Pub Date : 2020-08-01DOI: 10.1177/1938640019863260
Ryan G. Rogero, Justin Tsai, Daniel J. Fuchs, Rachel J Shakked, S. Raikin
Background: Tibiotalocalcaneal (TTC) arthrodesis implementing adjunctive allografts is a method of limb salvage for patients with complex hindfoot osseous deficits, though outcome results are limited. The purposes of this study were to assess functional and radiographic outcomes after TTC arthrodesis with femoral head allograft and retrospectively identify prognostic factors. Methods: The authors reviewed 24 TTC arthrodesis procedures with bulk femoral head allografts performed by a single surgeon from 2004 to 2016. Radiographic union at the ankle and subtalar joints along with stability of the allograft were assessed. Patients who had clinically successful arthrodeses were contacted to score the Foot and Ankle Ability Measure—Activities of Daily Living (FAAM-ADL) questionnaire, Visual Analog Scale (VAS) for pain, and Short Form-12 (SF-12) at a mean of 58.0 months (range, 28-102) postoperatively. Results: Complete radiographic union of involved joints was achieved in 15 patients (63%) and in 75% (36/48) of all joints; 21 ankles (88%) were assessed to be radiographically stable at final follow-up. Three patients (13%) underwent revision arthrodesis at a mean of 18.9 months postoperatively, and 21 patients (88%) did not require additional surgery as of final follow-up. Patients significantly improved to a mean FAAM-ADL score of 71.5 from 36.3 (P < .001). The mean VAS for pain significantly improved from 77.2 to 32.9 (P < .001). Male sex (P = .08) and a lateral operative approach (P = .03) both resulted in worse outcomes. Conclusion: Use of a femoral head allograft with TTC arthrodesis can offer improved functional scores and sustained radiographic outcomes. Level of Evidence: Level IV: Case series
{"title":"Midterm Results of Radiographic and Functional Outcomes After Tibiotalocalcaneal Arthrodesis With Bulk Femoral Head Allograft","authors":"Ryan G. Rogero, Justin Tsai, Daniel J. Fuchs, Rachel J Shakked, S. Raikin","doi":"10.1177/1938640019863260","DOIUrl":"https://doi.org/10.1177/1938640019863260","url":null,"abstract":"Background: Tibiotalocalcaneal (TTC) arthrodesis implementing adjunctive allografts is a method of limb salvage for patients with complex hindfoot osseous deficits, though outcome results are limited. The purposes of this study were to assess functional and radiographic outcomes after TTC arthrodesis with femoral head allograft and retrospectively identify prognostic factors. Methods: The authors reviewed 24 TTC arthrodesis procedures with bulk femoral head allografts performed by a single surgeon from 2004 to 2016. Radiographic union at the ankle and subtalar joints along with stability of the allograft were assessed. Patients who had clinically successful arthrodeses were contacted to score the Foot and Ankle Ability Measure—Activities of Daily Living (FAAM-ADL) questionnaire, Visual Analog Scale (VAS) for pain, and Short Form-12 (SF-12) at a mean of 58.0 months (range, 28-102) postoperatively. Results: Complete radiographic union of involved joints was achieved in 15 patients (63%) and in 75% (36/48) of all joints; 21 ankles (88%) were assessed to be radiographically stable at final follow-up. Three patients (13%) underwent revision arthrodesis at a mean of 18.9 months postoperatively, and 21 patients (88%) did not require additional surgery as of final follow-up. Patients significantly improved to a mean FAAM-ADL score of 71.5 from 36.3 (P < .001). The mean VAS for pain significantly improved from 77.2 to 32.9 (P < .001). Male sex (P = .08) and a lateral operative approach (P = .03) both resulted in worse outcomes. Conclusion: Use of a femoral head allograft with TTC arthrodesis can offer improved functional scores and sustained radiographic outcomes. Level of Evidence: Level IV: Case series","PeriodicalId":39271,"journal":{"name":"Foot and Ankle Specialist","volume":"13 1","pages":"315 - 323"},"PeriodicalIF":0.0,"publicationDate":"2020-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1938640019863260","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65810552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-08-01DOI: 10.1177/1938640020945093
