Weight-Bearing Cone Beam Ct Scans and Its Uses in Ankle, Foot, and Knee: An Update Article

Lôbo, Carlos Felipe Teixeira; Bordalo-Rodrigues, Marcelo

doi:10.1590/1413-785220212902236939

Cited by 5 publications

(4 citation statements)

References 54 publications

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“…In addition, it can be indicated for defining OA of multiple joints with different stages and inconsistent clinical assessment of pathologies in closely adjacent structures such as talonavicular and subtalar joints ( 19 , 20 , 21 ). In more recent years, the appearance and development of the weight-bearing CT scan has allowed a better 3D understanding of ankle OA and associated supra- and infra-malleolar deformities of the foot and ankle, in a physiological, standing, and loaded condition ( 22 , 23 , 24 , 25 , 26 , 27 ).…”

Section: Pathophysiology Peculiarities Of Tibiotalar Articular Cartilagementioning

confidence: 99%

Ankle osteoarthritis: comprehensive review and treatment algorithm proposal

et al. 2022

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Ankle osteoarthritis (OA) is much less frequent than knee or hip OA, but it can be equally disabling, greatly affecting the quality of life of the patients. Approximately 80% of ankle OA is post-traumatic, mainly secondary to malleolar fractures, being another of the main causes untreated in chronic instability. The average age of the patient affected by ankle OA is around 50 years, being therefore active patients and in working age who seek to maintain mobility and remain active. The authors conducted a comprehensive review of the conservative, medical, and surgical treatment of ankle OA. Initial conservative treatment is effective and should be attempted in any stage of OA. From a pharmacological point of view, non-steroidal anti-inflammatory drugs (NSAIDs) and intra-articular infiltrations can produce temporary relief of symptoms. After the failure of conservative-medical treatment, two large groups of surgical treatment have been described: joint-preserving and joint-sacrificing procedures. In the early stages, only periarticular osteotomies have enough evidence to recommend in ankle OA with malalignment. Both ankle arthrodesis and ankle replacement can produce satisfactory functional results if correctly indicated in the final stages of the disease. Finally, the authors propose a global treatment algorithm that can aid in the decision-making process.

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Section: Pathophysiology Peculiarities Of Tibiotalar Articular Cartilagementioning

confidence: 99%

Ankle osteoarthritis: comprehensive review and treatment algorithm proposal

et al. 2022

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“…CBCT has recently found application at the knee in the context of OA due to the ability to perform weight bearing acquisitions, 68 comparisons naturally being made with radiography. In 2016, Segal et al 69 showed that greater surface area with a low joint space width (JSW) measured on weight bearing CT (WBCT, Figure 4) correlated more strongly with tibial cartilage lesion severity than radiographic minimum JSW.…”

Section: Computed Tomographymentioning

confidence: 99%

Early knee OA definition–what do we know at this stage? An imaging perspective

Roemer

Cicuttini

et al. 2023

Therapeutic Advances in Musculoskeletal

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While criteria for early-stage knee osteoarthritis (OA) in a primary care setting have been proposed, the role of imaging has been limited to radiography using the standard Kellgren–Lawrence classification. Standardized imaging and interpretation are critical with radiographs, yet studies have also shown that even early stages of radiographic OA already demonstrate advanced damage to knee joint tissues such as cartilage, menisci, and bone marrow. Morphological magnetic resonance imaging (MRI) shows degenerative damage earlier than radiographs and definitions for OA using MRI have been published though no accepted definition of early OA based on MRI is currently available. The clinical significance of structural abnormalities has also not been well defined, and the differentiation between normal aging and structural OA development remains a challenge. Compositional MRI of cartilage provides information on biochemical, degenerative changes within the cartilage matrix before cartilage defects occur and when cartilage damage is potentially reversible. Studies have shown that cartilage composition can predict cartilage loss and radiographic OA. However, while this technology is most promising for characterizing early OA it has currently limited clinical application. Better standardization of compositional MRI is required, which is currently work in progress. Finally, there has been renewed interest in computed tomography (CT) for assessing early knee OA as new techniques such as weight bearing and spectral CT are available, which may provide information on joint loading, cartilage, and bone and potentially have a role in better characterizing early OA. In conclusion, while imaging may have a limited role in diagnosing early OA in a primary care setting, there are advanced imaging technologies available, which detect early degeneration and may thus significantly alter management as new therapeutic modalities evolve.

