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Anderle MR, Obert RM, Paxson RD, Brinker LZ, Clancy JT. A bi-radial approach to define the sagittal geometry of the healthy ankle. Foot Ankle Surg 2021; 27:813-819. [PMID: 33214032 DOI: 10.1016/j.fas.2020.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/19/2020] [Accepted: 10/24/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Previous descriptions of the sagittal geometry of the tibia and talus have involved single radius curves. The purpose of this investigation was to: determine if the sagittal curvature of the medial and lateral sides of the talus and tibia can be described by dividing the condyles into anterior and posterior regions, determine tibiotalar congruency, and categorize the morphological configurations of the talus and tibia. METHODS Eighteen subjects underwent weightbearing CT scans and the osseous curvature was analyzed. RESULTS For the talus, the medial anterior radius was smaller than the lateral anterior radius. For the distal tibia, the lateral posterior radius was smaller than the medial posterior radius. Tibiotalar congruency varied by region. The most common geometric configuration was two cones, one anterior and one posterior, pointed in opposite directions. CONCLUSION The sagittal profiles of the tibia and talus can be more accurately described using a bi-radial approach as compared to a single radius.
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Affiliation(s)
- Mathew R Anderle
- Paragon 28, Inc., 14445 Grasslands Dr. Englewood, CO, 80112, USA.
| | - Richard M Obert
- Focus Medical Design and Development, 210 Pierce Road, Suite 1, Oakland, TN, 38060, USA.
| | - Robert D Paxson
- Prolimbus, Inc., 9145 Wren Hill Drive, Lakeland, TN 38002, USA.
| | | | - James T Clancy
- Orthopedic Center of Palm Beach County, 180 John F Kennedy Drive, Suite 100, Atlantis, FL 33462, USA.
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Talbott HG, Wilkins RA, Redmond AC, Brockett CL, Mengoni M. Morphological variation of the hemophilic talus. Clin Anat 2021; 34:941-947. [PMID: 33998061 DOI: 10.1002/ca.23757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/30/2021] [Accepted: 05/14/2021] [Indexed: 11/12/2022]
Abstract
Flattening of the trochlear tali is clinically observed as structural and functional changes advance in patients with hemarthropathy of the ankle. However, the degree of this flattening has not yet been quantified, and distribution of the morphological changes across the talus not yet defined. Chronologically sequential MR images of both a hemophilic patient group (N = 5) and a single scan from a nondiseased, sex-matched, control group (N = 11) were used to take four measurements of the trochlear talus morphology at three locations (medial, central and lateral) along the sagittal plane. Three ratios of interest were defined from these to assess whether the talar dome flattens with disease. The control group MRI measurements were validated against literature data obtained from CT scans or planar X-Rays. The influence of disease on talar morphology was assessed by direct comparison of the hemophilic cases with the control group. The values for all three ratios, in all locations, differed between the control and the hemophilic group. Flattening was indicated in the hemophilic group in the medial and lateral talus, but differences in the central talus were not statistically significant. This work demonstrates that morphological assessment of the talus from MR images is similar to that from CT scans or planar X-Rays. Talar flattening does occur with hemarthropathy, especially at the medial and lateral edges of the joint surface. General flattening of the trochlear talus was confirmed in this small patient sample, however the degree and rate of change is unique to each ankle.
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Affiliation(s)
- Harriet G Talbott
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, UK
| | - Richard A Wilkins
- Leeds Institute of Rheumatology & Musculoskeletal Medicine, Chapel Allerton Hospital, Leeds, UK.,Leeds Haemophilia Comprehensive Care Centre, Leeds Teaching Hospitals NHS trust, Leeds, UK
| | - Anthony C Redmond
- Leeds Institute of Rheumatology & Musculoskeletal Medicine, Chapel Allerton Hospital, Leeds, UK.,Centre for Sports, Exercise and Osteoarthritis Versus Arthritis, Nottingham, Oxford, Loughborough, Leeds, UK
| | - Claire L Brockett
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, UK.,Leeds Institute of Rheumatology & Musculoskeletal Medicine, Chapel Allerton Hospital, Leeds, UK.,Centre for Sports, Exercise and Osteoarthritis Versus Arthritis, Nottingham, Oxford, Loughborough, Leeds, UK
| | - Marlène Mengoni
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, UK
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Claassen L, Yao D, Ettinger S, Lerch M, Daniilidis K, Stukenborg-Colsman C, Plaass C. Relevance of SPECT-CT in Complex Cases of Foot and Ankle Surgery: A Comparison With MRI. Foot Ankle Spec 2020; 13:451-462. [PMID: 31808360 DOI: 10.1177/1938640019890987] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Finding the right diagnoses in patients with complex foot and ankle disorders can be challenging. Single-photon emission computed tomography and computed tomography (SPECT-CT) has shown to be feasible in foot and ankle surgery. The aim of this study was to evaluate the reliability and accuracy of SPECT-CT and thereby its impact on final treatment decision compared with magnetic resonance imaging (MRI). METHODS A retrospective study was performed on 49 patients treated at our institution. Experienced foot and ankle surgeons independently, and blinded, analyzed clinical data and radiographs together with MRI, SPECT-CT, or a combination of both. Based on the determined final treatment decision Cohen's kappa values were calculated to illustrate interrater and intrarater reliability. RESULTS The kappa values for interrater reliability were higher for SPECT-CT at .68 and MRI + SPECT-CT at .71 compared to 0.38 for MRI alone (P < .05). The kappa values for intrarater reliability of MRI + SPECT-CT were higher at .75 compared with SPECT-CT alone at .67 (P < .05) and MRI at .35 (P < .01). CONCLUSION We found a higher interrater and intrarater reliability for SPECT-CT compared with MRI alone for diagnosing complex foot and ankle pathologies. SPECT-CT has a high impact on final treatment decision. The main indications are bony pathologies with diagnostic uncertainty especially in closely adjacent structures as the joints of the midfoot, occult coalitio, stress fractures, verification or exclusion of nonfusion, periprosthetic disorders after total ankle replacement and osteochondral lesion in cases of combined pathologies.Levels of Evidence: Level IV: Retrospective study.
