Compressed Lateral and anteroposterior Anatomical Systematic Sequences «CLASS»: compressed MRI sequences with assessed anatomical femoral and tibial ACL's footprints, a feasibility study

Abstract Purpose This study's main objective is to assess the feasibility of processing the MRI information with identified ACL-footprints into 2D-images similar to a conventional anteroposterior and lateral X-Ray image of the knee. The secondary aim is to conduct specific measurements to assess the reliability and reproducibility. This study is a proof of concept of this technique. Methods Five anonymised MRIs of a right knee were analysed. A orthopaedic knee surgeon performed the footprints identification. An ad-hoc software allowed a volumetric 3D image projection on a 2D anteroposterior and lateral view. The previously defined anatomical femoral and tibial footprints were precisely identified on these views. Several parameters were measured (e.g. coronal and sagittal ratio of tibial footprint, sagittal ratio of femoral footprint, femoral intercondylar notch roof angle, proximal tibial slope and others). The intraclass correlation coefficient (ICCs), including 95% confidence intervals (CIs), has been calculated to assess intraobserver reproducibility and interobserver reliability. Results Five MRI scans of a right knee have been assessed (three females, two males, mean age of 30.8 years old). Five 2D-"CLASS" have been created. The measured parameters showed a "substantial" to "almost perfect" reproducibility and an "almost perfect" reliability. Conclusion This study confirmed the possibility of generating "CLASS" with the localised centroid of the femoral and tibial ACL footprints from a 3D volumetric model. "CLASS" also showed that these footprints were easily identified on standard anteroposterior and lateral X-Ray views of the same patient, thus allowing an individual identification of the anatomical femoral and tibial ACL's footprints. Level of evidence Level IV diagnostic study

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The PBS Score – a clinical assessment tool for the ambulatory and recurrent clubfoot

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.13.190077 ◽

2019 ◽

Vol 13 (3) ◽

pp. 282-292 ◽

Cited By ~ 2

Author(s):

S. Böhm ◽

M. F. Sinclair

Keyword(s):

Correlation Coefficient ◽

Clinical Assessment ◽

Assessment Tool ◽

Interobserver Reliability ◽

Intraclass Correlation ◽

Rank Correlation ◽

Diagnostic Study ◽

Level Of Evidence ◽

Spearman’S Rank Correlation ◽

Spearman’S Rank Correlation Coefficient

Purpose The signs for clubfoot relapse are poorly defined in the literature and there is a lack of a scoring system that allows assessment of clubfeet in ambulatory children. The aim of this study is to develop an easy to use, reliable and validated evaluation tool for ambulatory children with a history of clubfoot. Methods A total of 52 feet (26 children, 41 clubfeet, 11 unaffected feet) were assessed. Three surgeons used the seven-item PBS Score to rate hindfoot varus, standing and walking supination, early heel rise, active/passive ankle dorsiflexion and subtalar abduction blinded to the other examiners. All parents answered the modified Roye score questionnaire prior to the clinical assessment. Correlation between the mean PBS Score and the Roye score was evaluated using Spearman’s rank correlation coefficient. Interobserver reliability was tested using weighted and unweighted Cohen’s Kappa coefficients. Results The Spearman’s rank correlation coefficient for correlation between mean PBS Score and Roye score was 0.73 (moderate to good correlation).The interobserver agreement for the total PBS Score resulted in an intraclass correlation coefficient of 0.93 (almost perfect agreement). Conclusion The PBS score is an easy to use, clinical assessment tool for walking age children with clubfoot deformity. It includes passive and active criteria with a very good interobserver reliability and moderate to good validity. Level of Evidence: Level I - Diagnostic study

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3D Biometrics for Hindfoot Alignment Using Weightbearing Computed Tomography

Foot & Ankle International ◽

10.1177/1071100719835492 ◽

2019 ◽

Vol 40 (6) ◽

pp. 720-726 ◽

Cited By ~ 24

Author(s):

