Objective: This cadaveric pilot study was to develop a weight bearing computed tomography (WBCT) three-dimensional (3D) distance mapping algorithm that would allow for detection of syndesmotic instability. Methods: Pilot study, two cadaveric specimens. Syndesmotic instability was induced by release of all syndesmotic ligaments through a conventional lateral ankle approach. WBCT imaging under simulated weight bearing was acquired before and after syndesmotic destabilization. Syndesmotic incisura and ankle gutter distances were assessed using a 3D distance mapping WBCT algorithm. Results: We found increases in the overall mean syndesmotic distances in the injured syndesmosis when compared to pre-injury state, and color coded distance maps allowed easy interpretation of the syndesmotic widening following ligament sectioning and destabilization of the syndesmotic joint. Conclusion: The WBCT 3D distance mapping algorithm has the potential to allow detection of mild syndesmotic instability with a relatively ease of interpretation by using color-coded distance maps. Level of Evidence V; Cadaveric Study.
Objective: The objective of the study was to assess the efficacy of the LapiCotton procedure on patients with hallux valgus (HV) combined with medial longitudinal arch collapse. Methods: Preoperative and postoperative weight-bearing computed tomography (WBCT) scans were obtained from patients with HV submitted to the LapiCotton procedure. Semi-automatic measurements were applied to 22 WBCT images across 11 patients enrolled in the study using a software package (Bonelogic, Disior™, Helsinki, Finland). Significance level was set at 0.05. Results: The hallux valgus angle (HVA) was significantly larger (p=0.026) in the preoperative group (Mdn = 27.52) than in the postoperative group (Mdn = 20). In addition, the Meary sagittal measurement was found to be significantly increased (p=0.033) in the preoperative group (Mdn = -14.28) when compared to the postoperative group (Mdn = -11.15). It was also observed that the intermetatarsal angle was significantly larger (p=0.003) in the preoperative group (Mdn = 15.68) compared to the postoperative group (Mdn = 11.26). Conclusion: The LapiCotton procedure effectively corrected radiographic parameters in patients with HV combined with the medial longitudinal arch collapse. Level of Evidence III; Therapeutic Studies; Comparative Retrospective Study.
Objective: The goal of this paper was to evaluate the validity of foot and ankle offset (FAO) measurements in the setting of severe foot and ankle deformities. Methods: This study included 57 feet (36 patients) that had a history of severe cavovarus deformity. Each participant received a weight-bearing computed tomography (WBCT) scan that was then used to measure FAO. This measurement was performed once using the traditional measurement technique and two additional times using a modified technique that allows for rotational correction of the images to align the talus. Results: Traditional FAO (TFAO) and modified FAO (MFAO) were found to have a significant correlation with one another (r (54)=0.92, p<0.001). There was a high positive correlation between the variables of the two techniques (r=0.92) with the intraobserver reliabilities (ICC=0.95) for FAO measurements. The agreement between TFAO and Modified foot and ankle offset (MFAO) measurements was also considered excellent (ICC=0.99). Conclusion: The MFAO method provides statistically similar FAO measurements compared to the TFAO method in this population. Thus, the TFAO method could potentially expand its patient population to provide surgeons with a reliable tool for assessing more severe deformities. Level of Evidence IV; Retrospective Study.
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