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Affiliation(s)
- Leif Claassen
- DIAKOVERE Annastift, Orthopädische Klinik der Medizinischen Hochschule Hannover (MHH), Hannover Medical School, Hannover, Germany (LC, DY, SE, ML, CS-C, CP).,OTC Regensburg, Regensburg, Germany (KD)
| | - Daiwei Yao
- DIAKOVERE Annastift, Orthopädische Klinik der Medizinischen Hochschule Hannover (MHH), Hannover Medical School, Hannover, Germany (LC, DY, SE, ML, CS-C, CP).,OTC Regensburg, Regensburg, Germany (KD)
| | - Sarah Ettinger
- DIAKOVERE Annastift, Orthopädische Klinik der Medizinischen Hochschule Hannover (MHH), Hannover Medical School, Hannover, Germany (LC, DY, SE, ML, CS-C, CP).,OTC Regensburg, Regensburg, Germany (KD)
| | - Matthias Lerch
- DIAKOVERE Annastift, Orthopädische Klinik der Medizinischen Hochschule Hannover (MHH), Hannover Medical School, Hannover, Germany (LC, DY, SE, ML, CS-C, CP).,OTC Regensburg, Regensburg, Germany (KD)
| | - Kiriakos Daniilidis
- DIAKOVERE Annastift, Orthopädische Klinik der Medizinischen Hochschule Hannover (MHH), Hannover Medical School, Hannover, Germany (LC, DY, SE, ML, CS-C, CP).,OTC Regensburg, Regensburg, Germany (KD)
| | - Christina Stukenborg-Colsman
- DIAKOVERE Annastift, Orthopädische Klinik der Medizinischen Hochschule Hannover (MHH), Hannover Medical School, Hannover, Germany (LC, DY, SE, ML, CS-C, CP).,OTC Regensburg, Regensburg, Germany (KD)
| | - Christian Plaass
- DIAKOVERE Annastift, Orthopädische Klinik der Medizinischen Hochschule Hannover (MHH), Hannover Medical School, Hannover, Germany (LC, DY, SE, ML, CS-C, CP).,OTC Regensburg, Regensburg, Germany (KD)
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Lee SH, Kim MB, Lee W, Kang HJ, Lee YH. Quantitative evaluation of posterior talar subluxation in posterior malleolar fractures: A preliminary study. Injury 2020; 51:1669-1675. [PMID: 32360088 DOI: 10.1016/j.injury.2020.03.064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 03/17/2020] [Accepted: 03/30/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUNDS Although ankle posterior subluxation is one of the major mechanisms by which posterior malleolar fractures (PMF) contribute to a worse prognosis, there is no parameter to address it quantitatively. So, we suggest a method that can evaluate posterior talar subluxation quantitatively in PMF. METHODS We retrospectively analyzed 37 patients with posterior malleolar fractures. The patients were divided into two groups: PMF without posterior talar subluxation (n = 18) and with posterior talar subluxation (n = 19). We measured the distance between the arc center of the talus and the anterior tibia (TAD), the percentage of articular involvement of the fracture fragment, the inter-fragment distance (IFD) and articular step-off. We analyzed significant differences and the correlations between the two groups for each index. The estimated area of the receiver operating characteristic (ROC) curve was calculated, and cutoff values were suggested to discriminate posterior talar subluxation. RESULTS TAD, IFD, and articular step-off were significantly greater in patients with posterior talar subluxation. (TAD: 14.3 vs. 2.8 mm, p < 0.001, IFD: 7.8 vs. 4.0 mm, p < 0.001, articular step-off: 3.6 vs. 2.0 mm, p = 0.004). The ROC curve showed that TAD was most useful to determine cutoff values for posterior talar subluxation. The area under the curve for TAD was 1.000, and the appropriate cutoff value was 5 mm. When a TAD of > 5 mm was used as a threshold, a sensitivity of 100% and a specificity of 100% were achieved in determining the presence of posterior talar subluxation. Also, higher TAD was correlated with IFD and articular step-off. CONCLUSIONS TAD can be a useful parameter for evaluating the posterior talar subluxation in PMF. It can reflect not only the degree of fracture displacement but also posterior talar subluxation quantitatively.
