Utility of Volumetric Measurement via Weight-Bearing Computed Tomography Scan to Diagnose Syndesmotic Instability

Bhimani, Rohan; Ashkani-Esfahani, Soheil; Lubberts, Bart; Guss, Daniel; Hagemeijer, Noortje; Waryasz, Gregory R.; DiGiovanni, Christopher W.

doi:10.1177/1071100720917682

Cited by 54 publications

(71 citation statements)

References 18 publications

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“…Bridging many of these concerns, WBCT allows crosssectional visualization of the Lisfranc region under physiologic load while affording a comparison to the uninjured side as an internal control. 7,22 The latter is critical given the variable anatomy of the Lisfranc joint across individuals. 13 The current study highlights the utility of WBCT 1D, 2D, and 3D measurements to evaluate Lisfranc instability.…”

Section: Discussionmentioning

confidence: 99%

“…It not only visualizes the Lisfranc joint complex while under physiological load, but also affords a direct comparison between the injured and uninjured sides. 6,7 Moreover, this newer technology comes with additional software capabilities that enable multidimensional analytic assessments heretofore unutilized. The primary aim of this study was thus to evaluate the ability of bilateral foot WBCT to diagnose Lisfranc instability utilizing one-dimensional (1D), two-dimensional (2D) and three-dimensional (3D) measurement amongst patients with operatively-confirmed Lisfranc instability, while using their contralateral, uninjured sides as internal controls.…”

Section: Introductionmentioning

confidence: 99%

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Using area and volume measurement via weightbearing CT to detect Lisfranc instability

Bhimani

Sornsakrin

Ashkani-Esfahani

et al. 2021

Journal Orthopaedic Research

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Weightbearing CT (WBCT) allows evaluation of the Lisfranc joint under physiologic load. We compared the diagnostic sensitivities of one-dimensional (1D) distance, two-dimensional (2D) area, and three-dimensional (3D) volumetric measurement of the injured Lisfranc joint complex (tarsometatarsal, intertarsal, and intermetatarsal) on WBCT among patients with surgically-confirmed Lisfranc instability. The experimental group comprised of 14 patients having unilateral Lisfranc instability requiring operative fixation who underwent preoperative bilateral foot and ankle WBCT. The control group included 36 patients without foot injury who underwent similar imaging. Measurements performed on WBCT images included: (1) Lisfranc joint (medial cuneiform-base of second metatarsal) area, (2) C1-C2 intercuneiform area, (3) C1-M2 distance, (4) C1-C2 distance, (5) M1-M2 distance, (6) first tarsometatarsal (TMT1) angular alignment, (7) second tarsometatarsal (TMT2) angular alignment, (8) TMT1 dorsal step off distance, and (9) TMT2 dorsal step-off distance.In addition, the volume of the Lisfranc joint in the coronal and axial plane were calculated. Among patients with unilateral Lisfranc instability, all WBCT measurements were increased on the injured side as compared to the contralateral uninjured side (p values: <.001-.008). Volumetric measurements in the coronal and axial plane had a higher sensitivity (92.3%; 91.6%, respectively) and specificity (97.7%; 96.5%, respectively) than 2D and 1D Lisfranc joint measurements, suggesting them to be the most accurate in diagnosing Lisfranc instability. The control group showed no difference in any of the measurements between the two sides. WBCT scan can effectively differentiate between stable and unstable Lisfranc injuries. Lisfranc joint volume measurements demonstrate high sensitivity and specificity, suggesting that this new assessment has high clinical implications for diagnosing subtle Lisfranc instability.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Using area and volume measurement via weightbearing CT to detect Lisfranc instability

Bhimani

Sornsakrin

Ashkani-Esfahani

et al. 2021

Journal Orthopaedic Research

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“…WBCT has recently become an important diagnostic imaging tool to evaluate not only the severity of PCFD 10,11,[14][15][16]18,19 but also the widening and instability of DTFS injuries. 7,28,[33][34][35]43,49 The FAO was proposed by Lintz et al 38 as a 3D semiautomatic tool for a multiplanar assessment of foot deformity. The measurement consists of harvesting multiplanar coordinates of the weightbearing points of the first and fifth metatarsal heads, calcaneal tuberosity, and most central and proximal aspect of the talar dome.…”

