RESUMEN
The understanding of foot and ankle biomechanics is improving as new technology provides more detailed information about the motion of foot and ankle bones with biplane fluoroscopy, as well as the ability to analyze the hindfoot under weightbearing conditions with weightbearing computed tomography. Three-dimensional anatomical coordinate systems are necessary to describe the 3D alignment and kinematics of the foot and ankle. The lack of standard coordinate systems across research study sites can significantly alter experimental data analyses used for pre-surgical evaluation and post-operative outcome assessments. Clinical treatment paradigms are changing based on the expanding knowledge of complex pes planovalgus morphologies or progressive collapsing foot deformity, which is present in both neurologic and non-neurologic populations. Four patient cohorts were created from 10 flexible PCFD, 10 rigid PCFD, 10 adult cerebral palsy, and 10 asymptomatic control patients. Six coordinate systems were tested on both the talus and calcaneus for all groups. The aim of this study was to evaluate axes definitions for the subtalar joint across four different patient populations to determine the influence of morphology on the implementation of previously defined coordinate systems. Different morphologic presentations from various pathologies have a substantial impact on coordinate system definitions, given that numerous axes definitions are defined through geometric fits or manual landmark selection. Automated coordinate systems that align with clinically relevant anatomic planes are preferred. Principal component axes are automatic, but do not align with clinically relevant planes and should not be used for such analysis where anatomic planes are critical.
Asunto(s)
Calcáneo , Astrágalo , Humanos , Astrágalo/diagnóstico por imagen , Astrágalo/fisiopatología , Adulto , Calcáneo/diagnóstico por imagen , Masculino , Femenino , Persona de Mediana Edad , Fenómenos Biomecánicos , Parálisis Cerebral/fisiopatología , Parálisis Cerebral/diagnóstico por imagen , Parálisis Cerebral/patologíaRESUMEN
En bloc resection is required for treatment of intermediate-grade talar tumors with extraosseous extension (Enneking stage 3) and malignant talar tumors without intra-articular invasion (Enneking stages IA and IIA). After resection, reconstruction options include tibiocalcaneal fusion, frozen autograft, and talar prosthesis; however, a talar prosthesis is preferable because it preserves ankle range of motion, does not cause leg length discrepancy, and is associated with good long-term outcomes. To the best of our knowledge, en bloc resection and reconstruction of a malignant talar tumor has not been previously reported in detail. We report a detailed surgical technique for en bloc resection of a malignant talar bone tumor using combined anterior and lateral approaches followed by reconstruction using a talar prosthesis.
Asunto(s)
Neoplasias Óseas , Astrágalo , Humanos , Astrágalo/cirugía , Astrágalo/diagnóstico por imagen , Astrágalo/patología , Neoplasias Óseas/cirugía , Neoplasias Óseas/diagnóstico por imagen , Masculino , Procedimientos de Cirugía Plástica/métodos , Femenino , Adulto , Implantación de Prótesis/métodos , Implantación de Prótesis/instrumentación , Prótesis e ImplantesRESUMEN
PURPOSE: Our aim in the study is to measure the area and volume of the tarsal bones and examine the typing of the talus and calcaneus joint surfaces according to sex. METHODS: In our study, the area and volume measurements of 630 tarsal bones and the morphology of the talus/calcaneus were analyzed by transferring thin-section Computed Tomography (CT) images to the 3D Slicer program. RESULTS: The volume and area sizes of the foot bones are calcaneus, talus, cuboid, navicular, medial cuneiform, lateral cuneiform, and intermediate cuneiform, respectively. All area and volume values of males were statistically higher than females (p < 0.05). The right side calcaneus area, intermediate cuneiform area, and lateral cuneiform area values were statistically higher than the left side (p < 0.045, p < 0.044, p < 0.030, respectively). There was no statistical relationship between age and area/volume values (p > 0.05). Three different types were seen in the calcaneus and seven in the talus. The most common type in the calcaneus was B1 (40%), and the least common type was A (27.8%). Regardless of the subgroups, the most common type in the talus was type B (37.8%), while the least common type was E2 (1.1%). CONCLUSION: Although morphometric measurements of tarsal bones differed according to sex, they did not differ according to age. The frequency of occurrence of the types of articular surfaces of the talus and calcaneus varies according to populations. We think that the morphometry and morphology of tarsal bones will contribute to invasive procedures regarding tarsal bones and surrounding structures, and that three-dimensional bone modeling can be used to create educational materials.
