Can Weightbearing Computed Tomography Scans Be Used to Diagnose Subtalar Joint Instability? A Cadaver Study

Krähenbühl, Nicola; Burssens, Arne; Davidson, Nathan; Allen, Chelsea McCarty; Henninger, Heath B.; Saltzman, Charles L.; Barg, Alexej

doi:10.1002/jor.24420

Cited by 13 publications

(14 citation statements)

References 35 publications

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“…Motion of the subtalar joint is complex. Due to the convex posterior facet of the calcaneus and corresponding concave facet of the talus, subtalar joint movement can be described as rotation, translation or a combination of both 1,15 . In general, subtalar joint motion has been described using a finite helical axis.…”

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confidence: 99%

Centre of Rotation of the Human Subtalar Joint Using Weight-Bearing Clinical Computed Tomography

Fernández

Hoxha

Chan

et al. 2020

Sci Rep

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Accurate in vivo quantification of subtalar joint kinematics can provide important information for the clinical evaluation of subtalar joint function; the analysis of outcome of surgical procedures of the hindfoot; and the design of a replacement subtalar joint prosthesis. The objective of the current study was to explore the potential of full weight-bearing clinical computed tomography (ct) to evaluate the helical axis and centre of rotation of the subtalar joint during inversion and eversion motion. A subject specific methodology was proposed for the definition of the subtalar joint motion combining threedimensional (3D) weight-bearing imaging at different joint positions with digital volume correlation (DVC). The computed subtalar joint helical axis parameters showed consistency across all healthy subjects and in line with previous data under simulated loads. A sphere fitting approach was introduced for the computation of subtalar joint centre of rotation, which allows to demonstrate that this centre of rotation is located in the middle facet of the subtalar joint. Some translation along the helical axis was also observed, reflecting the elasticity of the soft-tissue restraints. This study showed a novel technique for non-invasive quantitative analysis of bone-to-bone motion under full weight-bearing of the hindfoot. Identifying different joint kinematics in patients with ligamentous laxity and instability, or in the presence of stiffness and arthritis, could help clinicians to define optimal patient-specific treatments. The subtalar joint describes an articulation between talus and calcaneus, forming one of two joints of the hindfoot with the tibiotalar or ankle joint above the talus and the subtalar joint below. The talus comprises of three facets (anterior, middle and posterior) that articulate with the mating facets on the calcaneus at the subtalar joint. The bones are connected by a complex of ligamentous structures that connect the talus to the calcaneus and both structures to the adjacent navicular bone, which is intricately involved in hindfoot and midfoot motion (Fig. 1). The subtalar joint is the primary joint involved in motion and posture of the hindfoot in the frontal plane. Motion is complex and it combines dorsiflexion, abduction and eversion in one direction and plantarflexion, abduction and inversion in the other 1. Problems associated to the subtalar joint can have a significant impact on function 2 , preventing participation in sports and normal daily activities. Common pathologies affecting the joint include instability following ligamentous injury 3 , and painful flat feet in children and adults. In addition, end stage ankle and hindfoot arthritis is a major problem that has been shown to affect quality of life as much as end stage heart disease 4,5. Although the incidence of subtalar joint arthritis is unknown, approximately 3.4% of the population aged over 50 has radiographic hindfoot arthritis, which is more than 300,000 people in the UK 6. The most common cause of subtalar joint arthri...

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confidence: 99%

Centre of Rotation of the Human Subtalar Joint Using Weight-Bearing Clinical Computed Tomography

Fernández

Hoxha

Chan

et al. 2020

Sci Rep

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“…Third, a relatively small sample size was used, which could have an impact on the validity of the study. Still, the sample size was comparable to previous cadaveric research in this field, ranging from 6 to 20 specimens, 11,23,44 to assess three‐dimensional displacement associated with subtalar joint instability.…”

Section: Discussionmentioning

confidence: 95%

“…In a previously performed controlled laboratory study, 23 cadaver specimens were dissected and biomechanically tested according to a standardized protocol (Figure 1: Flow chart).…”

Section: Methodsmentioning

confidence: 99%

“…These types of models have also shown an added value in other orthopedic fields such as bone tumors or thermal necrosis 21,22 . Moreover, a recent investigation has demonstrated the applicability of WBCT to assess subtalar joint instability using the most relevant radiographic parameters 23 . However, several limitations were encountered as a consequence of the 2D measurements used to quantify the complex 3D displacement after a ligament injury.…”