Jian Zhong Zhang ◽

François Lintz ◽

Alessio Bernasconi ◽

Shu Zhang ◽

Keyword(s):

Computed Tomography ◽

Comparative Study ◽

Interobserver Reliability ◽

Intraclass Correlation ◽

Correlation Coefficients ◽

Level Of Evidence ◽

Hindfoot Alignment ◽

Mean Values ◽

Intraclass Correlation Coefficients ◽

Prospective Comparative Study

Background: Weightbearing computed tomography (WBCT) is a useful tool for the assessment of hindfoot alignment (HA). Foot ankle offset (FAO) is a recently introduced parameter, determined from WBCT images using semiautomatic software. The aim of this study was to determine the clinical relevance and reproducibility of FAO for the evaluation of HA. Methods: A prospective comparative study was performed on consecutive patients requiring bilateral WBCT between September 2017 and April 2018. Based on the clinical assessment of HA, patients were divided into 3 groups: (1) normal alignment group (G1), (2) valgus (G2), and (3) varus (G3). FAO and long axial view (HACT) were measured on WBCT images, and the groups were compared. The reproducibility of FAO and HACT was determined through intraclass correlation coefficients (ICCs). Regression analysis was performed to investigate the correlation between the 2 methods. Overall, 249 feet (126 patients) were included (G1 = 115, G2 = 78, and G3 = 56 feet). Results: The mean values for FAO and HACT were 1.2% ± 2.8% and 3.9 ± 3.1, respectively, in G1; 8.1% ± 3.7% and 9.7 ± 4.9 in G2; and −6.6% ± 4.8% and −8.2 ± 6.6 in G3. Intra- and interobserver reliability was 0.987 and 0.988 for FAO and 0.949 and 0.949 for HACT, respectively. There was a good linear correlation between HACT and FAO ( R2 = 0.744), with a regression slope of 1.064. Conclusions: WBCT was a useful method for the characterization of HA. FAO was reproducible and correlated well with physical examination. Level of Evidence: Level II, prospective comparative study.

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Reliability of the “Clinical Tibiofibular Line” Technique for Open Syndesmosis Reduction Assessment

Foot & Ankle Specialist ◽

10.1177/1938640020948667 ◽

2020 ◽

Vol 13 (6) ◽

pp. 516-521

Author(s):

Anthony A. Pollizzi ◽

Daniel C. Herman ◽

Gregory C. Berlet ◽

Christopher W. Reb

Keyword(s):

Computed Tomography ◽

Interobserver Reliability ◽

Intraclass Correlation ◽

Lower Limbs ◽

Diagnostic Study ◽

Radiographic Assessment ◽

Open Technique ◽

Safe Alternative ◽

Intraoperative Computed Tomography ◽

Measurement Series

Background: When intraoperative computed tomography (CT) is unavailable, open syndesmosis assessment is a universally available, safe alternative that is more accurate than radiographic assessment. However, it has a documented malreduction rate of up to 16%. This may be improved upon with a validated technique for assessing the accuracy of open syndesmosis reductions. The “tibiofibular line” (TFL) is a CT-based technique found to be sensitive for malreduction. The purpose of this study was to assess the feasibility of adapting the CT-TFL method into a reliable intraoperative open technique by refining the methodology of previous work exploring the clinical TFL technique. Methods: Three observers were instructed to clinically simulate the TFL on cadaveric lower limbs. For each specimen, observers repeated and recorded 3 clinical TFL measurements for each of 4 measurement series representing different degrees of fibula reduction. Intraclass correlation was used to assess intra- and interobserver reliabilities. Results: Mean intraobserver reliability was .88. Mean interobserver reliability was .75. Both intra- and interobserver reliabilities were highest for anatomic syndesmosis reduction. Conclusion: The findings of excellent to near perfect intraobserver and good to excellent interobserver reliability indicate the feasibility of translating the CT-TFL into a reliable open technique. Levels of Evidence: Level III: Diagnostic study

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Range of Normal and Abnormal Syndesmotic Measurements Using Weightbearing CT

Foot & Ankle International ◽

10.1177/1071100719866831 ◽

2019 ◽

Vol 40 (12) ◽

pp. 1430-1437 ◽

Cited By ~ 6

Author(s):

Noortje Catharina Hagemeijer ◽

Song Ho Chang ◽

Mohamed Elghazy Abdelaziz ◽

Jack Christopher Casey ◽

Gregory Richard Waryasz ◽

...