Asunto(s)
Imagenología Tridimensional , Huesos Tarsianos , Tomografía Computarizada por Rayos X , Humanos , Masculino , Femenino , Huesos Tarsianos/anatomía & histología , Huesos Tarsianos/diagnóstico por imagen , Adulto , Persona de Mediana Edad , Anciano , Adulto Joven , Adolescente , Calcáneo/anatomía & histología , Calcáneo/diagnóstico por imagen , Astrágalo/anatomía & histología , Astrágalo/diagnóstico por imagen , Factores Sexuales , Variación Anatómica , Anciano de 80 o más AñosRESUMEN
BACKGROUND: The sustentaculum tali is a biomechanically important stabilizer of the hindfoot and contributes to articular congruency of the subtalar joint. Sustentaculum injury associated with a talus fracture has been described infrequently and treatment of this combined injury varies. The purpose of this study was to describe and evaluate the outcomes of the combined talus and sustentaculum fracture. METHODS: Retrospective chart and radiographic review was performed on all talus fractures (n = 436) requiring operative fixation over a 21-year period at a single Level-1 trauma center. All talus fractures with sustentaculum fractures were included. Statistical analysis was performed using Chi-squared and Fishers exact tests where appropriate. RESULTS: Sustentaculum fractures occurred in 6.2 % (n = 27) of patients with talus fractures. Average follow-up was 14 months; 18.5 % were open fractures, 88.8 % were from high-energy mechanisms, and 44.4 % were polytraumas. Diagnosis of the sustentaculum fracture was missed on presenting radiographs in 69.2 % (n = 18). The most common associated talus fracture was a talar neck fracture (40.7 %) and the majority (73.7 %) were Hawkins II. Overall, 40.7 % (n = 11) of the sustentaculum fractures were treated with independent fixation and 7.4 % (n = 2) were treated with acute subtalar arthrodesis. Subtalar post-traumatic osteoarthritis (PTOA) at final follow-up was seen in 23.1 % of combined injuries. Independent sustentaculum fixation did not influence the rate of PTOA or re-operation (p = 0.92, p = 0.91, respectively). CONCLUSION: Talar fractures have an associated sustentaculum fracture in approximately 6 % of cases, especially with Hawkins II fracture-dislocations. Over two-thirds of the associated sustentaculum fractures were missed on presenting radiographs, reiterating the need for heightened awareness and consideration of advanced imaging for all talus fractures. The rate of PTOA following these combined injuries at mean follow-up of 24 months does not exceed established rates after isolated talus fractures. Further research is required to determine the optimal management of the sustentaculum in these combined injuries. LEVEL OF EVIDENCE: IV.
Asunto(s)
Fijación Interna de Fracturas , Fracturas Óseas , Radiografía , Astrágalo , Humanos , Astrágalo/lesiones , Astrágalo/diagnóstico por imagen , Astrágalo/cirugía , Estudios Retrospectivos , Masculino , Femenino , Adulto , Fijación Interna de Fracturas/métodos , Resultado del Tratamiento , Persona de Mediana Edad , Fracturas Óseas/diagnóstico por imagen , Fracturas Óseas/cirugía , Articulación Talocalcánea/lesiones , Articulación Talocalcánea/diagnóstico por imagen , Articulación Talocalcánea/cirugía , Adulto Joven , Centros Traumatológicos , Curación de Fractura , AncianoRESUMEN
Anterior talofibular ligament injuries and osteochondral lesions of the talus present unique challenges to orthopedic surgeons. This study aimed to investigate the relevant relationship between them by analyzing the Magnetic resonance imaging (MRI) results of clinical patients and single-cell RNA sequence (scRNA seq) results of healthy talus cartilage to discuss the risk factors. Data from 164 patients from 2018 to 2023 was retrospectively analyzed. The correlation analysis between ATFL injury grade and the Hepple stage of OLT determined by MRI was performed. Publicly available single-cell RNA datasets were collected. Single-cell RNA datasets from five volunteers of healthy talus cartilage were analyzed. ATFL injury grade was relevant with the Hepple stage of OLT (P < 0.05). The results of multivariate logistic regression analysis showed that injured area was the independent influencing factor of the incidence rate and the severity of OLT (P < 0.05). The Hepple stage of OLT was relevant with AOFAS and VAS (P < 0.05). Single-cell RNA sequence results showed that among the 9 subtypes of chondrocytes, the interaction strength between HTC-A and HTC-B is the highest. Their physical interactions are mainly achieved through the CD99 signaling pathway, and factor interactions are mainly achieved through the ANGPTL signaling pathway. Anterior talofibular ligament injury may lead to osteochondral lesions of the talus. Early medical intervention should be carried out for ligament injuries to restore joint stability and avoid cartilage damage.
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Ligamentos Laterales del Tobillo , Imagen por Resonancia Magnética , Astrágalo , Humanos , Astrágalo/lesiones , Astrágalo/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Masculino , Femenino , Adulto , Estudios Retrospectivos , Ligamentos Laterales del Tobillo/lesiones , Ligamentos Laterales del Tobillo/diagnóstico por imagen , Adulto Joven , Persona de Mediana Edad , Análisis de la Célula Individual/métodos , Cartílago Articular/lesiones , Cartílago Articular/diagnóstico por imagen , Cartílago Articular/patología , Condrocitos/metabolismo , Traumatismos del Tobillo/diagnóstico por imagen , Adolescente , Análisis de Secuencia de ARN/métodosRESUMEN
Background: To investigate the search for an Iliac-Talar Grafts on the iliac bone that is morphologically matched to a multiplanar injury lesion of the talus; while utilizing a bone-harvesting guide to ensure precise positioning of the Iliac-Talar Grafts. Methods: A total of twenty-two cases with both talar CT data and iliac CT data were collected from January 2019 to June 2023. One case each of talar deformity injury and bone disease were excluded, resulting in a selection of 20 cases. The medial and lateral target repair areas of the talus were formulated, and virtual surgery was performed by using digital orthopedic technology to locate an iliac-talar restoration on the iliac bone that matched the morphology of the multiplanar injury lesion of the talus. 3D chromatographic deviation analysis was used to assess the accuracy of Iliac-Talar Grafts in terms of morphometric matching and positioning, while personalized iliac bone extraction guides were designed to ensure accurate positioning of the Iliac-Talar Grafts. Results: The best fitting point for repairing the medial talar lesion is determined to be medial to the anterior iliac crest, specifically 2.935 ± 0.365 cm posterior to the anterior superior iliac spine, and 2.550 ± 0.559 cm anterior to the valgus-iliac crest point (VICP). Similarly, for the repair of the lateral talar lesion, the ideal position is found to be lateral to the posterior iliac crest, approximately 2.695 ± 0.640 cm posterior to the valgus-iliac crest point (VICP). Utilizing bone extraction guides enables precise positioning for iliac bone extraction. Conclusion: This study utilizes virtual surgery, 3D chromatographic deviation analysis, and guide plate techniques in digital orthopedics to precisely locate the Iliac-Talar Graft on the iliac bone, matching the morphology of the talar lesion; it provides a new solution for cutting the iliac bone implant that matches the the multifaceted talar lesion to be repaired.
