Diagnostic validity of alternative manual stress radiographic technique detecting subtalar instability with concomitant ankle instability

Lee, Byung‐Hoon; Choi, Kyoung-Seong; Seo, Dong Yeon; Choi, Sang Min; Kim, Gab-Lae

doi:10.1007/s00167-016-4037-x

Cited by 27 publications

(34 citation statements)

References 43 publications

(57 reference statements)

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“…A review of the literature showed that measurements at the level of both the subtalar (STT) and the ankle joint (ATT/TT) are most frequently used to assess the integrity of the ligaments providing stability to the subtalar joint . The TT and ATT were measured on the AP and the lateral view, while the STT was assessed on the 30°/40° Broden view . The rationale to use ATT and TT measurements was that the CFL and deltoid ligament cross both the ankle and subtalar joint.…”

Section: Methodsmentioning

confidence: 99%

“…Chronic hindfoot instability is a frequent problem that is evident in up to 33% of patients with a history of ankle sprains . Hindfoot instability often includes the ankle joint but can also affect the subtalar joint . While ankle joint instability can be diagnosed clinically, an accurate assessment of the subtalar joint remains elusive .…”

mentioning

confidence: 99%

“…The impact of subtalar joint instability on this development remains unclear . This emphasizes the relevance of a radiographic diagnosis, currently performed by several two‐dimensional (2D) measurements including tibio‐talar tilt (TT), anterior talar translation (ATT), and subtalar tilt (STT) . However, these measurements are limited in their ability to identify subtalar joint instability when using stress radiographs …”

mentioning

confidence: 99%

“…1 Hindfoot instability often includes the ankle joint but can also affect the subtalar joint. [2][3][4] While ankle joint instability can be diagnosed clinically, an accurate assessment of the subtalar joint remains elusive. 2,3,5 To provide an adequate treatment for patients with posttraumatic hindfoot instability, a meaningful assessment of the subtalar joint is desirable.…”

mentioning

confidence: 99%

“…15 This emphasizes the relevance of a radiographic diagnosis, currently performed by several twodimensional (2D) measurements including tibio-talar tilt (TT), anterior talar translation (ATT), and subtalar tilt (STT). 2,4,[16][17][18][19][20][21] However, these measurements are limited in their ability to identify subtalar joint instability when using stress radiographs. 2,4 While conventional radiographs are limited in assessing the subtalar joint, weightbearing computed tomography (CT) scans have demonstrated emerging diagnostic applications as they offer an accurate representation of hindfoot joint alignment under weightbearing conditions.…”

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confidence: 99%

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

Krähenbühl

Burssens

Davidson

et al. 2019

Journal Orthopaedic Research

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Chronic hindfoot instability is a frequent problem that includes the ankle and/or the subtalar joint. While ankle joint instability can be diagnosed clinically, accurate assessment of the subtalar joint remains elusive. This study's purpose was to assess the ability of weightbearing computed tomography (CT) scans to detect subtalar joint instability. Seven pairs of fresh frozen male cadavers (tibial plateau to toe‐tip) were tested. A radiolucent frame held specimens in a plantigrade position while non‐weightbearing and weightbearing CT scans (with and without torque application) were taken. First, intact ankles (Native) were scanned. Second, one specimen from each pair underwent interosseous talo‐calcaneal ligament (ITCL) transection, while the contralateral underwent calcaneo‐fibular ligament (CFL) transection. Third, the remaining intact ITCL or CFL was transected. Finally, the deltoid ligament was transected in all ankles. Eight radiographic measurements were performed to assess the congruency of the subtalar joint on digitally reconstructed radiographs and single CT images. Axial loading did not impact most measurements, whereas torque did impact most measurements. Radiographic measurements performed at the subtalar joint level were more reliable and better predictors for subtalar joint instability compared with measurements performed at the ankle joint level. While torque application is crucial to identify subtalar joint instability, axial load application should be avoided. Measurements to assess the subtalar joint stability should primarily be performed at the subtalar joint level rather than at the ankle joint level when using weightbearing CT scans. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2457–2465, 2019

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Section: Methodsmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%