{"title":"Calendar for August 2020","authors":"","doi":"10.1177/1938640020945093","DOIUrl":"https://doi.org/10.1177/1938640020945093","url":null,"abstract":"","PeriodicalId":39271,"journal":{"name":"Foot and Ankle Specialist","volume":"13 1","pages":"358 - 360"},"PeriodicalIF":0.0,"publicationDate":"2020-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1938640020945093","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41883680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-08-01DOI: 10.1177/1938640019863252
G. McWilliams, L. Yao, Luke B. Simonet, Connor W Haysbert, E. Giza, Christopher Kreulen, R. Boutin
Objective:To describe the imaging findings of patients treated with subchondroplasty (SCP) of the ankle and hindfoot. Materials and Methods: Eighteen patients (10 men, 8 women; age mean 43.1 years [range 20.1-67.7 years]) underwent ankle and hindfoot SCP at a single center over a 14-month period. Imaging data were reviewed retrospectively by 2 radiologists by consensus interpretation, including preoperative radiography (18), computed tomography (CT) (11), and magnetic resonance imaging (MRI) (13) and postoperative radiography (10), CT (4), and MRI (6). Follow-up imaging was acquired 1 month to 1.6 years following SCP. Results: Indications for SCP included symptomatic bone marrow lesions (BMLs) secondary to an osteochondral lesion (OCL) (16/18) or stress fracture (2/18). While focal radiodensity related to the SCP procedure was retrospectively identifiable on postoperative radiography in all except 1 case (10/11), postprocedural findings were not described by the interpreting radiologist in 6/11 cases. On CT, the average injected synthetic calcium phosphate (CaP) volume was 1.15 cm3 (SD = 0.33 cm3); mean CT attenuation of the injectate was 1220 HU (range 1058-1465 HU). In all patients who had pre- and postoperative MRI (5/18), BML size decreased on follow-up MRI. Extra-osseous extrusion of CaP was not seen on postoperative radiography, CT, or MRI. Conclusion: Physicians should be aware of the expanding preoperative indications and postoperative imaging findings of SCP, which is being performed with increasing frequency in the ankle and hindfoot. Levels of Evidence: Diagnostic, Level III: Retrospective cohort study
{"title":"Subchondroplasty of the Ankle and Hindfoot for Treatment of Osteochondral Lesions and Stress Fractures: Initial Imaging Experience","authors":"G. McWilliams, L. Yao, Luke B. Simonet, Connor W Haysbert, E. Giza, Christopher Kreulen, R. Boutin","doi":"10.1177/1938640019863252","DOIUrl":"https://doi.org/10.1177/1938640019863252","url":null,"abstract":"Objective:To describe the imaging findings of patients treated with subchondroplasty (SCP) of the ankle and hindfoot. Materials and Methods: Eighteen patients (10 men, 8 women; age mean 43.1 years [range 20.1-67.7 years]) underwent ankle and hindfoot SCP at a single center over a 14-month period. Imaging data were reviewed retrospectively by 2 radiologists by consensus interpretation, including preoperative radiography (18), computed tomography (CT) (11), and magnetic resonance imaging (MRI) (13) and postoperative radiography (10), CT (4), and MRI (6). Follow-up imaging was acquired 1 month to 1.6 years following SCP. Results: Indications for SCP included symptomatic bone marrow lesions (BMLs) secondary to an osteochondral lesion (OCL) (16/18) or stress fracture (2/18). While focal radiodensity related to the SCP procedure was retrospectively identifiable on postoperative radiography in all except 1 case (10/11), postprocedural findings were not described by the interpreting radiologist in 6/11 cases. On CT, the average injected synthetic calcium phosphate (CaP) volume was 1.15 cm3 (SD = 0.33 cm3); mean CT attenuation of the injectate was 1220 HU (range 1058-1465 HU). In all patients who had pre- and postoperative MRI (5/18), BML size decreased on follow-up MRI. Extra-osseous extrusion of CaP was not seen on postoperative radiography, CT, or MRI. Conclusion: Physicians should be aware of the expanding preoperative indications and postoperative imaging findings of SCP, which is being performed with increasing frequency in the ankle and hindfoot. Levels of Evidence: Diagnostic, Level III: Retrospective cohort study","PeriodicalId":39271,"journal":{"name":"Foot and Ankle Specialist","volume":"13 1","pages":"306 - 314"},"PeriodicalIF":0.0,"publicationDate":"2020-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1938640019863252","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47093593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-06-01DOI: 10.1177/1938640020927843