Asunto(s)
Trasplante Óseo , Ilion , Astrágalo , Tomografía Computarizada por Rayos X , Humanos , Ilion/trasplante , Astrágalo/cirugía , Astrágalo/lesiones , Astrágalo/diagnóstico por imagen , Masculino , Trasplante Óseo/métodos , Femenino , Adulto , Inestabilidad de la Articulación/cirugía , Inestabilidad de la Articulación/etiología , Traumatismos del Tobillo/cirugíaRESUMEN
AIM: This study aimed to evaluate the hypothesis that the utilization of percutaneous screw guides enhances the precision of screw placement in the surgical fixation of talar fractures. METHODS: Computed tomography (CT) scans of ankle joints were obtained from 40 healthy adults and 10 cadaveric specimens between April 2019 and August 2020 at Ningbo No. 6 Hospital. The acquired CT data were imported into Materialise Interactive Medical Image Control System (MIMICS) software for processing. Three-dimensional (3D) digital models of the ankle joints were reconstructed, and relevant anatomical parameters were measured. A percutaneous screw guide (PSG) was designed and fabricated to facilitate accurate screw placement in the posterior talar process. Ten eligible cadaveric ankle joints were selected for further analysis and their 3D models were reconstructed using the MIMICS software. Screw trajectory parameters were then measured and analyzed based on these cadaveric models, forming the model group for comparative analyses. Ten cadaveric specimens were utilized in this study, equally divided into two groups: a guider group (n = 5) and a free-hand group (n = 5). In the guider group, talar posterior process screws were inserted using percutaneous screw guidance. In the free-hand group, screws were inserted into the talar posterior process without guidance. Post-operative CT scans were performed on all specimens. The following parameters were quantitatively compared between the two groups: screw trajectories, entry point distances in specimens with preselected screws, entry point distance trajectories in the 3D model, operation time, frequency of fluoroscopic imaging, and number of drilling attempts. RESULTS: Following the generation of the 3D models from 10 cadavers, a virtual screw was digitally inserted into each model. In the model group, the preselected screw trajectory was oriented towards the medial aspect of the talar neck base, with a cephalad inclination angle (CIA) of 3.1° ± 1.5° in the transverse~plane and a medial diverge angle (MDA) of 12.0° ± 1.4° in the coronal plane. The CIA and MDA of the screw trajectory in the guider group were 2.1° ± 1.7° and 11.2° ± 1.6°, respectively, whereas the CIA and MDA in the free-hand group were 6.0° ± 2.2° and 18.8° ± 1.6°, respectively. Statistical analysis revealed significant differences in both CIA and MDA between the two groups (p < 0.05). Furthermore, the guider group yielded superior outcomes in terms of entry point distance, operation time, fluoroscopic exposure time, and number of drilling attempts compared to the free-hand group (p < 0.05). CONCLUSIONS: Percutaneous screw guidance can improve the accuracy and safety of the posterior process of the talar screws, which can be feasible for percutaneous fixation. Further studies are required to confirm the efficacy and clinical outcomes of percutaneous screw guidance.
Asunto(s)
Tornillos Óseos , Cadáver , Fijación Interna de Fracturas , Fracturas Óseas , Astrágalo , Tomografía Computarizada por Rayos X , Humanos , Astrágalo/cirugía , Astrágalo/lesiones , Astrágalo/diagnóstico por imagen , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/instrumentación , Masculino , Adulto , Femenino , Fracturas Óseas/cirugía , Fracturas Óseas/diagnóstico por imagen , Cirugía Asistida por Computador/métodos , Imagenología Tridimensional , Persona de Mediana EdadRESUMEN
New technologies in additive manufacturing and patient-specific CT-based custom implant designs make it possible for previously unimaginable salvage and limb-sparing operations a practical reality. This study presents the design and fabrication of a lattice-structured implant for talus replacement surgery. Our primary case involved a young adult patient who had sustained severe damage to the talus, resulting in avascular necrosis and subsequent bone collapse. This condition caused persistent and debilitating pain, leading the medical team to consider amputation of the left foot at the ankle level as a last resort. Instead, we proposed a Ti6Al4V-based patient-specific implant with lattice structure specifically designed for pan-talar fusion. Finite element simulation is conducted to estimate its performance. To ensure its mechanical integrity, uniaxial compression experiments were conducted. The implant was produced using selective laser melting technology, which allowed for precise and accurate construction of the unique lattice structure. The patient underwent regular monitoring for a period of 24 months. At 2-years follow-up the patient successfully returned to activities without complication. The patient's functional status was improved, limb shortening was minimized.
