Bone Mineralization Changes in the Subchondral Bone of the Medial Gutter in Chronic Lateral Ankle Instability

Nakasa, Tomoyuki; Ikuta, Yasunari; Ota, Yuki; Kanemitsu, Munekazu; Sumii, Junichi; Nekomoto, Akinori; Adachi, Nobuo

doi:10.1177/1071100720938049

Cited by 18 publications

(8 citation statements)

References 39 publications

(41 reference statements)

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“…showed that ankles with repetitive ankle sprains exhibited greater internal rotation of the talus from heel contact to 60% of the stance phase [25]. Our previous report showed higher HU values at the medial gutter in patients with CLAI than in those without CLAI [9]. The stress distribution on the medial gutter due to internal rotation, in addition to the increasing inversion angle of the talus, may lead to a varus type OA.…”

Section: Discussionmentioning

confidence: 86%

“…The HU is defined based on a scale created by the linear transformation of the original linear attenuation coefficient measurement into one where the radiodensity of distilled water at standard temperature and pressure is set at 0 and that of air at − 1000 [5,6]. Using this technique, small changes in the subchondral bone can be detected, and several studies have reported the usefulness of this technique for evaluation stress distributions in several joints [7][8][9][10]. The measurement of the HU unit on CT images enables us to understand the stress distribution pattern in talocrural and subtalar joints in patients with CLAI.…”

Section: Introductionmentioning

confidence: 99%

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High-stress distribution in the lateral region of the subtalar joint in the patient with chronic lateral ankle instability

Nakasa

Ikuta

Sumii

et al. 2021

Arch Orthop Trauma Surg

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Purpose Chronic lateral ankle instability (CLAI) is associated with osteoarthritis (OA). However, the characteristics of patients with CLAI who progress to OA are not clear. Measurement of Hounsfield Unit (HU) value on computed tomography (CT) is reported to be useful to evaluate the stress distribution. We aimed to evaluate the stress distribution in the ankle and subtalar joints and factors enhancing it in patients with CLAI. Materials and methods Thirty-three ankles with CLAI (CLAI group) and 26 ankles without CLAI (control group) were included. A mean age of CLAI was 35.2 years and control was 30.3 years. Color map was created in the ankle and subtalar joint according to the HU values using three-dimensional CT to identify the region with high HU values, and HU values in those regions were measured using two-dimensional CT and compared between control and CLAI groups. In CLAI group, the relationships between HU values and ankle activity score (AAS), OA, talar tilting angle (TTA), cartilage injury were assessed. ResultsThe HU values in the anteromedial region of the talus and lateral region in the subtalar joint were higher than those in the control. In CLAI, patients with an AAS of ≧ 6, over 10° of TTA, cartilage injury, and OA changes in the medial gutter had significantly higher HU values in the lateral region of the subtalar joint than those with an AAS of ≦5, less than 10° of TTA without cartilage injury and OA change. Conclusions CLAI patients, especially in the patients with high activity level, large TTA, cartilage injury, and OA changes at the medial gutter, have high HU values in the lateral region of the subtalar joint, which suggests that disruption of the subtalar compensation toward OA will occur. For these patients, instability should be completely eliminated to prevent ankle OA. Level of evidence Level III, comparative series.

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Section: Discussionmentioning

confidence: 86%

Section: Introductionmentioning

confidence: 99%

High-stress distribution in the lateral region of the subtalar joint in the patient with chronic lateral ankle instability

Nakasa

Ikuta

Sumii

et al. 2021

Arch Orthop Trauma Surg

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“…The CT images of the ankle joint can aid in the evaluation of articular cartilage injury and bone mineralization changes in the subchondral bone. 24,25 Therefore, in addition to the conventional imaging examination such as stress radiograph and MRI, degeneration of the deltoid ligament should be evaluated on CT images to utilize HU measurements for the diagnosis of RAI in CAI patients. Further studies with larger sample sizes should be required to determine the cut-off value of HU measurements in deltoid ligament degradation for diagnosis of RAI.…”

Section: Discussionmentioning

confidence: 99%

“…Low HU values of the dPTL might indicate a perceived risk of developing OA because CAI patients with initial OA changes presented low HU values of the dPTL compared to CAI patients without radiographic early OA changes, regardless of whether their MRI findings of dPTL injury were negative or positive. The CT images of the ankle joint can aid in the evaluation of articular cartilage injury and bone mineralization changes in the subchondral bone 24,25. Therefore, in addition to the conventional imaging examination such as stress radiograph and MRI, degeneration of the deltoid ligament should be evaluated on CT images to utilize HU measurements for the diagnosis of RAI in CAI patients.…”

