Bilateral Symmetry, Sex Differences, and Primary Shape Factors in Ankle and Hindfoot Bone Morphology

Gabrielli, Alexandra S.; Gale, Tom; Hogan, MaCalus V.; Anderst, William

doi:10.1177/2473011420908796

Cited by 14 publications

(9 citation statements)

References 28 publications

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“…the variety was such that not even a standardized 10 cm above the ankle joint cut-off could be attempted (Gabrielli et al, 2020). Incorporating muscle and ligament modeling would allow for an in-depth analysis of the association of isolated spring ligament tears, degeneration of the deltoid ligament, and posterior tibial tendon dysfunctions to certain shape variations (Bastias et al, 2018;Lin et al, 2015;Ling & Lui, 2017;Masaragian et al, 2020).…”

Section: Discussionmentioning

confidence: 99%

“…Nine PC modes were extracted for each joint along with each individual subject's weighted shape parameter for each PC, indicating how far a subject's geometry is from the average for a specific PC (Figure 1). Nine PC modes were selected as later modes can refer to noise and too subtle changes to notice (Gabrielli et al, 2020; Tümer, Vuurberg, et al, 2019). These principal components are referred to further as modes of variation to better visualize the shape changes.…”

Section: Methodsmentioning

confidence: 99%

“…SSMs have emerged over the past 5 years to analyze the anklefoot complex. Initial studies focused on defining and refining SSM methods for the bones of the feet (Grant et al, 2020;Melinska et al, 2015Melinska et al, , 2017, before comparative studies reported differences between genders and ethnicities in tibia, calcaneus, and talus geometry (Gabrielli et al, 2020;Nelson et al, 2017;Tümer, Arbabi, et al, 2019). Normal population reference values for the talocrural and subtalar joints were defined by comparing ±2SD of the normal shape variation for the talus, calcaneus, tibia, and fibula bones (Krähenbühl et al, 2020;Lenz et al, 2021).…”

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Unique shape variations of hind and midfoot bones in flatfoot subjects—A statistical shape modeling approach

et al. 2022

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Flatfoot deformity is a prevalent hind‐ and midfoot disorder. Given its complexity, single‐plane radiological measurements omit case‐specific joint interaction and bone shape variations. Three‐dimensional medical imaging assessment using statistical shape models provides a complete approach in characterizing bone shape variations unique to flatfoot condition. This study used statistical shape models to define specific bone shape variations of the subtalar, talonavicular, and calcaneocuboid joints that characterize flatfoot deformity, that differentiate them from healthy controls. Bones of the aforementioned joints were segmented from computed tomography scans of 40 feet. The three‐dimensional hindfoot alignment angle categorized the population into 18 flatfoot subjects (≥7° valgus) and 22 controls. Statistical shape models for each joint were defined using the entire study cohort. For each joint, an average weighted shape parameter was calculated for each mode of variation, and then compared between flatfoot and controls. Significance was set at p < 0.05, with values between 0.05 ≤ p < 0.1 considered trending towards significance. The flatfoot population showed a more adducted talar head, inferiorly inclined talar neck, and posteriorly orientated medial subtalar articulation compare to controls, coupled with more navicular eversion, shallower navicular cup, and more prominent navicular tuberosity. The calcaneocuboid joint presented trends of a more adducted calcaneus, more abducted cuboid, narrower calcaneal roof, and less prominent cuboid beak compared to controls. Statistical shape model analysis identified unique shape variations which may enhance understanding and computer‐aided models of the intricacies of flatfoot, leading to better diagnosis and, ultimately, surgical treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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Unique shape variations of hind and midfoot bones in flatfoot subjects—A statistical shape modeling approach

et al. 2022

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“…Three-dimensional bone models were made from segmented bone tissue 36 . Anatomic coordinate systems were created for each bone in the right foot with use of an automated algorithm and were mirrored to the left side after co-registering each corresponding bone 37,38 (Fig. 3-D).…”

Section: Methodsmentioning

confidence: 99%

Syndesmosis Repair Affects in Vivo Distal Interosseous Tibiofibular Ligament Elongation Under Static Loads and During Dynamic Activities