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Osteonecrosis , Diseño de Prótesis , Astrágalo , Humanos , Astrágalo/cirugía , Astrágalo/lesiones , Astrágalo/diagnóstico por imagen , Osteonecrosis/cirugía , Osteonecrosis/etiología , Osteonecrosis/diagnóstico por imagen , Masculino , Adulto , Aleaciones , Titanio , Prótesis e Implantes , Adulto Joven , Análisis de Elementos Finitos , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Talar neck non-unions result in significant hindfoot deformity and morbidity and are infrequently reported in the literature. The optimal surgical management for this condition is evolving, with various authors reporting the results of open reduction and internal fixation (ORIF) with bone grafting (BG), ankle fusion and modified Blair fusion. We performed this study to report the clinical and radiological outcomes of a cohort of talar neck non-unions managed by ankle joint preserving reconstruction. METHODS: This was an ambispective study which included 8 patients (7 male and 1 female) with talar neck non-unions. All patients underwent ORIF+BG through dual approaches. Additional medial malleolar osteotomy was done in 2 cases, and calcaneofibular split approach to the subtalar joint in 3. Adjunct subtalar fusion was done in 5 cases. Clinical and radiological evaluation was performed pre- and post-operatively. Functional outcomes were assessed by the Manchester Oxford Foot Questionnaire (MOxFQ). RESULTS: The mean age of patients 32.3 ± 13.1 years. The mean surgical delay was 4.1 ± 1.7 months. As per Zwipp and Rammelt classification of post-traumatic talar deformities, 5 cases were classified as Type 3, 2 were Type 4, and 1 was Type 1. Union was achieved in 7 cases at a mean of 3.4 ± 1.3 months. One case had progressive collapse, which was managed by pantalar arthrodesis. All 3 cases where subtalar fusion was not performed primarily demonstrated subtalar arthrosis, but none required a secondary subtalar fusion. The MOxFQ score from 61.1 ± 10.1 to 41 ± 14.1 postoperatively (P = 0.005). The mean follow-up was 14.6 ± 6.8 months. CONCLUSION: ORIF+BG of the talar neck, with or without subtalar fusion has the potential to achieve solid union, correct the hindfoot deformity and improve functional outcomes. However, larger studies with longer follow-up are needed to evaluate the long-term efficacy of this procedure.
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Articulación del Tobillo , Trasplante Óseo , Fijación Interna de Fracturas , Fracturas no Consolidadas , Radiografía , Astrágalo , Humanos , Masculino , Femenino , Adulto , Resultado del Tratamiento , Fijación Interna de Fracturas/métodos , Articulación del Tobillo/cirugía , Articulación del Tobillo/diagnóstico por imagen , Articulación del Tobillo/fisiopatología , Fracturas no Consolidadas/cirugía , Fracturas no Consolidadas/diagnóstico por imagen , Astrágalo/cirugía , Astrágalo/diagnóstico por imagen , Trasplante Óseo/métodos , Artrodesis/métodos , Osteotomía/métodos , Persona de Mediana Edad , Adulto Joven , Curación de Fractura/fisiología , Procedimientos de Cirugía Plástica/métodos , Estudios Retrospectivos , Rango del Movimiento Articular , Fracturas de Tobillo/cirugía , Fracturas de Tobillo/diagnóstico por imagenRESUMEN
BACKGROUND: Total talus dislocation without ankle (malleoli) fracture is a very rare injury with prevalence of only 0.06% of all dislocations and only 2% of talar injuries, and are usually associated with common complications such as infection, avascular necrosis, and posttraumatic arthritis. The treatment usually involves debridement, reduction, stabilization of the ankle joint, and primary or secondary closure of the wound. CASE PRESENTATION: We present the case of a 40-year-old South Asian woman who was involved in an accident. She was rushed to our hospital, whereby subsequent examination revealed an open total talus dislocation with the talus being exposed in its entirety from a contaminated wound in the medial side. Furthermore, radiograph confirmed total talus dislocation without concomitant malleoli fracture. She was immediately taken to the operating theater whereby debridement and immediate reduction was performed under anesthesia, and the ankle was stabilized with external fixator for about 6 weeks. She is now able to bear weight on the affected ankle with minimal tolerable pain and has normal range of motion of the ankle. CONCLUSIONS: Open total talus dislocation without concomitant malleoli fracture is a rare injury. Reduction of the talus in combination with complete wound debridement potentially successfully avoids infection, provides early revascularization preventing avascular necrosis, and preserves the normal ankle anatomy.
