Reliability and clinical features associated with the IPSG MRI tibiotalar and subtalar joint scores in children, adolescents and young adults with haemophilia

Abstract

Objectives:To assess the reliability of the IPSG MRI scale for tibiotalar (TTJ) and subtalar joint (STJ) changes in young haemophilic patients, correlating MRI findings with functional scores and 3D-rearfoot kinematics.Methods: A total of 37 haemophilic patients underwent bilateral MRI of the footankle, clinical evaluation and quantitative assessment of their 3D-rearfoot kinematics during walking. TTJ and STJ soft tissues were assessed twice along with osteochondral changes by two radiologists using the IPSG MRI scale. Inter-and intra-observer reproducibility of MRI scoring were tested by means of kappa statistics. Correlational analyses were performed between MRI findings and the Haemophilia Joint Health Score 2.1 (HJHS) and 3D-rearfoot kinematic data. Results:The intra-reader reliability of MRI scoring was good to excellent (Kappa: 0.62-1), whereas the inter-reader reliability was moderate to good (Kappa: 0.54-0.79). Weak yet significant correlations were found between the frontal plane rearfoot range of motion (ROM) during loading response of gait and STJ score, as well as between frontal plane rearfoot ROM during the terminal stance phase and the rearfoot osteochondral lesions. Conclusion:The IPSG score appears applicable to not only the TTJ but also the STJ.Contrary to TTJ lesions, those of the STJ do not correlate with the HJHS but do with 3D-rearfoot kinematic data.

Clinical gait features are associated with MRI findings in patients with haemophilic ankle arthropathy

“…An association between total IPSG‐MRI scores and both clinical gait features was found. Brunel et al previously reported weak associations between this IPSG‐MRI score and kinematic gait features in haemophilic children with no to moderate ankle joint damage. These authors did however not find any associations between synovial hypertrophy findings and gait features as synovial hypertrophy lesions were not common in their study population, contrarily to the current study.…”

“…The main findings of this study seem to substantiate our initial hypothesis as PwH with severely damaged ankle joints generate and absorb less ankle joint power, which is correlated with a lowered tolerance towards ankle joint stress during walking. Potential reasons for the found correlations might arise from ankle pain during walking, limited mobility and stiffness and calf muscle atrophy and/or weakness due to muscle bleedings or disuse in patients with severe haemophilia. These functional consequences in the ankle joint often lead to antalgic walking patterns.…”

“…Brunel et al previously reported weak associations between this IPSG‐MRI score and kinematic gait features in haemophilic children with no to moderate ankle joint damage. These authors did however not find any associations between synovial hypertrophy findings and gait features as synovial hypertrophy lesions were not common in their study population, contrarily to the current study. Our findings did show that synovial hypertrophy on MRI might serve as a good parameter to predict functional outcome, probably through the manifestation of impingement‐induced pain during the inflammatory stage of haemarthroses .…”

“…Three‐dimensional gait analysis is found to be an ideal methodological tool to characterize joint function during walking and receives increasing attention in PwH . One study to date investigated the relationship between ankle joint structure and ankle joint function in children, adolescents and young adults by associating the IPSG‐MRI score with their respective ankle joint kinematics during walking . The findings of this study highlighted a poor correlation between ankle joint structure and function in the aforementioned population.…”

Postural control during a transition task in haemophilic children, adolescents and young adults with haemophilic ankle arthropathy

“…Joint structural integrity in these studies was assessed with disease‐specific clinical scores (eg HJHS, World Federation of Haemophilia clinical score). However, these scores show good sensitivity with respect to the detection of early stages of ankle arthropathy but not for other major foot joints such as the subtalar joint . Thus, the relationship between HA and postural control remains poorly studied.…”