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Affiliation(s)
- Seung Hoo Lee
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Min Bom Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, South Korea.
| | - Wonik Lee
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, South Korea
| | - Hyo-Jin Kang
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, South Korea
| | - Young Ho Lee
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, South Korea
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Hongyu C, Haowen X, Xiepeng Z, Kehui W, Kailiang C, Yanyan Y, Qing H, Youqiong L, Jincheng W. Three-dimensional morphological analysis and clinical application of ankle joint in Chinese population based on CT reconstruction. Surg Radiol Anat 2020; 42:1175-1182. [PMID: 32361880 DOI: 10.1007/s00276-020-02482-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 04/23/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To study the anatomical features of the ankle joint in Chinese northeast healthy adults and provide accurate data for the design of the total ankle arthroplasty (TAA) prosthesis. METHODS Computer tomography (CT) images from 156 healthy subjects, 86 males and 70 females, were collected and reconstructed through Mimics software. The 3D morphology of the distal tibia/fibula section and the whole talar was analyzed by measuring 28 parameters including maximal tibial thickness (MTiTh), anterior-posterior inclination angle, trochlea tali width (TaW), distal tibial width (TiW) and trochlea tali arc chode length (TaAL) and calculating MTiTh/TiW, TaAL/TaW. Gender difference and accuracy of CT images were evaluated. The measurements were compared with previously reported data from Caucasian subjects and Asian subjects. Statistical analysis was conducted by independent-samples t test through SPSS software. RESULTS (1) Twenty two out of the 28 parameters were found significantly different between males and females. Most of the parameters in males were found larger than that in females (p < 0.05). (2) The difference was found larger in comparison with the Caucasian subject groups than that with Asian subject groups. (3) All the selected 11 parameters measured by CT images were found to be smaller than those by X-ray images (p < 0.05). CONCLUSION The morphological parameters were found different between the Caucasian and Chinese northeast populations. Precise data of the ankle joint morphology were provided for the design and clinical application of TAA in the Chinese population.
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Affiliation(s)
- Chu Hongyu
- Department of Radiology, China-Japan Union Hospital, Jilin University, Changchun, 130033, China
| | - Xue Haowen
- Department of Orthopedics, Second Hospital, Jilin University, Changchun, 130041, China
| | - Zuo Xiepeng
- Department of Orthopedics, Second Hospital, Jilin University, Changchun, 130041, China
| | - Wu Kehui
- Department of Orthopedics, Second Hospital, Jilin University, Changchun, 130041, China
| | - Cheng Kailiang
- Department of Radiology, China-Japan Union Hospital, Jilin University, Changchun, 130033, China
| | - Yang Yanyan
- Department of Radiology, China-Japan Union Hospital, Jilin University, Changchun, 130033, China.
| | - Han Qing
- Department of Orthopedics, Second Hospital, Jilin University, Changchun, 130041, China.
| | - Li Youqiong
- Department of Human Anatomy, College of Basic Medicine, Jilin University, Changchun, 130021, China
| | - Wang Jincheng
- Department of Orthopedics, Second Hospital, Jilin University, Changchun, 130041, China
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Ankle morphometry based on computerized tomography. Foot Ankle Surg 2019; 25:674-678. [PMID: 30306892 DOI: 10.1016/j.fas.2018.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 07/02/2018] [Accepted: 08/01/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Thorough understanding of the morphometry of the ankle joint is crucial to optimize conservative and operative therapy of ankle joint disorders. Despite recent improvements, basic anatomic and biomechanical correlations of the ankle joint including the orientation of the ankle joint axis and joint morphology as its key biomechanical features are not sufficiently recorded to date. The aim of this study was the evaluation of the ankle morphometry to gain information about the ankle joint axis. MATERIAL AND METHODS In this study 98 high-resolution CT-scans of complete Caucasian cadaver legs were analysed. Using the software Mimics and 3-Matic (Materialize) 22 anatomic parameters of the talocrural joint were assessed, including the length, width and surface area of the tibial and talar articular areas. Additionally, the radii of the articular areas, the medial distal tibial angle and the height of the talar dome were determined. RESULTS The radius of the central trochlea tali was 44.6±4.1mm (mean±SD). The central trochlea tali arc length was 40.8±3.0mm and its width was 27.4±2.5mm. Additionally we determined 47.0±4.4mm for the tibial sagittal radius, 27.6±3.0mm for the tibial arc length and 27.4±2.5mm for the central tibial width. CONCLUSION The present study describes the three-dimensional morphometry of Caucasian ankle joints in detail. This dimensional analysis of the ankle joint will inform the development and placements of implants and prostheses.
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