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“…Supported by growing evidence from weightbearing computed tomography (WBCT) imaging PCFD literature, 2,14,16,22,27,31,34 PTS was included in the recently proposed PCFD classification system, where the presence of sinus tarsi impingement, subtalar joint subluxation, and subfibular impingement denote increased severity of the deformity. 26,36 Foot and ankle offset (FAO) WBCT measurements, assessing the 3D relationship of the position of the weightbearing foot tripod (calcaneal tuberosity, first and fifth metatarsal heads) and the center of the ankle joint, among other 3D measurements, 5,37 have also been demonstrated to represent accurately the overall 3D deformity in PCFD.…”

Section: Introductionmentioning

confidence: 99%

“…15,18 Advanced degeneration of the talocalcaneal interosseus ligament has been shown to be directly correlated with the presence of subfibular impingement, 15 which can be considered a marker of extreme PTS and multidirectional subtalar joint instability, with frank lateral translation of the calcaneus and direct impingement into the distal aspect of the fibula. 20,28,35 Supported by growing evidence from weightbearing computed tomography (WBCT) imaging PCFD literature, 2,14,16,22,27,31,34 PTS was included in the recently proposed PCFD classification system, where the presence of sinus tarsi impingement, subtalar joint subluxation, and subfibular impingement denote increased severity of the deformity. 26,36 Foot and ankle offset (FAO) WBCT measurements, assessing the 3D relationship of the position of the weightbearing foot tripod (calcaneal tuberosity, first and fifth metatarsal heads) and the center of the ankle joint, among other 3D measurements, 5,37 have also been demonstrated to represent accurately the overall 3D deformity in PCFD.…”

Section: Introductionmentioning

confidence: 99%

Effect of Peritalar Subluxation Correction for Progressive Collapsing Foot Deformity on Patient-Reported Outcomes

de Cesar Netto,

Barbachan Mansur,

Lalevee

et al. 2023

Foot Ankle Int.

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Background: Peritalar subluxation (PTS) is part of progressive collapsing foot deformity (PCFD). This study aimed to evaluate initial deformity correction and PTS optimization in PCFD patients with flexible hindfoot deformity undergoing hindfoot joint-sparing surgical procedures and its relationship with improvements in patient-reported outcome measures (PROMs) at latest follow-up. We hypothesized that significant deformity/PTS correction would be observed postoperatively, positively correlating with improved PROMs. Methods: A prospective comparative study was performed with 26 flexible PCFD patients undergoing hindfoot joint-sparing reconstructive procedures, mean age 47.1 years (range, 18-77). We assessed weightbearing computed tomography (WBCT) overall deformity (foot and ankle offset [FAO]) and PTS markers (distance and coverage maps) at 3 months, as well as PROMs at final follow-up. A multivariate regression model assessed the influence of initial deformity correction and PTS optimization in patient-reported outcomes. Results: Mean follow-up was 19.9 months (6-39), and the average number of procedures performed was 4.8 (2-8). FAO improved from 9.4% (8.4-10.9) to 1.9% (1.1-3.6) postoperatively ( P < .0001). Mean coverage improved by 69.6% ( P = .012), 12.1% ( P = .0343) and 5.2% ( P = .0074) in, respectively, the anterior, middle, and posterior facets, whereas the sinus tarsi coverage decreased by an average 57.1% ( P < .0001) postoperatively. Improvements in patient-reported outcomes were noted for all scores assessed ( P < .03). The multivariate regression analysis demonstrated that improvement in both FAO and PTS measurements significantly influenced the assessed PROMs. Conclusion: This study demonstrated significant improvements in the overall 3D deformity, PTS markers, and PROMs following hindfoot joint-sparing surgical treatment in patients with flexible PCFD. More importantly, initial 3D deformity correction and improvement in subtalar joint coverage and extraarticular impingement have been shown to influence PROMs significantly and positively. Addressing these variables should be considered as goals when treating PCFD. Level of Evidence: Level II, prospective cohort study.

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Weight-Bearing Cone Beam Ct Scans and Its Uses in Ankle, Foot, and Knee: An Update Article

Cited by 5 publications

References 54 publications

Ankle osteoarthritis: comprehensive review and treatment algorithm proposal

Ankle osteoarthritis: comprehensive review and treatment algorithm proposal

Early knee OA definition–what do we know at this stage? An imaging perspective

Effect of Peritalar Subluxation Correction for Progressive Collapsing Foot Deformity on Patient-Reported Outcomes

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