Keyword(s):

Internal Control ◽

Early Recognition ◽

Interobserver Reliability ◽

Ankle Injury ◽

P Value ◽

Diagnostic Study ◽

Level Of Evidence ◽

Measurement Variation ◽

Tibiofibular Joint ◽

Weightbearing Ct

Background: Early recognition of syndesmotic instability is critical for optimizing clinical outcome. Injuries causing a more subtle instability, however, can be difficult to diagnose. The purpose of this study was to evaluate both distal tibiofibular articulations using weightbearing computed tomography (CT) in patients with known syndesmotic instability, thereafter comparing findings between the injured and uninjured sides. We also aimed to define the range of normal measurement variation among patients without syndesmotic injury. Methods: Patients with unilateral syndesmotic instability requiring operative fixation ( n = 12) underwent preoperative bilateral ankle weightbearing CT. A separate cohort of patients without ankle injury who also underwent bilateral ankle weightbearing CT were included as comparative controls ( n = 24). For each weightbearing CT, a series of 7 axial plane tibiofibular joint measurements, including 1 angular measurement, were utilized to evaluate parameters of the syndesmotic anatomy at a level 1 cm above the tibial plafond. Values were recorded by 2 independent observers to assess for interobserver reliability. Results: Among those with unilateral syndesmotic instability, values differed between the injured and uninjured sides in 4 of the 7 measurements performed including the syndesmotic area: direct anterior, middle, and posterior differences, and sagittal translation ( P < .001, < .001, < .001, and < .001, respectively). In the control population without ankle injury, no differences were identified between any of the bilateral measurements ( P value range, .172-.961). Conclusion: This study highlights the ability of weightbearing CT to effectively differentiate syndesmotic diastasis among patients with surgically confirmed syndesmotic instability from those without syndesmotic instability. It underscores the substantial utility and importance of using the contralateral, uninjured side as a valid internal control whenever the need for confirming potential syndesmotic instability arises. Prospective studies are necessary to fully understand the accuracy of weightbearing CT in diagnosing occult syndesmotic instability among patients for whom the diagnosis remains in question. Level of Evidence: Level III, comparative diagnostic study.

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FEMORAL NECK FRACTURES GARDEN I AND II: EVALUATION OF THE DEVIATION IN LATERAL VIEW

Acta Ortopédica Brasileira ◽

10.1590/1413-785220172502169349 ◽

2017 ◽

Vol 25 (2) ◽

pp. 107-109 ◽

Cited By ~ 2

Author(s):

Natália Zalc Leonhardt ◽

Lucas da Ponte Melo ◽

David Gonçalves Nordon ◽

Fernando Brandão de Andrade e Silva ◽

Kodi Edson Kojima ◽

...

Keyword(s):

Femoral Neck ◽

Comparative Study ◽

Femoral Neck Fracture ◽

Lateral View ◽

Femoral Neck Fractures ◽

Level Of Evidence ◽

X Ray ◽

Neck Fracture ◽

Anteroposterior View ◽

Retrospective Comparative Study

ABSTRACT Objective: To evaluate the rate of deviation in the lateral radiographic incidence in patients with femoral neck fracture classified as non-diverted in the anteroposterior view (Garden I and II). Methods: Nineteen selected patients with femoral neck fractures classified as Garden I and II were retrospectively evaluated, estimating the degree of deviation in the lateral view. Results: Fifteen cases (79%) presented deviations in lateral view, with a mean of 18.6 degrees (±15.5). Conclusion: Most fractures of the femoral neck classified as Garden I and II present some degree of posterior deviation in the X-ray lateral view. Level of Evidence III, Retrospective Comparative Study.

