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CT may be a potential tool in planning arthroscopy for osteochondral talar defects
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COPENHAGEN — 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 presentation at the 12th EFORT Congress 2011 held here.
Christiaan van Bergen, MD, said that almost half of the talar dome could be accessed directly through anterior ankle arthroscopy.
Van Bergen and his group performed a prospective study of CT scans from 46 consecutive patients. For the CTs, patients had their affected ankle in full plantar flexion. 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 of the 46 patients.
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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 co-efficients, and a Bland and Altman graph. Anterior and posterior borders of the talar dome and anterior tibial plafond were marked on the 46 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.
Van Bergen said arthroscopy and CT measurements displayed excellent agreement, with one of the 46 patients displaying a difference of more than 2.0 mm.
Van Bergen reported 47.3% of the lateral talar dome – and 47.7% 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.”
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.