{"title":"Calendar for June 2020","authors":"","doi":"10.1177/1938640020927843","DOIUrl":"https://doi.org/10.1177/1938640020927843","url":null,"abstract":"","PeriodicalId":39271,"journal":{"name":"Foot and Ankle Specialist","volume":"13 1","pages":"260 - 262"},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1938640020927843","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43018319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-06-01DOI: 10.1177/1938640019868061
J. Mortimer, Maryse Bouchard, Anna M. Acosta, V. Mosca
Background. The “foot-CORA” (center of rotation of angulation) method confirms the medial cuneiform as the site of deformity in most forefoot/midfoot deformities and is therefore the ideal location to correct those deformities. It has been consistently observed intraoperatively by the senior author that there is a secondary, unintentional deformity created in the transverse plane when dorsiflexion and plantar flexion osteotomies of the medial cuneiform are performed to correct pronation and supination forefoot deformities, respectively. These effects may not be desirable. This biplanar effect of medial cuneiform osteotomies has been observed but not studied. The purpose of this study was to perform the 4 commonly used medial cuneiform osteotomy techniques on cadaveric feet to demonstrate their biplanar effects. Methods. Four formaldehyde preserved cadaveric feet were used to perform 4 techniques of medial cuneiform osteotomy: dorsiflexion plantar-based opening wedge, plantar flexion dorsal-based opening wedge, dorsiflexion dorsal-based closing wedge, and plantar flexion plantar-based closing wedge. Photographs and fluoroscopy were used to assess the angular changes in the sagittal and transverse planes. Angular measurements were made using OsiriX software on fluoroscopic images. Results. The medial cuneiform opening wedge osteotomies produced midfoot abduction in addition to the desired dorsiflexion and plantar flexion. The medial cuneiform closing wedge osteotomies produced midfoot adduction in addition to the desired dorsiflexion and plantar flexion. Conclusion. We confirm that intentional sagittal uniplanar osteotomies of the medial cuneiform create obligate biplanar effects. This is likely a result of tethering by ligaments and the joint capsules on the lateral border of the medial cuneiform. The obligate transverse plane effect can be used to one’s advantage or result in an undesired effect if not considered during surgical planning and execution. We propose a simple treatment algorithm for selecting the appropriate medial cuneiform osteotomy for forefoot/midfoot deformities. Levels of Evidence: Level V
{"title":"The Biplanar Effect of the Medial Cuneiform Osteotomy","authors":"J. Mortimer, Maryse Bouchard, Anna M. Acosta, V. Mosca","doi":"10.1177/1938640019868061","DOIUrl":"https://doi.org/10.1177/1938640019868061","url":null,"abstract":"Background. The “foot-CORA” (center of rotation of angulation) method confirms the medial cuneiform as the site of deformity in most forefoot/midfoot deformities and is therefore the ideal location to correct those deformities. It has been consistently observed intraoperatively by the senior author that there is a secondary, unintentional deformity created in the transverse plane when dorsiflexion and plantar flexion osteotomies of the medial cuneiform are performed to correct pronation and supination forefoot deformities, respectively. These effects may not be desirable. This biplanar effect of medial cuneiform osteotomies has been observed but not studied. The purpose of this study was to perform the 4 commonly used medial cuneiform osteotomy techniques on cadaveric feet to demonstrate their biplanar effects. Methods. Four formaldehyde preserved cadaveric feet were used to perform 4 techniques of medial cuneiform osteotomy: dorsiflexion plantar-based opening wedge, plantar flexion dorsal-based opening wedge, dorsiflexion dorsal-based closing wedge, and plantar flexion plantar-based closing wedge. Photographs and fluoroscopy were used to assess the angular changes in the sagittal and transverse planes. Angular measurements were made using OsiriX software on fluoroscopic images. Results. The medial cuneiform opening wedge osteotomies produced midfoot abduction in addition to the desired dorsiflexion and plantar flexion. The medial cuneiform closing wedge osteotomies produced