Section: Discussionmentioning

confidence: 99%

Distal Tibiofibular Syndesmotic Widening in Progressive Collapsing Foot Deformity

et al. 2021

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Background: Lateral overload in progressive collapsing foot deformity (PCFD) takes place as hindfoot valgus, peritalar subluxation, and valgus instability of the ankle increase. Fibular strain due to chronic lateral impingement may lead to distraction forces over the distal tibiofibular syndesmosis (DTFS). This study aimed to assess and correlate the severity of the foot and ankle offset (FAO) as a marker of progressive PCFD with the amount of DTFS widening and to compare it to controls. Methods: In this case-control study, 62 symptomatic patients with PCFD and 29 controls who underwent standing weightbearing computed tomography (WBCT) examination were included. Two fellowship-trained blinded orthopedic foot and ankle surgeons performed FAO (%) and DTFS area measurements (mm2). DTFS was assessed semiautomatically on axial-plane WBCT images, 1 cm proximal to the apex of the tibial plafond. Values were compared between patients with PCFD and controls, and Spearman correlation between FAO and DTFS area measurements was assessed. P values of less than .05 were considered significant. Results: Patients with PCFD demonstrated significantly increased FAO and DTFS measurements in comparison to controls. A mean difference of 6.9% ( P < .001) in FAO and 10.4 mm2 ( P = .026) in DTFS was observed. A significant but weak correlation was identified between the variables, with a Þ of 0.22 ( P = .03). A partition predictive model demonstrated that DTFS area measurements were highest when FAO values were between 7% and 9.3%, with mean (SD) values of 92.7 (22.4) mm2. Conclusion: To our knowledge, this was the first study to assess syndesmotic widening in patients with PCFD. We found patients with PCFD to demonstrate increased DTFS area measurements compared to controls, with a mean difference of approximately 10 mm2. A significantly weak positive correlation was found between FAO and DTFS area measurements, with the highest syndesmotic widening occurring when FAO values were between 7% and 9.3%. Our study findings suggest that chronic lateral impingement in patients with PCFD can result in a negative biomechanical impact on syndesmotic alignment, with increased DTFS stress and subsequent widening. Level of Evidence: Level III, retrospective comparative study.

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“…Therefore, noninvasive, dynamic studies such as weightbearing computed tomography or point-of-care dynamic ultrasound may overcome some of these challenges. 1,7 Additional studies are necessary to better delineate their role. Lastly, the use of arthroscopy is likely quite accurate, but the use of image analysis calibrated to a probe with a carefully applied standard force is not directly applicable in the operating room.…”

Section: Discussionmentioning

confidence: 99%

Do Coronal or Sagittal Plane Measurements Have the Highest Accuracy to Arthroscopically Diagnose Syndesmotic Instability?

et al. 2021

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Background: To compare the accuracy of arthroscopic sagittal versus coronal plane distal tibiofibular motion toward diagnosing syndesmotic instability. Methods: Arthroscopic assessment of the syndesmosis was performed on 21 above-knee cadaveric specimens, first with all ligaments intact and subsequently with sequential transection of the anterior inferior tibiofibular ligament, the interosseous ligament, the posterior inferior tibiofibular ligament, and the deltoid ligament. A lateral hook test, an anterior-to-posterior (AP) translation test, and a posterior-to-anterior (PA) translation test were performed under 100 N of applied force. Anterior and posterior third coronal plane diastasis and AP and PA sagittal plane fibular translations were measured relative to the static tibia. Results: Receiver operating characteristic (ROC) curve analysis revealed that the area under the curve (AUC) was higher for the combined AP and PA sagittal measurements (AUC, 0.91; accuracy, 83.5%; sensitivity, 78%; specificity, 89%) than the coronal plane measurements (anterior third: AUC, 0.65; accuracy, 60.5%; sensitivity, 63%; specificity, 59%; posterior third: AUC, 0.73; accuracy, 68.5%; sensitivity, 80%; specificity, 57%) ( P < .001), underscoring the higher accuracy of sagittal plane measurements. Conclusion: Arthroscopic measurement of sagittal plane fibular translation is more accurate than coronal plane diastasis for evaluating syndesmotic instability. Clinical Relevance: Clinicians should focus on distal tibiofibular motion in the sagittal plane when arthroscopically evaluating suspected syndesmotic instability. Level of Evidence: Biomechanical cadaveric study.

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Utility of Volumetric Measurement via Weight-Bearing Computed Tomography Scan to Diagnose Syndesmotic Instability

Cited by 54 publications

References 18 publications

Using area and volume measurement via weightbearing CT to detect Lisfranc instability

Using area and volume measurement via weightbearing CT to detect Lisfranc instability

Distal Tibiofibular Syndesmotic Widening in Progressive Collapsing Foot Deformity

Do Coronal or Sagittal Plane Measurements Have the Highest Accuracy to Arthroscopically Diagnose Syndesmotic Instability?

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