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confidence: 99%

Quantitative Analysis of Deltoid Ligament Degradation in Patients With Chronic Ankle Instability Using Computed Tomographic Images

et al. 2021

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Background: Rotational ankle instability (RAI) is associated with the faster onset of severe ankle osteoarthritis via dysfunction of the anterior talofibular ligament, calcaneofibular ligament, and deltoid ligament. No specific clinical examination is available for RAI, and diagnostic imaging has limitations in evaluating ligament degradation. This study investigated the deltoid ligament degeneration using Hounsfield unit (HU) values on computed tomography (CT) images. Methods: Patients were enrolled in this retrospective analysis if they had undergone magnetic resonance imaging (MRI) and CT scans of the ankle. The chronic ankle instability (CAI) group comprised 20 ankles with CAI (9 men, 11 women; mean age, 28.7 years) and the control group comprised 28 ankles (16 men, 12 women, mean age, 41.3 years). The average HU values of the deep posterior tibiotalar ligament (dPTL) that constitutes the deltoid ligament were measured on coronal CT images, and MRI results were used as a reference. All patients were subdivided based on the MRI findings of dPTL injury such as fascicular disruption, irregularity, and the loss of striation. Results: A strong negative correlation was identified between age and HU values for all patients (Spearman ρ = −0.63; P < .001). The mean HU values of the dPTL for participants aged <60 years were 81.0 HU for the control group (21 ankles) and 69.5 HU for the CAI group ( P = .0075). No significant differences in the HU values were observed for the dPTL among the MRI subgroups. Conclusion: In addition to the conventional imaging examination such as stress radiographs and MRI, HU measurements of CT images could be useful for quantitatively and noninvasively evaluating degenerative changes in the deltoid ligament for CAI patients to assist the diagnosis of RAI. Level of Evidence: Level III. case-control study.

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“…HU values are standardized linear attenuation coefficients for tissue [ 13 ]. Studies have reported the use of HU measurements to determine the subchondral bone density, in which specific stress distributional patterns of the medial gutter in the talocrural joint and the lateral aspect of the subtalar joints were studied in patients with chronic lateral ankle instability [ 14 , 15 ]. Previous studies on bone density analysis have revealed that the distal-dorsolateral area is the densest portion of the medial cuneiform [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

Distributional patterns of subchondral bone density and histopathological features of the first tarsometatarsal joint in hallux valgus feet

Ikuta

Nakasa

Sumii

et al. 2022

BMC Musculoskelet Disord

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Background Hypermobility of the first tarsometatarsal (TMT) joint is frequently identified in patients with hallux valgus (HV); however, its association with the development of osteoarthritis in the first TMT joint in such patients remains unknown. The purpose of this study was to clarify the distribution of subchondral bone density of the first TMT joint via computed tomography (CT) using Hounsfield units (HU). Methods Patients were divided into three groups: the osteotomy (20 feet; 20 women, mean age: 61.8 years), arthrodesis (23 feet; two men, 21 women, 71.2 years), and control group (patients without HV deformity who had undergone CT scans of the foot; 13 feet; seven men, six women, 29.7 years). The HU ratios were calculated, which were defined as the HU value of each subdivision of the subarticular spongiosa of the first TMT joint [dorsomedial (DM), dorsolateral (DL), plantomedial (PM), and plantolateral (PL)] divided by the HU values of the entire joint surface. The ratios for the osteotomy, arthrodesis, and control groups were compared. The degradation of the articular cartilage in the first TMT joint was histologically graded in the arthrodesis group. Tukey–Kramer multiple comparison analysis was conducted to compare the HU ratios among the three groups, and the histological grade in each subdivision. Results The arthrodesis group demonstrated high HU ratios in the DM area of the medial cuneiform, and significantly lower HU ratios in the PL area of the first metatarsal. Lower HU ratios in the DL area were observed in both the osteotomy and the arthrodesis group when compared to that in the medial cuneiform of the control group. The histological evaluation indicated nearly normal articular cartilage for all subdivided areas in both the medial cuneiform and the first metatarsal in patients with severe HV. Conclusions Although high subchondral bone density was identified in the DM area of the medial cuneiform in severe HV, only mild degradation was histologically observed in the articular cartilage of the first TMT joint. Our findings suggest that the indications for arthrodesis of the first TMT should be reconsidered based on the severity of the degenerative changes in the first TMT joint.

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Bone Mineralization Changes in the Subchondral Bone of the Medial Gutter in Chronic Lateral Ankle Instability

Cited by 18 publications

References 39 publications

High-stress distribution in the lateral region of the subtalar joint in the patient with chronic lateral ankle instability

High-stress distribution in the lateral region of the subtalar joint in the patient with chronic lateral ankle instability

Quantitative Analysis of Deltoid Ligament Degradation in Patients With Chronic Ankle Instability Using Computed Tomographic Images

Distributional patterns of subchondral bone density and histopathological features of the first tarsometatarsal joint in hallux valgus feet

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