Canton

Gale

Onyeukwu

et al. 2021

Journal of Bone and Joint Surgery

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Background:Ligamentous ankle injuries are the most common injuries sustained by athletes and by the general population, with an incidence of approximately 2 million per year in the U.S. Injuries to the ankle syndesmosis (i.e., “high ankle sprains”) are generally treated operatively. Although cadaveric studies can evaluate syndesmosis fixation strength, they cannot predict how healing, neuromuscular adaptation, or dynamic loading will affect in vivo biomechanics. Using dynamic biplane radiography (DBR), we tested the hypothesis that syndesmosis repair would restore ankle kinematics and ligament elongation during static and dynamic loading.Methods:A convenience sample of 6 male patients who had undergone fixation (2 screw, 3 suspensory, 1 hybrid) of syndesmosis injury were assessed with use of DBR during forward running, backpedaling, a 45° angled single-leg hop, and 1 static standing trial at 2 to 4.5 years postoperatively. Three-dimensional ankle kinematics and elongation of the distal interosseous ligament, anterior inferior tibiofibular ligament, and the posterior inferior tibiofibular ligament were measured bilaterally. Comparisons were made between the operative and uninjured sides. Clinical outcomes were evaluated with use of the Foot and Ankle Ability Measure.Results:Static load increased the lengths of the distal interosseous ligament (p = 0.02 to 0.05) and middle segment of the anterior inferior tibiofibular ligament (p = 0.02) in the operative ankle. The distal syndesmosis length was greater on the operative side during the static unloaded and loaded conditions (p = 0.02). Length of the distal syndesmosis on the operative side was greater than the corresponding healthy syndesmosis length during all 3 dynamic activities. On average, the operative ankle was in less dorsiflexion over the support phase of the angled hop (p = 0.05) and running (p < 0.01). The average Foot and Ankle Ability Measure Activities of Daily Living and Sports subscale scores were 95 and 88, respectively.Conclusions:This study provides the first in vivo evidence of post-fixation changes in biomechanics after syndesmosis repair. Syndesmosis repair fails to restore healthy static and dynamic distal tibiofibular anatomy, even in patients who report good to excellent clinical outcomes.Level of Evidence:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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“…Using SSM, a statistical model can be created to compare mean bone shape morphology and identify anatomical modes of variation. Previous ankle SSM studies have been limited to a single bone and could not, therefore, evaluate multi-domain joint relationships ( Melinska et al, 2015 ; Melinska et al, 2017 ; Tümer et al, 2019a ; Tümer et al, 2019b ; Gabrielli et al, 2020 ; Krähenbühl et al, 2020 ; Liu et al, 2020 ; Schmutz et al, 2021 ; Arbabi et al, 2022 ; Peiffer et al, 2022 ; Vafaeian et al, 2022 ). A multi-domain technique can be implemented to capture morphological and alignment changes for multiple bones throughout a population.…”

Section: Introductionmentioning

confidence: 99%

Multi-level multi-domain statistical shape model of the subtalar, talonavicular, and calcaneocuboid joints

Peterson

Lisonbee²,

Krähenbühl³

et al. 2022

Front. Bioeng. Biotechnol.

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Traditionally, two-dimensional conventional radiographs have been the primary tool to measure the complex morphology of the foot and ankle. However, the subtalar, talonavicular, and calcaneocuboid joints are challenging to assess due to their bone morphology and locations within the ankle. Weightbearing computed tomography is a novel high-resolution volumetric imaging mechanism that allows detailed generation of 3D bone reconstructions. This study aimed to develop a multi-domain statistical shape model to assess morphologic and alignment variation of the subtalar, talonavicular, and calcaneocuboid joints across an asymptomatic population and calculate 3D joint measurements in a consistent weightbearing position. Specific joint measurements included joint space distance, congruence, and coverage. Noteworthy anatomical variation predominantly included the talus and calcaneus, specifically an inverse relationship regarding talar dome heightening and calcaneal shortening. While there was minimal navicular and cuboid shape variation, there were alignment variations within these joints; the most notable is the rotational aspect about the anterior-posterior axis. This study also found that multi-domain modeling may be able to predict joint space distance measurements within a population. Additionally, variation across a population of these four bones may be driven far more by morphology than by alignment variation based on all three joint measurements. These data are beneficial in furthering our understanding of joint-level morphology and alignment variants to guide advancements in ankle joint pathological care and operative treatments.

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Bilateral Symmetry, Sex Differences, and Primary Shape Factors in Ankle and Hindfoot Bone Morphology

Cited by 14 publications

References 28 publications

Unique shape variations of hind and midfoot bones in flatfoot subjects—A statistical shape modeling approach

Unique shape variations of hind and midfoot bones in flatfoot subjects—A statistical shape modeling approach

Syndesmosis Repair Affects in Vivo Distal Interosseous Tibiofibular Ligament Elongation Under Static Loads and During Dynamic Activities

Multi-level multi-domain statistical shape model of the subtalar, talonavicular, and calcaneocuboid joints

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