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Enhancing precision in osteochondral lesions of the talus measurements and improving agreement in surgical decision-making using weight-bearing computed tomography and distance mapping

Ben Efrima

Corresponding Author

Ben Efrima

Orthopedic Department, Tel Aviv Medical Center, Tel Aviv, Israel

Correspondence Ben Efrima, Orthopedic Department, Tel Aviv Medical Center, Waitzman 6, Tel Aviv, Israel.

Email: [email protected]

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Jari Dahmen

Jari Dahmen

Department of Orthopedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands

Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands

Amsterdam Collaboration for Health & Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands

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Agustin Barbero

Agustin Barbero

Ankle and Foot Unit, Humanitas San Pio X Hospital, Milan, Italy

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Amit Benady

Amit Benady

Orthopedic Department, Tel Aviv Medical Center, Tel Aviv, Israel

Levin Center of Surgical Innovation and 3D Printing, Tel Aviv Medical Center, Tel Aviv, Israel

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Camilla Maccario

Camilla Maccario

Ankle and Foot Unit, Humanitas San Pio X Hospital, Milan, Italy

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Cristian Indino

Cristian Indino

Ankle and Foot Unit, Humanitas San Pio X Hospital, Milan, Italy

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Gino Kerkhoffs

Gino Kerkhoffs

Department of Orthopedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands

Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands

Amsterdam Collaboration for Health & Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands

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Federico Giuseppe Usuelli

Federico Giuseppe Usuelli

Ankle and Foot Unit, Humanitas San Pio X Hospital, Milan, Italy

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First published: 09 April 2024

This study was performed at Humanitas San Pio X Hospital, Milan, Italy.

Abstract

Purpose

Weight-bearing computed tomography (WBCT) enables the creation of a three-dimensional (3D) model that represents the ankle morphology in a standing position. Distance mapping (DM) is a complementary feature that uses color coding to represent the relative intraarticular distance and can be used to outline intraarticular defects. Consequently, DM offers a novel approach to delineating osteochondral lesions of the talus (OLT), allowing for the quantification of its surface, volume and depth. The reliability of DM for OLT measurements has yet to be thoroughly evaluated. This study primarily aims to determine the reliability of DM in measuring the surface, depth and volume of OLT. A secondary objective is to ascertain whether measurements obtained through DM, when integrated with a predefined treatment algorithm, can facilitate consensus among surgeons regarding the optimal surgical intervention.

Methods

This cohort comprised 36 patients with 40 OLTs evaluated using WBCT and DM. Two raters used DM to determine the lesion boundary (LB) and lesion fundus (LF) and calculate the lesion depth, surface and volume. The raters were asked to choose between bone marrow stimulation, autologous matrix-induced chondrogenesis and osteochondral transposition based on the measurement. Inter-rater and intra-rater agreement was measured.

Results

Interclass correlation of the lesion's depth surface produced an excellent inter-rater and intra-rater agreement of 0.90–0.94 p < 0.001. Cohen's κ agreement analysis of the preferable preoperative plan produced a κ = 0.834, p < 0.001, indicating a near-perfect agreement.

Conclusion

WBCT-based 3D modules and DM can be used to measure the lesion's surface, depth and volume with excellent inter-rater and inter-rater agreement; using this measurement and a predetermined treatment algorithm, a near-perfect inter-rater agreement for the preoperative planning was reached. WBCT in conjunction with AI capabilities could help determine the type of surgery needed preoperatively, evaluate the hindfoot alignment and assess if additional surgeries are needed.

Level of Evidence

Level III.

CONFLICT OF INTEREST STATEMENT

Federico G. Usuelli reports relationship with Zimmer Biomet that includes: consulting or advisory and speaking and lecture fees; relationship with Arthrex Inc. that includes: consulting or advisory and speaking and lecture fees; relationship with Episurf that includes: consulting or advisory and speaking and lecture fees; relationship with Planmed Oy that includes: consulting or advisory and speaking and lecture fees; relationship with Geistlich Pharma AG that includes: consulting or advisory and speaking and lecture fees; relationship with BRM Trust that includes: consulting or advisory and speaking and lecture fees; relationship with Paragon 28 Inc that includes: consulting or advisory, employment, paid expert testimony and speaking and lecture fees; membership: International Editor Foot and Ankle International. The remaining authors declare no conflict of interest.

DATA AVAILABILITY STATEMENT

Data supporting this study are not publicly available due to patient confidentiality. Please contact our research group at [email protected] for more information.