Ankle post-traumatic osteoarthritis: a CT arthrography study in patients with bi- and trimalleolar fractures

Kraniotis, Pantelis; Maragkos, Spyridon; Tyllianakis, Minos; Petsas, Theodore; Karantanas, Apostolos H.

doi:10.1007/s00256-011-1292-2

Cited by 17 publications

(24 citation statements)

References 30 publications

(47 reference statements)

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“…Contrast agents have been used in X‐ray arthographies for decades . However, the main goal has been to evaluate the morphology of the articular surface and to detect macroscopic cartilage lesions . The idea of delayed CT imaging of cartilage was introduced in 2006 .…”

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confidence: 99%

In vivo diagnostics of human knee cartilage lesions using delayed CBCT arthrography

et al. 2013

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The aim of this study was to investigate the feasibility of delayed cone beam (CBCT) arthrography for clinical diagnostics of knee cartilage lesions. Knee joints with cartilage lesions were imaged using native radiography, MRI, and delayed CBCT arthrography techniques in vivo. The joints were imaged three times with CBCT, just before, immediately after (arthrography) and 45 min after the intra-articular injection of contrast agent. The arthrographic images enabled sensitive detection of the cartilage lesions. Use of arthrographic and delayed images together with their subtraction image enabled also detection of cartilage with inferior integrity. The contrast agent partition in intact cartilage (ICRS grade 0) was lower (p < 0.05) than that of cartilage surrounding the ICRS grade I-IV lesions. Delayed CBCT arthrography provides a novel method for diagnostics of cartilage lesions. Potentially, it can also be used in diagnostics of cartilage degeneration. Due to shorter imaging times, higher resolution, and lower costs of CT over MRI, this technique could provide an alternative for diagnostics of knee pathologies. However, for comprehensive evaluation of the clinical potential of the technique a further clinical study with a large pool of patients having a wide range of cartilage pathologies needs to be conducted. Keywords: cartilage lesions; contrast agent diffusion; computed tomography; delayed CBCT arthrography; osteoarthrosis Cartilage lesions are common and can lead to progressive joint degeneration at high cost for the healthcare system. Early diagnosis and grading of cartilage lesions could improve the early selection of treatment, enable monitoring the effect of new treatments and therefore reduce the risk for post traumatic osteoarthritis (OA).Detection of acute cartilage lesions or early OA is challenging since cartilage is not visible in X-ray imaging. Resolution of magnetic resonance imaging (MRI) is limited, and queuing times are long, but it is still the routine method used in cartilage lesion diagnostics and in clinical decision making for or against arthroscopy. In planar X-ray imaging the Xray attenuation of the cartilage is similar with that of the surrounding soft tissues and therefore cartilage is not visible in the images. For this reason diagnosis is mainly based on decreased joint separation and changes in subchondral bone. On the other hand, MRI is not based on ionizing radiation and can be used to visualize soft tissues enabling detection of cartilage defects. Cone beam computed tomography (CBCT) utilizes a conical X-ray beam, covering a large volume with a single rotation about the patient. Due to differences in imaging geometry and collimation of X-rays the radiation dose of CBCT is much smaller than that of spiral CT.1 MRI is especially useful for diagnostics of meniscal tears and lesions of anterior cruciate ligament (ACL) with accuracies of 81% to 98% and specificities of 69% to 98%, respectively, 2 but in the diagnostics of cartilage lesions its sensitivity and specificity ha...

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confidence: 99%

In vivo diagnostics of human knee cartilage lesions using delayed CBCT arthrography

et al. 2013

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“…CTA of the ankle joint is still clinically relevant [16] and the diagnostic value may be underrepresented in the literature. Using the terms “CT arthrography” and “ankle” in a PubMed search, only 49 studies were found.…”

Section: Discussionmentioning

confidence: 99%

“…Using the terms “CT arthrography” and “ankle” in a PubMed search, only 49 studies were found. Kraniotis et al described that CTA detects radiographically silent osteochondral lesions in patients with fractures of the ankle joint but did not compare CTA to other imaging techniques [16]. In the study by Chemouni et al CT arthrography showed an accuracy of 88% [31].…”

Section: Discussionmentioning

confidence: 99%

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Diagnostic Value of CT Arthrography for Evaluation of Osteochondral Lesions at the Ankle

Kirschke

Braun

Baum

et al. 2016

BioMed Research International

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Background. To retrospectively determine the diagnostic value of computed tomography arthrography (CTA) of the ankle in the evaluation of (osteo)chondral lesions in comparison to conventional magnetic resonance imaging (MRI) and intraoperative findings. Methods. A total of N = 79 patients had CTAs and MRI of the ankle; in 17/79 cases surgical reports with statements on cartilage integrity were available. Cartilage lesions and bony defects at talus and tibia were scored according to defect depth and size by two radiologists. Statistical analysis included sensitivity analyses and Cohen's kappa calculations. Results. On CTA, 41/79 and 31/79 patients had full thickness cartilage defects at the talus and at the tibia, respectively. MRI was able to detect 54% of these defects. For the detection of full thickness cartilage lesions, interobserver agreement was substantial (0.72 ± 0.05) for CTA and moderate (0.55 ± 0.07) for MRI. In surgical reports, 88–92% and 46–62% of full thickness defects detected by CTA and MRI were described. CTA findings changed the further clinical management in 15.4% of cases. Conclusions. As compared to conventional MRI, CTA improves detection and visualization of cartilage defects at the ankle and is a relevant tool for treatment decisions in unclear cases.

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“…CT scans may be utilised to gain an improved appreciation of post-traumatic changes at the tibiotalar joint, non-unions and in cases of complex deformity or retained hardware. Recently, CT scans have been utilised to predict posttraumatic ankle osteoarthritis in the acute trauma setting, in both ankle fractures and intra-articular tibial plafond fractures 10,11 . CT scans are less susceptible to hardware artefacts and motion artefacts compared to MRI.…”

Section: Reviewmentioning

confidence: 99%

Ankle arthritis: Diagnosis and conservative management

Grunfeld¹,

Aydogan²,

Juliano³

et al. 2013

OA Musculoskeletal Medicine

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Ankle post-traumatic osteoarthritis: a CT arthrography study in patients with bi- and trimalleolar fractures

Abstract: CTa detects radiographically silent cartilage lesions in patients with fractures of the ankle joint. There is no correlation of the extent of lesions and the patient's AOFAS score.

Cited by 17 publications

References 30 publications

In vivo diagnostics of human knee cartilage lesions using delayed CBCT arthrography

In vivo diagnostics of human knee cartilage lesions using delayed CBCT arthrography

Diagnostic Value of CT Arthrography for Evaluation of Osteochondral Lesions at the Ankle

Ankle arthritis: Diagnosis and conservative management

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