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Desbridamiento , Luxaciones Articulares , Astrágalo , Humanos , Femenino , Astrágalo/lesiones , Astrágalo/cirugía , Astrágalo/diagnóstico por imagen , Adulto , Luxaciones Articulares/cirugía , Luxaciones Articulares/diagnóstico por imagen , Fracturas de Tobillo/cirugía , Fracturas de Tobillo/diagnóstico por imagen , Resultado del Tratamiento , Traumatismos del Tobillo/cirugía , Traumatismos del Tobillo/diagnóstico por imagen , Traumatismos del Tobillo/complicaciones , Radiografía , Articulación del Tobillo/cirugía , Articulación del Tobillo/diagnóstico por imagen , Fijadores ExternosRESUMEN
PURPOSE: The purpose of this retrospective review was to determine the prevalence of osteochondral lesions (OCLs) of the lateral talar dome in patients with anterior ankle impingement with an associated hypertrophic distal fascicle of the anterior tibio-fibular ligament. METHODS: Retrospective chart review identified 40 patients who underwent anterior ankle arthroscopy for the management of anterior ankle impingement. Clinical outcomes assessed included pre- and postoperative foot and ankle outcome score (FAOS), visual analogue scale (VAS), complications, failures, secondary surgical procedures, return-to-work data and return-to-sport data. RESULTS: Thirty-two patients with a mean follow-up time of 29.3 ± 10.4 months were included. The hypertrophic distal fascicle of the anterior tibio-fibular ligament was hypertrophic in 29 patients (90.6%), with a mean thickness of 2.5 ± 0.4 mm on MRI. There were 22 OCLs of the lateral talar dome (75.9%) with an associated hypertrophic distal fascicle of the anterior tibio-fibular ligament visualized during arthroscopy. The international cartilage repair society gradings of the lesions included 3 (13.6%) grade I lesions, 15 (68.1%) grade II lesions, 3 (13.6%) grade III lesions, and 1 (4.6%) grade IV lesion. There was a statistically significant improvement in mean FAOS and VAS scores from preoperative to postoperative (p < 0.001). No cases of syndesmotic instability were observed following resection of hypertrophic distal fascicle of the anterior tibio-fibular ligament. CONCLUSION: This retrospective case series demonstrated that a hypertrophic distal fascicle of the anterior tibio-fibular ligament was associated with an OCL of the lateral talar dome identified during arthroscopic evaluation. In addition, preoperative MRI demonstrated poor sensitivity for the detection of these OCLs. Heightened awareness is warranted for potential lateral talar dome OCLs in patients presenting with anterolateral ankle impingement with a hypertrophic ATiFLdf identified on preoperative MRI in the absence of an associated OCLs. LEVEL OF EVIDENCE: Level IV, Retrospective case series.
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Articulación del Tobillo , Artroscopía , Hipertrofia , Imagen por Resonancia Magnética , Astrágalo , Humanos , Estudios Retrospectivos , Astrágalo/cirugía , Astrágalo/diagnóstico por imagen , Masculino , Femenino , Adulto , Artroscopía/métodos , Hipertrofia/cirugía , Articulación del Tobillo/cirugía , Persona de Mediana Edad , Traumatismos del Tobillo/cirugía , Traumatismos del Tobillo/complicaciones , Adulto Joven , Ligamentos Articulares/cirugía , Cartílago Articular/cirugía , Cartílago Articular/diagnóstico por imagenRESUMEN
BACKGROUND: To evaluate T1ρ relaxation mapping in patients with symptomatic talar osteochondral lesions (OLT) and healthy controls (HC) at rest, with axial loading and traction. METHODS: Participants underwent 3-T ankle magnetic resonance imaging at rest and with 500 N loading and 120 N traction, without axial traction for a subcohort of 17/29 HC. We used a fast low-angle shot sequence with variable spin-lock intervals for monoexponential T1ρ fitting. Cartilage was manually segmented to extract T1ρ values. RESULTS: We studied 29 OLT patients (age 31.7 ± 7.5 years, 15 females, body mass index [BMI] 25.0 ± 3.4 kg/m2) and 29 HC (age 25.2 ± 4.3 years, 17 females, BMI 22.5 ± 2.3 kg/m2. T1ρ values of OLT (50.4 ± 3.4 ms) were higher than those of intact cartilage regions of OLT patients (47.2 ± 3.4 ms; p = 0.003) and matched HC cartilage (48.1 ± 3.3 ms; p = 0.030). Axial loading and traction induced significant T1ρ changes in the intact cartilage regions of patients (loading, mean difference -1.1 ms; traction, mean difference 1.4 ms; p = 0.030 for both) and matched HC cartilage (-2.2 ms, p = 0.003; 2.3 ms, p = 0.030; respectively), but not in the OLT itself (-1.3 ms; p = 0.150; +1.9 ms; p = 0.150; respectively). CONCLUSION: Increased T1ρ values may serve as a biomarker of cartilage degeneration in OLT. The absence of load- and traction-induced T1ρ changes in OLT compared to intact cartilage suggests that T1ρ may reflect altered biomechanical properties of hyaline cartilage. TRIAL REGISTRATION: DRKS, DRKS00024010. Registered 11 January 2021, https://drks.de/search/de/trial/DRKS00024010 . RELEVANCE STATEMENT: T1ρ mapping has the potential to evaluate compositional and biomechanical properties of the talar cartilage and may improve therapeutic decision-making in patients with osteochondral lesions. KEY POINTS: T1ρ values in osteochondral lesions increased compared to intact cartilage. Significant load- and traction-induced T1ρ changes were observed in visually intact regions and in healthy controls but not in osteochondral lesions. T1ρ may serve as an imaging biomarker for biomechanical properties of cartilage.