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Assessment of the ankle joint in clubfeet and normal feet to the age of four years by ultrasonography

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.12.170217 ◽

2018 ◽

Vol 12 (3) ◽

pp. 262-272 ◽

Cited By ~ 1

Author(s):

A. Johansson ◽

Y. Aurell ◽

B. Romanus

Keyword(s):

Ankle Joint ◽

Interobserver Reliability ◽

Plantar Flexion ◽

Intraclass Correlation ◽

Neutral Position ◽

Healthy Children ◽

Level Of Evidence ◽

Posterior Aspect ◽

Talocrural Joint ◽

Interexaminer Reliability

Purpose To establish reproducible posterior ultrasonographic projections for evaluation of the movement in the talocrural joint in clubfeet and normal feet from the perinatal period up to the age of four years. Methods The feet in 105 healthy children and 46 patients (71 clubfeet and 21 normal feet) were examined. In all, 14 feet in seven patients were examined twice by two examiners independently to evaluate the repeatability of the ultrasonography scans. A posterior sagittal projection was used. The distance from the posterior aspect of the tibial physis to the posterior border of the talocalcaneal joint (Tib. phys – TCJ) was measured with the foot in neutral position and dorsiflexion. In plantar flexion the shortest distance between the tibial physis and the calcaneus was measured. The distance from the skin to the tibial epiphyses and the talus was measured in neutral position. The intraclass correlation coefficient (ICC) was calculated to evaluate the repeatability of the measurements. Results The interexaminer reliability was 0.71 to 0.89 ICC. The intra- and interobserver reliability measured as ICC was 0.68 to 0.99 for all measurements. The correlation between Tib. phys. – TCJ and clinical dorsiflexion varied much between the age groups. Conclusion Ultrasonography of the posterior aspect of the ankle joint can be done with high interexaminer reliability. The repeatability of image evaluation was high. Correlation to clinical measurements varied, therefore dynamic ultrasound in real time is clinically more useful than single measurements on frozen ultrasound images. Level of Evidence III

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Three-Dimensional Quantification of Glenoid Bone Loss in Anterior Shoulder Instability: The Anatomic Concave Surface Area Method

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211011058 ◽

2021 ◽

Vol 9 (6) ◽

pp. 232596712110110

Author(s):

Marine Launay ◽

Muhammad Naghman Choudhry ◽

Nicholas Green ◽

Jashint Maharaj ◽

Kenneth Cutbush ◽

...

Keyword(s):

Bone Loss ◽

Surface Area ◽

Shoulder Instability ◽

Interobserver Reliability ◽

Intraclass Correlation ◽

Glenoid Bone Loss ◽

Concave Surface ◽

Anterior Shoulder Instability ◽

Level Of Evidence ◽

Best Fit

Background: Recurrent shoulder instability may be associated with glenoid erosion and bone loss. Accurate quantification of bone loss significantly influences the contemplation of surgical procedure. In addition, assessment of bone loss is crucial for surgical planning and accurate graft placement during surgery. Purpose: To quantify the concave surface area of glenoid bone loss by using 3-dimensional (3D) segmented models of the scapula and to compare this method with the best-fit circle and glenoid height/width methods, which use the glenoid rim for bone loss estimations. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: A total of 36 consecutive preoperative bilateral computed tomography scans of patients eligible for a primary Latarjet procedure were selected from our institutional surgical database (mean patient age, 29 ± 9 years; 31 men and 5 women). The 3D models of both scapulae were generated using medical segmentation software and were used to map the anatomic concave surface area (ACSA) of the inferior glenoid using the diameter of the best-fit circle of the healthy glenoid. Bone loss was calculated as a ratio of the difference between surface areas of both glenoids (healthy and pathological) against the anatomic circular surface area of the healthy glenoid (the ACSA method). These results were compared with bone loss calculations using the best-fit circle and glenoid height/width methods. Inter- and intraobserver reliability were also calculated. Results: The mean (± SD) bone loss calculated using the ACSA, the best-fit circle, and glenoid height/width methods was 9.4% ± 6.7%, 14.3% ± 6.8%, and 17.6% ± 7.3%, respectively. The ACSA method showed excellent interobserver reliability, with an intraclass correlation coefficient (ICC) of 0.95 versus those for the best-fit circle (ICC, 0.71) and glenoid height/width (ICC, 0.79) methods. Conclusion: Quantification of instability-related glenoid bone loss is reliable using the 3D ACSA method.

