for osseous contusion pattern, classified as grade 1 (mild), 2 (moderate), or 3 (severe). Grade 3 contusions were further subdivided by the presence or absence of fracture, defined as discrete cortical disruption on MRI or follow-up CT. RTP was calculated from date of injury to next game played based on game log data. Statistical analysis was performed using ANOVA and post hoc unpaired t test. RESULTS Mean RTP for grade 1, 2, and 3 injuries was 2.8, 4.5, and 20.3 days, respectively. Grade 3 injuries without and with cortical fractures had mean RTP of 18.3 and 21.4 days, respectively. ANOVA analysis between groups achieved statistical significance (p < 0.001). Post hoc t test demonstrated statistically significant differences between grade 3 and grades 1 (p < 0.001) and 2 (p < 0.001) injuries. There was no statistical difference in RTP between grade 3 subgroups without and with fracture (p = 0.327). CONCLUSION We propose a novel MRI grading system for assessing severity of osseous contusions and predicting RTP. Clinically, there was no statistically significant difference in RTP between severe osseous contusions and nondisplaced fractures in elite hockey players.
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Affiliation(s)
- Jeffrey A Belair
- Department of Radiology, Thomas Jefferson University, 132 South 10th Street Suite 1085, Philadelphia, PA, 19107, USA.
| | - Jin Jung
- Larchmont Medical Imaging, Mt Laurel Township, NJ, USA
| | - Vishal Desai
- Department of Radiology, Thomas Jefferson University, 132 South 10th Street Suite 1085, Philadelphia, PA, 19107, USA
| | - William B Morrison
- Department of Radiology, Thomas Jefferson University, 132 South 10th Street Suite 1085, Philadelphia, PA, 19107, USA
| | | | - Adam C Zoga
- Department of Radiology, Thomas Jefferson University, 132 South 10th Street Suite 1085, Philadelphia, PA, 19107, USA
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Xiang F, Liu ZQ, Zhang XP, Li YJ, Wen J. Accessory navicular in children. World J Clin Cases 2023; 11:8256-8262. [PMID: 38130606 PMCID: PMC10731211 DOI: 10.12998/wjcc.v11.i35.8256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/06/2023] [Accepted: 12/04/2023] [Indexed: 12/14/2023] Open
Abstract
Accessory navicular (AN) is a developmental variation of the secondary ossification center of the navicular tuberosity. Ten percent of patients with AN will have pain symptoms that affect walking and life. As the AN changes the position of the posterior tibial tendon insertion, children with AN often have posterior tibial tendon function insufficiency and flexible flat foot. Surgical treatment is often required after failure of conservative treatment. This article reviewed the etiology, clinical manifestations, complications, and treatment methods of AN.
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Affiliation(s)
- Feng Xiang
- Department of Traumatic Orthopedics, Zhuzhou Central Hospital, The Affiliated Zhuzhou Hospital of Xiangya Medical College, Central South University, Zhuzhou 412007, Hunan Province, China
| | - Zhi-Qing Liu
- Department of Traumatic Orthopedics, Zhuzhou Central Hospital, The Affiliated Zhuzhou Hospital of Xiangya Medical College, Central South University, Zhuzhou 412007, Hunan Province, China
| | - Xi-Ping Zhang
- Department of Traumatic Orthopedics, Zhuzhou Central Hospital, The Affiliated Zhuzhou Hospital of Xiangya Medical College, Central South University, Zhuzhou 412007, Hunan Province, China
| | - Yan-Jun Li
- Department of Traumatic Orthopedics, Zhuzhou Central Hospital, The Affiliated Zhuzhou Hospital of Xiangya Medical College, Central South University, Zhuzhou 412007, Hunan Province, China
| | - Jie Wen
- Department of Pediatric Orthopedics, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
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Sharkey B, Yatsonsky D, Huffman N, Dong T, Lewis A. Symptomatic Patient With Two Separate Accessory Navicular Bones. Cureus 2023; 15:e47881. [PMID: 38022136 PMCID: PMC10681632 DOI: 10.7759/cureus.47881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2023] [Indexed: 12/01/2023] Open
Abstract
We present the case of a symptomatic patient with two separate accessory navicular bones, a novel finding that does not fall within current classification standards. Furthermore, there is a paucity of current literature with regard to the management of symptomatic cases. Accessory navicular bones, sometimes referred to as os naviculare, are ossicles that can occur in multiple configurations and are considered developmental anomalies. The accessory navicular is an accessory bone found on the medial side of the navicular bone of the foot. While often asymptomatic, they can occasionally lead to clinically significant pain and/or deformity that can cause patients to seek out treatment and sometimes surgical correction. Diagnosis relies on clinical suspicion and imaging studies. A nine-year-old female patient presented initially with complaints of sharp pain over the medial side of her left foot, after which X-rays were obtained that demonstrated an accessory navicular bone. Upon diagnosis, conservative measures were implemented, including placing the patient in a short-leg cast with limited activity. After a failed trial of conservative measures, the patient underwent surgical excision of the accessory navicular bone, with imaging and intraoperative findings of two separate accessory navicular bones, a unique finding in patients with accessory navicular bones. During the six-week follow-up, the patient improved with no new complaints or concerns and was informed she could begin weight-bearing as tolerated with two crutches; she was then weaned from the crutches and returned to normal activity. In the current case, we followed the same route of treatment used to treat a single accessory navicular bone, utilizing first non-surgical interventions and then ultimately surgical excision after continual pain despite conservative measures. This case highlights the promising outcome for a patient with two separate accessory navicular bones when following the guidelines for the treatment of a single accessory navicular bone.