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Cartílago Hialino , Imagen por Resonancia Magnética , Astrágalo , Humanos , Femenino , Astrágalo/diagnóstico por imagen , Adulto , Masculino , Imagen por Resonancia Magnética/métodos , Cartílago Hialino/diagnóstico por imagen , Fenómenos Biomecánicos , Biomarcadores , Estudios de Casos y Controles , Cartílago Articular/diagnóstico por imagen , Adulto JovenRESUMEN
INTRODUCTION: Fracture of the lateral tubercle of the posterior process of the talus (Shepherd fracture) is an uncommon injury seen in sport. It is secondary either to indirect trauma on the plantarflexed foot or to high-impact direct trauma. The fracture can be missed with conventional X-rays and therefore advanced imaging methods such as CT scans are usually warranted for management planning. There is a low threshold towards surgical management in the displaced or comminuted case as the delayed functional outcome with conservative treatment is frequently sub-optimal with long-term pain, degenerative changes and non-union. In this regard, recent years saw an increasing interest in the role of minimally invasive approaches for Shepherd´s fracture treatment, such as arthroscopic reduction and internal fixation (ARIF). CASE REPORT: We present a case of a 27-year-old white male professional football player from Serbia who had Shepard fracture and successfully managed with arthroscopic osteosynthesis. The technical approach is detailed with posterior ankle arthroscopy offering the advantages of a minimally invasive approach with low morbidity and a rapid return to regular sporting activities. CONCLUSION: The utilization of the 2-port arthroscopic approach this method enables the direct observation of the articular surface along with the corresponding fracture lines, thereby affording the surgeon the chance to achieve accurate reduction via a minimally invasive soft tissue aperture. We advocate that Arthroscopic reduction and internal fixation (ARIF) is a reliable method for the fixation of Shepherd's fracture in the hands of experienced ankle arthroscopists.
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Artroscopía , Fijación Interna de Fracturas , Astrágalo , Humanos , Fijación Interna de Fracturas/métodos , Astrágalo/lesiones , Astrágalo/cirugía , Astrágalo/diagnóstico por imagen , Masculino , Artroscopía/métodos , Adulto , Fracturas Óseas/cirugía , Fracturas Óseas/diagnóstico por imagen , Resultado del Tratamiento , Tomografía Computarizada por Rayos X , Fracturas de Tobillo/cirugía , Fracturas de Tobillo/diagnóstico por imagenRESUMEN
BACKGROUND: Congenital Vertical Talus (CVT) is a rare form of rigid flatfoot commonly seen in patients with underlying neurologic syndromes. This study aims to evaluate the long-term effectiveness of the minimally invasive method for correcting CVT deformity in a large cohort of syndromic patients. METHODS: A single author recorded preoperative, 2-week postoperative, 1-year postoperative, and most recent radiographic measurements and complications for 25 patients treated with the minimally invasive method from 2006 to 2021. Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaires were administered for 12 patients after January 1, 2015, when the institution began collecting PROMIS in all orthopaedic patients. Average follow-up was 55 months (13-111); 18 patients had minimum 24-month follow-up. RESULTS: Forty feet in 25 patients were analyzed. The average preoperative lateral talar axis-first metatarsal base angle (TAMBA) was 68.7 ± 21.3 vs 12.1 ± 8.9 after initial surgical intervention (P < .0001). There was a statistically significant increase in the lateral TAMBA between the initial postoperative and final follow-up visits (13.0 vs 21.6, P = .02). Radiographic recurrence of talonavicular deformity was noted in 12 feet (30.9%); 7 (15.55%) required corrective surgery. Larger preoperative lateral TAMBA was predictive of recurrence. Notably, patients with arthrogryposis experienced higher radiographic recurrence than other syndromic patients (45.0% vs 14.3%, P = .0384). PROMIS scores were within population norms. CONCLUSION: The study suggests that less than one-third of syndromic CVT patients experienced a radiographic recurrence of talonavicular deformity, with 15% requiring further surgical intervention at an average of 55 months following the initial procedure. A higher incidence of radiographic recurrence occurred in patients with distal arthrogryposis. These findings, along with the satisfactory patient-reported outcomes, suggest that the minimally invasive technique is an effective treatment method for syndromic CVT, underscoring the necessity for clinicians to provide detailed prognoses and consider more intensive follow-up for those at higher risk.
