Quantitative Analysis of Subtalar Joint Motion With 4D CT: Proof of Concept With Cadaveric and Healthy Subject Evaluation

Teixeira, Pedro Augusto Gondim; Formery, Anne-Sophie; Jacquot, Adrien; Lux, Guillaume; Loiret, Isabelle; Perez, Manuela; Blum, Alain

doi:10.2214/ajr.16.16434

Cited by 25 publications

(15 citation statements)

References 19 publications

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“…To date, there is no literature relating to the assessment of the syndesmotic ligaments using novel CT technologies such as weight‐bearing cone beam CT of the lower extremity or 4D CT. Weight‐bearing cone beam CT could potentially be used for diagnosis of high grade injuries and may offer further dynamic information relating to the tibiofibular relationship that could potentially assist with management . 4D CT generates functional imaging of the joint and given its early promise in other articulations may have additional benefits in terms of being able to quantify the degree of instability in the syndesmosis …”

Section: Resultsmentioning

confidence: 99%

Diagnostic imaging of ankle syndesmosis injuries: A general review

et al. 2018

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Literature on the various techniques for imaging injuries to the ankle syndesmosis to determine the most appropriate imaging modality for diagnosing syndesmosis ligament disruption and instability was reviewed using the following data sources: Pubmed, Google scholar, SportsDiscus, E-journals and PLOSone. Search terms used were: syndesmosis paired with injury, imaging, radiology, X-ray, stress X-ray, arthrography, ultrasound, nuclear medicine scan, CT scan, MRI and arthroscopy. Articles were selected by reading abstracts and the full article if indicated. Further articles were derived from the references of the primary articles. Plain x-rays of the ankle will detect approximately half on AP view to two-thirds on mortise view of syndesmosis injuries. Syndesmosis injuries frequently occur in association with tibial or fibular fractures. Intra-operative stress radiography failed to detect approximately half of instabilities confirmed at arthroscopy. The current benchmark imaging techniques to diagnose syndesmosis injury and diastasis are arthroscopy and high-power (3T) MRI. Ultrasound is a promising, developing, cost-effective imaging technique which is yet to reach its full diagnostic potential. CT and nuclear medicine scans have limited roles. MRI (3T) scanning in the plane of the syndesmotic ligaments is the investigation of choice to detect ankle syndesmosis injuries. In the presence of associated injuries requiring surgery, arthroscopic viewing with stress examination is the diagnostic benchmark when available.

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Section: Resultsmentioning

confidence: 99%

Diagnostic imaging of ankle syndesmosis injuries: A general review

et al. 2018

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“…The dynamic evaluation of joint kinematics makes it possible to evaluate motion trajectory and patterns, and therefore could lead to identifying pathologies which may occur only during motion. The potential feasibility of 4DCT for such purposes is already shown in several studies 8–10 . Studies attempting to simulate pathological conditions showed that 4DCT may be able to detect altered joint kinematics.…”

Section: Introductionmentioning

confidence: 83%

“…Studies attempting to simulate pathological conditions showed that 4DCT may be able to detect altered joint kinematics. Simulation of subtalar joint instability by means of subsequent sectioning of the cervical ligament and the interosseous talocalcaneal ligament showed increases in joint motion amplitude 8 . In a similar study where the scapholunate ligament was cut to mimic scapholunate instability, orthopaedic surgeons could discern images before and after induced ligamentous damage.…”

Section: Introductionmentioning

confidence: 98%

Four-dimensional CT as a valid approach to detect and quantify kinematic changes after selective ankle ligament sectioning

Buzzatti

Keelson

Apperloo

et al. 2019

Sci Rep

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The objective of the current study was to explore the potential of dynamic computed tomography to detect kinematic changes, induced by sequential sectioning of the lateral collateral ligaments of the ankle, during full motion sequence of the talocrural joint. A custom-made device was used to induce cyclic controlled ankle inversion movement in one fresh frozen cadaver leg. A 256-slice CT scanner was used to investigate four different scenarios. Scenario 1 with all ligaments intact was first investigated followed by sequential section of the anterior talo-fibular ligament (Scenario 2), the calcaneo-fibular ligament (Scenario 3) and posterior talo-fibular ligament (Scenario 4). Off-line image processing based on semi-automatic segmentation and bone rigid registration was performed. Motion parameters such as translation, rotational angles and orientation and position of the axis of rotation were calculated. Differences between scenarios were calculated. Progressive increase of cranio-caudal displacement up to 3.9 mm and flexion up to 10° compared to Scenario 1 were reported. Progressive changes in orientation (up to 20.6°) and position (up to 4.1 mm) of the axis of rotation were also shown. Estimated effective dose of 0.005 mSv (1.9 mGy CTDIvol) was reported. This study demonstrated that kinematic changes due to the absence of ligament integrity can be detected with 4DCT with minimal radiation exposure. Identifying abnormal kinematic patterns could have future application in helping clinicians to choose patients’ optimal treatment. Therefore, further studies with bigger in vitro sample sizes and consequent investigations in vivo are recommended to confirm the current findings.

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“…Coronal tomosynthesis stress imaging provides clearer visualization of the subtalar joint compared with other cross-sectional imaging, such as CT or MRI, with lower dose of exposure to radiation and shorter examination time than those of CT. 172 Quantitative dynamic CT provides a detailed analysis of subtalar motion and can assist in the evaluation of subtalar instability. 53 …”

Section: Diagnosis Of Subtalar Instabilitymentioning

confidence: 99%

Current Concepts on Subtalar Instability

Pereira

Andrade

Espregueira-Mendes

et al. 2021

Orthopaedic Journal of Sports Medicine

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Subtalar instability remains a topic of debate, and its precise cause is still unknown. The mechanism of injury and clinical symptoms of ankle and subtalar instabilities largely overlap, resulting in many cases of isolated or combined subtalar instability that are often misdiagnosed. Neglecting the subtalar instability may lead to failure of conservative or surgical treatment and result in chronic ankle instability. Understanding the accurate anatomy and biomechanics of the subtalar joint, their interplay, and the contributions of the different subtalar soft tissue structures is fundamental to correctly diagnose and manage subtalar instability. An accurate diagnosis is crucial to correctly identify those patients with instability who may require conservative or surgical treatment. Many different nonsurgical and surgical approaches have been proposed to manage combined or isolated subtalar instability, and the clinician should be aware of available treatment options to make an informed decision. In this current concepts narrative review, we provide a comprehensive overview of the current knowledge on the anatomy, biomechanics, clinical and imaging diagnosis, nonsurgical and surgical treatment options, and outcomes after subtalar instability treatment.

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Quantitative Analysis of Subtalar Joint Motion With 4D CT: Proof of Concept With Cadaveric and Healthy Subject Evaluation

Abstract: Quantitative dynamic CT of the subtalar joint can provide a detailed analysis of joint motion, supporting its potential role in the evaluation of subtalar instability.

Cited by 25 publications

References 19 publications

Diagnostic imaging of ankle syndesmosis injuries: A general review

Diagnostic imaging of ankle syndesmosis injuries: A general review

Four-dimensional CT as a valid approach to detect and quantify kinematic changes after selective ankle ligament sectioning

Current Concepts on Subtalar Instability

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