midfoot adduction in addition to the desired dorsiflexion and plantar flexion. Conclusion. We confirm that intentional sagittal uniplanar osteotomies of the medial cuneiform create obligate biplanar effects. This is likely a result of tethering by ligaments and the joint capsules on the lateral border of the medial cuneiform. The obligate transverse plane effect can be used to one’s advantage or result in an undesired effect if not considered during surgical planning and execution. We propose a simple treatment algorithm for selecting the appropriate medial cuneiform osteotomy for forefoot/midfoot deformities. Levels of Evidence: Level V","PeriodicalId":39271,"journal":{"name":"Foot and Ankle Specialist","volume":"13 1","pages":"250 - 257"},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1938640019868061","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47966064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-01DOI: 10.1177/1938640020920737
{"title":"Calendar for April 2020","authors":"","doi":"10.1177/1938640020920737","DOIUrl":"https://doi.org/10.1177/1938640020920737","url":null,"abstract":"","PeriodicalId":39271,"journal":{"name":"Foot and Ankle Specialist","volume":"13 1","pages":"171 - 173"},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1938640020920737","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45092807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Veljkovic, Oliver J. Gagné, Monther Abuhantash, A. Younger, M. Symes, K. Abbas, M. Penner, K. Wing, Khaled A. Syed, J. Lau
Background: A patient’s healthcare experience can be modulated by their understanding of their pre-operative disability along with their overall coping strategy. It is hypothesized that patient’s catastrophization and expectation on what they deem to be a successful surgery can affect their outcome. Methods: This current study prospectively assessed a consecutive cohort of patients undergoing foot and ankle reconstruction to describe the relationship between Pain Catastrophizing Scale (PCS) and patient-reported outcomes: SF-12 & FAOS. The PCS has a total score and three subcategories which are rumination, helplessness and magnification. Results: Forty-six patients were found to be eligible in the study with an average age of 54.7±14.4 years-old, a majority female (65%), a minority employed at the pre-operative visit (41%) and with an average BMI of 26.2±5.56. Looking at the FAOS Pain domain, it correlated significantly with the PCS Rumination and Helplessness subcategories. The FAOS Activity of Daily Living domain showed significant correlation with the PCS Rumination and Helplessness subcategories. The FAOS Quality of life domain was also statistically significant for the PCS Rumination and Helplessness subcategories. We found that the mental domain of the SF-12 had a statistically significant effect when compared to the Rumination (p=0.01) and Helplessness (p=0.001) subcategories.Conclusion: This study showed a significant association between an increase preoperative PCS and a worse one-year outcome looking at the FAOS domains. As such, in elective foot and ankle surgery, catastrophization should be screened for and potentially modulated pre-operatively to improve patient operative outcomes.
{"title":"High Pain Catastrophizing Scale predicts lower patient-reported outcome measures in the foot and ankle patient","authors":"A. Veljkovic, Oliver J. Gagné, Monther Abuhantash, A. Younger, M. Symes, K. Abbas, M. Penner, K. Wing, Khaled A. Syed, J. Lau","doi":"10.21203/rs.2.23223/v1","DOIUrl":"https://doi.org/10.21203/rs.2.23223/v1","url":null,"abstract":"\u0000 Background: A patient’s healthcare experience can be modulated by their understanding of their pre-operative disability along with their overall coping strategy. It is hypothesized that patient’s catastrophization and expectation on what they deem to be a successful surgery can affect their outcome. Methods: This current study prospectively assessed a consecutive cohort of patients undergoing foot and ankle reconstruction to describe the relationship between Pain Catastrophizing Scale (PCS) and patient-reported outcomes: SF-12 & FAOS. The PCS has a total score and three subcategories which are rumination, helplessness and magnification. Results: Forty-six patients were found to be eligible in the study with an average age of 54.7±14.4 years-old, a majority female (65%), a minority employed at the