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Pie Plano , Procedimientos Quirúrgicos Mínimamente Invasivos , Humanos , Pie Plano/cirugía , Pie Plano/diagnóstico por imagen , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Niño , Femenino , Masculino , Astrágalo/cirugía , Astrágalo/anomalías , Astrágalo/diagnóstico por imagen , Estudios Retrospectivos , Preescolar , Adolescente , Deformidades Congénitas del Pie/cirugía , Deformidades Congénitas del Pie/diagnóstico por imagen , Radiografía , Medición de Resultados Informados por el PacienteRESUMEN
Background: This study aims to report the midterm outcomes after surgical treatment of Hawkins Classification III Talar neck fractures. Methods: From March 2010 to April 2022, among a total of 155 patients who visited our hospital with talus fractures, 31 patients underwent surgical treatment for Hawkins classification III talar neck fractures. The inclusion criteria comprised patients with a symptom duration of over 1 year who were available for outpatient follow-up and underwent magnetic resonance imaging (MRI) follow-up 2 months after surgery. Exclusion criteria included patients without preoperative ankle periarticular arthritis, and a total of 27 patients were enrolled. Traffic accidents and falls accounted for 86% of 23 cases, open fractures were 8 cases, and the mean follow-up period was 34.10 months (range, 12-80 months). Clinical outcomes were measured by American Orthopaedic Foot and Ankle Society (AOFAS) score and Foot function index (FFI), and radiological results were obtained using simple radiographs before and after surgery and MRI at 2 months postoperatively to confirm bone union and complications. Results: Complete bone union was achieved in all cases, and the mean duration of union was 4.9 months (range, 4-6 months) and there were no nonunion and varus malunion. At the final follow-up, the mean AOFAS score was 80.18 points (range, 36-90 points) and the mean FFI score was 31.43 points (range, 10-68 points), showing relatively good clinical outcomes. There were 15 cases of avascular necrosis, 6 cases of traumatic arthritis of the ankle joint, 6 cases of irritation of the posterior tibial nerve, and 4 cases of wound problems. Conclusions: Hawkins classification III talar neck fractures are mostly caused by high-energy injuries and have a relatively poor prognosis due to the high incidence of complications such as avascular necrosis or posttraumatic arthritis. However, if correct anatomical reduction and rigid internal fixation are performed within a short time after the injury, good results can be expected.
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Fijación Interna de Fracturas , Fracturas Óseas , Astrágalo , Humanos , Astrágalo/cirugía , Astrágalo/lesiones , Astrágalo/diagnóstico por imagen , Masculino , Femenino , Adulto , Persona de Mediana Edad , Fijación Interna de Fracturas/métodos , Fracturas Óseas/cirugía , Fracturas Óseas/diagnóstico por imagen , Adulto Joven , Anciano , Estudios Retrospectivos , Resultado del Tratamiento , Adolescente , Imagen por Resonancia MagnéticaRESUMEN
Background: Sagittal talar translation is an important factor influencing the sagittal alignment of total ankle arthroplasty (TAA). Thus, accurate measurement of sagittal talar translation is crucial. This study proposes a simple method (tibiotalar distance [TTD]) that can quantify talar translation without being affected by the ankle and subtalar joint condition or the talar component position in patients with TAA. Methods: We enrolled 280 eligible patients (296 ankles) who underwent primary TAA between 2005 and 2019 and retrospectively reviewed them for sagittal talar translation. The TTD was measured for each patient on weight-bearing lateral ankle radiographs by 3 raters. In addition, we analyzed interrater and intrarater reliability for the TTD method. Results: We found that the TTD method could quantify the talar translation and was not affected by the preoperative condition of the ankle joint surface, subtalar joint pathologies, or the postoperative talar component position. The TTD method showed an excellent intraclass correlation coefficient (> 0.9) in all interrater and intrarater reliability analyses. In the analysis of 157 healthy, unoperated contralateral ankles, we identified that TTD showed a Gaussian distribution (p = 0.284) and a mean of 38.91 mm (normal range, 29.63-48.20 mm). Conclusions: The TTD method is a simple and reliable method that could be applied to patients with TAA to assess the sagittal talar translation regardless of the pre-and postoperative joint condition and implantation status.
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Artroplastia de Reemplazo de Tobillo , Astrágalo , Humanos , Artroplastia de Reemplazo de Tobillo/métodos , Masculino , Femenino , Persona de Mediana Edad , Estudios Retrospectivos , Anciano , Astrágalo/diagnóstico por imagen , Astrágalo/cirugía , Adulto , Reproducibilidad de los Resultados , Tibia/diagnóstico por imagen , Tibia/cirugía , Articulación del Tobillo/diagnóstico por imagen , Articulación del Tobillo/cirugía , Anciano de 80 o más Años , RadiografíaRESUMEN
PURPOSE: The aim of this study was to determine anatomical predictors for the occurrence of medial osteochondral lesions of the talus (OLT), by analyzing morphometric variables obtained from magnetic resonance imaging (MRI). METHODS: A total of 430 ankles with 215 ankle MRIs from patients with nontraumatic OLTs on the medial side of the talar dome and an equal number of age, sex, and side-matched healthy controls were analyzed in this retrospective study. The specific MRI parameters that were measured include the anterior opening angle of the talus (AOT), the angle between the tibial axis and medial malleolus (TMM), the angle of the tibial plafond to the malleoli (PMA), the angle between the anterior and posterior talofibular ligaments (ATFL-PTFL angle), length of the trochlea tali arc (TAL), sagittal length of distal tibial articular surface (TAS), the ratio of the sagittal length of distal tibial articular surface to the length of the trochlea tali arc (TAS/TAL), and the depth of the incisura fibularis (IncDep). RESULTS: AOT, IncDep, ATFL-PTFL angle, PMA, TMM, TAL, and TAS/TAL exhibited significant differences between the two groups. The established cut-off values were 13° (AUC 0.875) for AOT, 3.7 mm (AUC 0.565) for IncDep, 78° (AUC 0.729) for ATFL-PTFL angle, 14° (AUC 0.581) for PMA, 15° (AUC 0.907) for TMM, 34.3 mm (AUC 0.599) for TAL, and 0.81 (AUC 0.719) for TAS/TAL. Multivariate logistic regression analysis revealed Odds Ratio (OR) = 22.22 for AOT > 13°, OR = 4.23 for ATFL-PTFL angle > 78°, OR = 1.99 for PMA ≤ 14°, OR = 31.598 for TMM > 15°, OR = 3.79 for TAS/TAL ≤ 0.81. CONCLUSION: This study highlights the significance of anatomical parameters, particularly the TMM and AOT, as key predictors of OLT.
