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CT may be a tool in planning osteochondral talar defect arthroscopy
Researchers found that anterior arthroscopy could access about 48% of the talar dome.
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COPENHAGEN, Denmark — The arthroscopic approach for osteochondral talar defects can be planned accurately preoperatively through computed tomography of the ankle in full plantar flexion, according to a recently presented study.
Christiaan J.A. van Bergen, MD, of the Netherlands, said that almost half of the talar dome could be accessed directly through anterior ankle arthroscopy. Van Bergen presented his team’s study results at the 12th EFORT Congress 2011.
Image assessments
Van Bergen and his group performed a prospective study of 59 CT scans from 57 patients. The CTs were taken with the patients’ affected ankle in full plantar flexion, using a specially developed metal-free 3-D footplate. The team used CT imagery and anterior ankle arthroscopy to measure the distance between the anterior border of the osteochondral talar defect and the anterior tibial plafond in the first 20 patients of the group who were treated by anterior ankle arthroscopy.
Van Bergen reported his team assessed intraobserver and interobserver reliability of CT — in addition to any similarities in findings between CT and arthroscopy — through intraclass correlation coefficients (ICCs), and a Bland and Altman graph. Anterior and posterior borders of the talar dome and anterior tibial plafond were marked on the 59 scans, and computers were used to assess accessible area by calculating the proportion of the talar dome that remained uncovered by the tibial plafond laterally and medially.
Access to the talus
Van Bergen said arthroscopy and CT measurements displayed excellent agreement, with one of the 20 patients displaying a difference of more than 2.0 mm and ICCs of more than 0.99.
He reported 47.8% of the lateral talar dome – and 48.2% of the medial talar dome – remained uncovered by the tibial plafond.
“The following recommendation can be made: When the anterior part of the part of the defect is located on the anterior half of the talar dome, anterior ankle arthroscopy can usually be performed,” van Bergen said. “In case of doubt, a CT of the ankle with full plantar flexion is advised.” – by Robert Press
Reference:
- Van Bergen, C, Tuijthof G, Blankevoort L, et al. Preoperative planning of arthroscopic access to the talus with computed tomography of the ankle in full plantar flexion. Paper#2616. Presented at the 12th EFORT Congress 2011. June 1-4. Copenhagen, Denmark.
- Christiaan J.A. van Bergen, MD, can be reached at Department of Orthopaedic Surgery, Orthopaedic Research Center Amsterdam, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands. 31 20 - 525 9111; email: c.j.vanbergen@amc.nl.
- Disclosure: Van Bergen has no relevant financial disclosures.