pre-operative visit (41%) and with an average BMI of 26.2±5.56. Looking at the FAOS Pain domain, it correlated significantly with the PCS Rumination and Helplessness subcategories. The FAOS Activity of Daily Living domain showed significant correlation with the PCS Rumination and Helplessness subcategories. The FAOS Quality of life domain was also statistically significant for the PCS Rumination and Helplessness subcategories. We found that the mental domain of the SF-12 had a statistically significant effect when compared to the Rumination (p=0.01) and Helplessness (p=0.001) subcategories.Conclusion: This study showed a significant association between an increase preoperative PCS and a worse one-year outcome looking at the FAOS domains. As such, in elective foot and ankle surgery, catastrophization should be screened for and potentially modulated pre-operatively to improve patient operative outcomes.","PeriodicalId":39271,"journal":{"name":"Foot and Ankle Specialist","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67948970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-02-01DOI: 10.1177/1938640020907349
{"title":"Calendar for February 2020","authors":"","doi":"10.1177/1938640020907349","DOIUrl":"https://doi.org/10.1177/1938640020907349","url":null,"abstract":"","PeriodicalId":39271,"journal":{"name":"Foot and Ankle Specialist","volume":"13 1","pages":"76 - 78"},"PeriodicalIF":0.0,"publicationDate":"2020-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1938640020907349","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48320279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-06DOI: 10.1177/1938640019890987
L. Claassen, D. Yao, S. Ettinger, M. Lerch, K. Daniilidis, C. Stukenborg-Colsman, C. Plaass
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
{"title":"Relevance of SPECT-CT in Complex Cases of Foot and Ankle Surgery: A Comparison With MRI","authors":"L. Claassen, D. Yao, S. Ettinger, M. Lerch, K. Daniilidis, C. Stukenborg-Colsman, C. Plaass","doi":"10.1177/1938640019890987","DOIUrl":"https://doi.org/10.1177/1938640019890987","url":null,"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","PeriodicalId":39271,"journal":{"name":"Foot and Ankle Specialist","volume":"13 1","pages":"451 - 462"},"PeriodicalIF":0.0,"publicationDate":"2019-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1938640019890987","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48113074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-02DOI: 10.1177/1938640019890738
James L. Thomas, A. Kopiec, K. Mark, L. Mae Chandler
Introduction. Injury to the Lisfranc’s joint, in particular to the second metatarsal–medial cuneiform (second MMC) joint, can be difficult to evaluate, especially in subtle Lisfranc injuries. The purpose of this study was to determine the value of the Lisfranc joint width (diastasis) of the adult foot in a standardized population thereby establishing a potential reference range when investigating this area for potential injury. Methods. The 2nd MMC joint in 50 men and 50 women was evaluated. Individuals with a history of foot/ankle pain, previous foot/ankle operation or fracture, or a history of systemic disease were excluded from the study. Bilateral weightbearing digital anterior-posterior and lateral radiographs were taken using a standardized method. Results. The mean 2nd MMC diastasis in 200 feet was 5.6 mm (95% CI 5.39-5.81). In the female population, the mean 2nd MMC diastasis was 5.8 mm (95% CI 5.51-6.09) as compared with 5.6 mm (95% CI 5.31-5.89) in males. The mean distance between the fifth metatarsal base and first cuneiform in the entire study population was 16.3 mm (95% CI 15.57-17.03). Conclusion. This study helps define baseline measurements of the Lisfranc joint for the general population, which can provide a standard measurement against which suspected foot injuries can be compared. Level of Evidence: Level IV.
介绍。对Lisfranc关节的损伤，特别是第二跖内侧楔形关节(第二MMC)的损伤，很难评估，特别是在轻微的Lisfranc损伤中。本研究的目的是在标准化人群中确定成人足Lisfranc关节宽度(离断)的值，从而在调查该区域潜在损伤时建立一个潜在的参考范围。方法。对50名男性和50名女性的第二MMC关节进行了评估。有足部/踝关节疼痛史、既往足部/踝关节手术或骨折史或全身性疾病史的个体被排除在研究之外。采用标准化方法拍摄双侧负重数字前后位和侧位片。结果。200英尺的平均第2次MMC转移为5.6 mm (95% CI 5.39-5.81)。在女性人群中，平均第2 MMC转移为5.8 mm (95% CI 5.51-6.09)，而男性为5.6 mm (95% CI 5.31-5.89)。在整个研究人群中，第五跖骨基部与第一楔形骨之间的平均距离为16.3 mm (95% CI 15.57-17.03)。结论。这项研究有助于为一般人群确定Lisfranc关节的基线测量值，这可以提供一个标准的测量值，用于比较可疑的足部损伤。证据等级:四级。
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