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Imagen por Resonancia Magnética , Astrágalo , Humanos , Astrágalo/diagnóstico por imagen , Masculino , Femenino , Adulto , Estudios Retrospectivos , Persona de Mediana Edad , Adulto Joven , Adolescente , Articulación del Tobillo/diagnóstico por imagen , Anciano , Estudios de Casos y ControlesRESUMEN
OBJECTIVE: To assess the equatorial talar line (ETL) as a sensitive radiographic parameter to predict Sanders type III and IV fractures and the presence of lateral wall blowout. METHODS: Reliability of the ETL was assessed using the intraclass correlation coefficient (ICC) and receiver operating curve (ROC) to predict sensitivity. Using lateral ankle radiographs, raters determined whether the calcaneal tuberosity was "above" (predicting Sanders type I or II) or "below" (predicting Sanders type III or IV and lateral wall blowout). RESULTS: In determining the "above" or "below" location of the ETL, the calculated ICC was 1.0 for each session. As a predictor of Sanders fracture classification type, the calculated ICC was 0.93 for the first session and 0.89 for the second session for an overall ICC of 0.91. As a predictor of Sanders fracture type, ROC analysis yielded an overall sensitivity of 0.82. As a predictor of lateral wall blowout, ROC analysis yielded an overall sensitivity of 0.81. CONCLUSION: The ETL is a reproducible radiographic parameter that can be reliably used to crudely predict between Sanders type I or II (ETL is "above") and Sanders type III or IV (ETL is "below") calcaneus fractures as well as the presence of lateral wall blowout.
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Calcáneo , Fracturas Óseas , Radiografía , Astrágalo , Calcáneo/lesiones , Calcáneo/diagnóstico por imagen , Humanos , Fracturas Óseas/diagnóstico por imagen , Fracturas Óseas/clasificación , Astrágalo/lesiones , Astrágalo/diagnóstico por imagen , Reproducibilidad de los Resultados , Curva ROC , Valor Predictivo de las Pruebas , Masculino , Femenino , Adulto , Sensibilidad y Especificidad , Persona de Mediana EdadRESUMEN
Total ankle arthroplasty is the gold standard surgical treatment for severe ankle arthritis and fracture. However, revision surgeries due to the in vivo failure of the ankle implant are a serious concern. Extreme bone density loss due to bone remodelling is one of the main reasons for in situ implant loosening, with aseptic loosening of the talar component being one of the primary reasons for total ankle arthroplasty revisions. This study is aimed at determining the performance and potential causes of failure of the talar component. Herein, we investigated the stress, strain, and bone density changes that take place in the talus bone during the first 6 months of bone remodelling due to the total ankle arthroplasty procedure. Computed tomography scans were used to generate the 3D geometry used in the finite element (FE) model of the Intact and implanted ankle. The Scandinavian Total Ankle Replacement (STAR™) CAD files were generated, and virtual placement within bone models was done following surgical guidelines. The dorsiflexion physiological loading condition was investigated. The cortical region of the talus bone was found to demonstrate the highest values of stress (5.02 MPa). Next, the adaptive bone remodelling theory was used to predict bone density changes over the initial 6-month post-surgery. A significant change in bone density was observed in the talus bone due to bone remodelling. The observed quantitative changes in talus bone density over 6-month period underscore potential implications for implant stability and fracture susceptibility. These findings emphasise the importance of considering such biomechanical factors in ankle implant design and clinical management.
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Artroplastia de Reemplazo de Tobillo , Densidad Ósea , Remodelación Ósea , Análisis de Elementos Finitos , Estrés Mecánico , Astrágalo , Humanos , Remodelación Ósea/fisiología , Astrágalo/cirugía , Astrágalo/diagnóstico por imagen , Densidad Ósea/fisiología , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: In end-stage arthritis indicated for total ankle arthroplasty (TAA), full-thickness cartilage damage, subchondral bone defect/shaving, and fluttering of the talar dome occur, shortening the distance between the tibial and talar insertions of ligaments and leading to laxity of ligaments surrounding the ankle joint. Under such conditions, medial ligaments (including the deltoid ligament) would not be expected to function properly. To stabilize the ankle joint during the stance phase, medial ligament function under tension is important. This study therefore examined whether TAA contributes to lengthening of the medial tibio-talar joint as evaluated radiographically, as a preferable method for achieving tensile effects on medial ligaments. MATERIALS AND METHODS: Twenty-four feet with end-stage varus deformity of the ankle joint that underwent TAA were retrospectively investigated, excluding cases with any malleolar osteotomy or fracture. Distance between proximal and distal insertions of medial ligaments, lateralization of the talus, and talar tilt angle under valgus/varus stress condition were evaluated pre- and postoperatively. RESULTS: Distance between proximal and distal insertions of medial ligaments was significantly elongated after TAA. At the same time, the talus showed significant lateralization. Furthermore, talar tilt under valgus/varus stress conditions was also significantly reduced after TAA. CONCLUSION: TAA affects distal translation and lateralization of the talus in cases of varus ankle deformity. These effects might contribute to re-providing tensile force on lax medial ligaments, improving ligament function.