Section: Introductionmentioning

confidence: 99%

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Interaction of loading and ligament injuries in subtalar joint instability quantified by 3D weightbearing computed tomography

Burssens

Krähenbühl

Lenz

et al. 2021

Journal Orthopaedic Research

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Despite decades of research since its first description, subtalar joint instability remains a diagnostic enigma within the concept of hindfoot instability. This could be attributed to current imaging techniques, which are impeded by two‐dimensional measurements. Therefore, we used weightbearing computed tomography imaging to quantify three‐dimensional displacement associated with subtalar joint instability. Three‐dimensional models were generated in seven paired cadaver specimens to compute talocalcaneal displacement after different patterns of axial load (85 kg) combined with torque in internal and external rotation (10 Nm). Sequential imaging was repeated in the subtalar joint containing intact ligaments to determine reference displacement. Afterward, the interosseus talocalcaneal ligament (ITCL) or calcaneofibular ligament (CFL) was sectioned, then the ITCL with CFL and after the ITCL, CFL with the deltoid ligament (DL). The highest translation could be detected in the dorsal direction and the highest rotation occurred in the internal direction when external torque was applied to the foot without load. These displacements differed significantly from the condition containing intact ligaments, with a mean difference of 1.6 mm (95% CI, 1.3 to 1.9) for dorsal translation and a mean of 12.4° (95% CI, 10.1 to 14.8) for internal rotation. Clinical relevance: Our study provides a novel and noninvasive analysis to quantify subtalar joint instability based on three‐dimensional WBCT imaging. This approach overcomes former studies using trans‐osseous fixation to determine three‐dimensional subtalar joint displacement and implements an imaging device and software modalities that are readily available. Based on our findings, we recommend applying torque in external rotation to the foot to optimize the detection of subtalar joint instability.

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“…The advantage of DRRs over conventional X-rays is that DRRs make it possible to view multiple simulated radiographic projections from a single CT data set ( 19 ) . In research investigating foot and ankle pathologies, such as hallux valgus ( 20 ) , hindfoot alignment ( 21 ) , syndesmosis injuries ( 22 ) , and subtalar joint instability ( 23 ) , DRRs have been used in place of conventional X-rays in the calculation of angular measurements ( 3 ) . Multiplanar reconstructions and DRRs, both of which are obtained without increasing the radiation dose, serve as a gradual learning experience for a generation trained in the age of 2D imaging.…”

Section: Cbctmentioning

confidence: 99%

Weight-bearing cone-beam computed tomography in the foot and ankle specialty: where we are and where we are going - an update

et al. 2021

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Cone-beam computed tomography (CBCT) has been applied in dentistry and medicine for nearly two decades. Its application in the foot and ankle specialty has grown exponentially in recent years. Weight-bearing CBCT allows clinicians to obtain weight-bearing images that can be viewed in all three planes and to construct three-dimensional models, similar to those constructed from traditional CT scans, as well as exposing patients to less radiation than do traditional CT scans. This technology has revolutionized diagnoses, improving the understanding of various lesions and surgical planning in the foot and ankle specialty. Ongoing studies of the use of weight-bearing CBCT in foot and ankle surgery are focused on fully automated and semi-automated three-dimensional measurements, as well as bone segmentation, mapping of the distances/orientation of the joints, and the production of customized implants. The aims of this review article are to show the evolution of this emerging tool in the foot and ankle specialty, to update those in related specialties on its use in current clinical practice, and to indicate where the research community is heading.

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Can Weightbearing Computed Tomography Scans Be Used to Diagnose Subtalar Joint Instability? A Cadaver Study

Cited by 13 publications

References 35 publications

Centre of Rotation of the Human Subtalar Joint Using Weight-Bearing Clinical Computed Tomography

Centre of Rotation of the Human Subtalar Joint Using Weight-Bearing Clinical Computed Tomography

Interaction of loading and ligament injuries in subtalar joint instability quantified by 3D weightbearing computed tomography

Weight-bearing cone-beam computed tomography in the foot and ankle specialty: where we are and where we are going - an update

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