Three-Dimensional Distance Mapping to Identify Safe Zones for Lateral Column Lengthening

Abstract

Background: Evans (E-LCL) and Hintermann LCL (H-LCL) lateral column lengthening osteotomies are standard surgical solutions for flexible, progressive collapsing feet. E-LCL is performed between the anterior and middle facets and endangers specific os calcis subtalar joint (OCST) subtypes without distinct facets. H-LCL is oriented between the posterior and middle facets and should be suitable for all OCSTs. Both osteotomies are associated with increased subtalar osteoarthritis, indicating iatrogenic damage. Distance mapping (DM) enables visualization of the relative distance between 2 articular surfaces represented by color patterns. This study aims to measure the safe zones for LCL using 3-dimensional (3D) models and DM; we hypothesize that it could be measured with high reproducibility. Methods: Two raters categorized 200 feet across 134 patients into OCSTs based on the Bruckner classification. Four angles were measured independently. The proximal and distal extents of the posterior safe zone (PSZ) angles were determined for H-LCL osteotomies; similarly, the proximal and distal extents of the anterior safe zone (ASZ) angles were identified for E-LCL osteotomies. Consequently, the surface available for safe osteotomies were calculated. An interclass correlation was used to assess the agreement between the 2 raters. Additionally, analysis of variance and Mann-Whitney U test were used to compare the safe zones between OCSTs. Results: The mean proximal and distal extents of the PSZ angles were 68 ± 7 and 75 ± 5 degrees from a line parallel to the lateral border of the calcaneus, respectively, and the proximal and distal extent of the ASZ angles were 89 ± 6 and 95 ± 5 degrees, respectively. There were no statistically significant differences between the OCSTs. Two raters measured the angles with good to excellent interrater and intrarater agreement. In 18 cases, we were unable to plan for H-LCL or E-LCL osteotomies. Conclusion: Distance mapping could be used to measure the safe zone, tailor a preoperative plan, and potentially reduce the risk for iatrogenic damage in LCL. 3D models and DM can increase the reliability of preoperative plans in bones with complex 3D structures. Level of Evidence: Level III, retrospective comparative study.

Enhancing precision in osteochondral lesions of the talus measurements and improving agreement in surgical decision‐making using weight‐bearing computed tomography and distance mapping

“…The results demonstrated an excellent agreement across all measurements of the lesions. This reproducibility is attributed to computed-generated colour-coded landmarks that accurately represent the LB [12]. Establishing a reference point to define the 3D morphology of the lesion has the potential to enhance measurements and, theoretically, improve clinical and surgical decision-making [10,12].…”

“…An orthopaedic surgeon marked each bone in a designated maker point. The software then creates a 3D module, and the predetermined landmark is used to visually represent the bone axis, calculate angles semiautomatically and create a distance map of the tibiotalar joint (Figure 1) [9,12].…”

“…It assigns a spectrum of predetermined colours representing the distance between the articular surface. It creates a colour pattern that resembles a topographic map, where red represents the minimal distance and blue represents the maximal distance [12].…”