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Affiliation(s)
- Brandon Sharkey
- Department of Orthopaedic Surgery, University of Toledo College of Medicine and Life Science, Toledo, USA
| | - David Yatsonsky
- Department of Orthopaedic Surgery, University of Toledo College of Medicine and Life Science, Toledo, USA
| | - Nickelas Huffman
- Department of Orthopaedic Surgery, University of Toledo College of Medicine and Life Science, Toledo, USA
| | - Tony Dong
- Department of Orthopaedic Surgery, University of Toledo College of Medicine and Life Science, Toledo, USA
| | - Adrian Lewis
- Department of Pediatric Orthopaedic Surgery, ProMedica Toledo Hospital, Toledo, USA
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Gan TJ, Liu X, Li YX, Chen Y, Li J, Zhang H. Is Kidner procedure necessary during subtalar arthroereisis for pediatric flexible flatfoot that combined with symptomatic type 2 accessory navicular? A retrospective comparative study. Foot Ankle Surg 2023:S1268-7731(23)00094-2. [PMID: 37221108 DOI: 10.1016/j.fas.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 05/11/2023] [Accepted: 05/13/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND Kidner procedure is thought to be able to eliminate the medial foot pain and contribute to restoring the medial longitudinal foot arch, making it particularly suitable for surgical treatment of pes planus that combined with symptomatic type 2 accessory navicular (AN). However, controversy remains, and the clinical evidence is still lacking. The aim of the current study is to verify the necessity of Kidner procedure during subtalar arthroereisis (STA) for pediatric flexible flatfoot (PFF) that combined with symptomatic type 2 AN. METHODS Forty pediatric patients (72 feet) who had undergone STA for flexible flatfoot and were also diagnosed with symptomatic type 2 AN concomitantly were reviewed retrospectively and divided into two groups (STA + Kidner vs STA alone). The visual analog scale (VAS), the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale, the Oxford ankle foot questionnaire for children (OAFQC), and the radiographic parameters that quantifying pes planus were evaluated as primary outcomes. Secondary outcomes included the incidence of complications. RESULTS There were 35 feet in the STA + Kidner group and 37 feet in the STA alone group, with mean follow-up periods of 2.7 years and 2.1 years, respectively. The VAS, AOFAS, OAFQC scores and radiographic parameters presented no significant difference between the two groups both preoperatively and at final follow-up (P > 0.05 for each). The complications of STA surgery occurred equally in both groups, and Kidner procedure could lead to more incision problems (22.9% vs. 2.7%) and a longer time to return to activity. CONCLUSION Kidner procedure may be unnecessary during surgical treatment of PFF that combined with painful type 2 AN. Correcting the PFF while leaving the AN alone has a high possibility of relieving the pain in the AN region, and tibialis posterior tendon (TPT) rerouting hardly aids in reconstruction of the medial foot arch. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Ting-Jiang Gan
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province 610041, China
| | - Xi Liu
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province 610041, China
| | - Ya-Xing Li
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province 610041, China; Disaster Medicine Center, Sichuan University, Chengdu, Sichuan Province 610041, China
| | - Yu Chen
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province 610041, China
| | - Jia Li
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province 610041, China
| | - Hui Zhang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province 610041, China; Disaster Medicine Center, Sichuan University, Chengdu, Sichuan Province 610041, China.
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Antonio GE, Griffith JF. How to Report: Ankle MRI. Semin Musculoskelet Radiol 2021; 25:700-708. [PMID: 34861715 DOI: 10.1055/s-0041-1736191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Reporting ankle magnetic resonance imaging involves the assessment of multiple joints, tendons, and ligaments in several planes and numerous sequences. This article describes an approach using four anatomical categories (subcutaneous fat, bones and joints, tendons, and ligaments) to simplify and improve reporting efficiency. The main pathologies are covered, emphasizing the specific features to comment on, as well as suggesting terminology and phrases to use when reporting.
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Affiliation(s)
| | - James Francis Griffith
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China
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