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Validity and Reliability of a New Radiological Method to Estimate Medial Column Internal Rotation in Hallux Valgus Using Foot Weight-Bearing X-Ray

Foot & Ankle Specialist ◽

10.1177/19386400211029162 ◽

2021 ◽

pp. 193864002110291

Author(s):

Pablo Wagner ◽

Nicole Lescure ◽

Noman Siddiqui ◽

Jessica Fink ◽

Emilio Wagner

Keyword(s):

Internal Rotation ◽

Hallux Valgus ◽

Interobserver Agreement ◽

Interobserver Reliability ◽

Weight Bearing ◽

Intraclass Correlation ◽

Validity And Reliability ◽

Substantial Agreement ◽

X Ray ◽

Rotation Measurement

Background Medial column internal rotation in hallux valgus (HV) can be measured using weight-bearing computed tomography (WBCT). Anteroposterior weight-bearing foot radiographs’ (WBXR) ability to estimate medial column internal rotation in HV was evaluated comparing these measurements with those obtained from WBCT. Methods Three observers evaluated WBCT and WBXR of 33 HV feet twice. Medial column internal rotation was measured with WBCT and classified into 3 levels according to WBXR findings. Intra- and interobserver reliability were obtained for WBXR and WBCT, in addition to WBXR-WBCT correlation. Results WBXR and WBCT intraobserver agreement was substantial and near perfect, respectively (κ 0.79 and 0.84). Their interobserver agreement was excellent (intraclass correlation 0.85 and 0.9, respectively). The WBXR-WBCT correlation was substantial (κ 0.68). WBXR diagnostic accuracy to predict the WBCT results was 85%. Conclusions The proposed method for medial column internal rotation measurement using WBXR is reliable and has a substantial agreement with WBCT measurements. Levels of Evidence Level III

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Reliability of a Novel Scoring System for MRI Assessment of Severity in Gluteal Tendinopathy: The Melbourne Hip MRI Score

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121998389 ◽

2021 ◽

Vol 9 (4) ◽

pp. 232596712199838

Author(s):

Chi Kin Nathan Tso ◽

Richard O’Sullivan ◽

Hussain Khan ◽

Jane Fitzpatrick

Keyword(s):

Scoring System ◽

Interobserver Reliability ◽

Intraclass Correlation ◽

Future Research ◽

Level Of Evidence ◽

Trochanteric Bursitis ◽

Gluteal Tendinopathy ◽

Cortical Irregularity ◽

Tendon Pathology ◽

Hip Mri

Background: Gluteal tendinopathy is commonly reported in the literature, but there is a need for a validated magnetic resonance imaging (MRI)-based scoring system to grade the severity of the tendinopathy. Purpose: To use intra- and interobserver reliability to validate a new scoring system, the Melbourne Hip MRI (MHIP) score, for assessing the severity of gluteal tendinopathy. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: The MHIP score assesses gluteal tendinopathy according to each 1 of 5 categories: (1) extent of tendon pathology (maximum 5 points); (2) muscle atrophy (maximum 4 points); (3) trochanteric bursitis (maximum 4 points); (4) cortical irregularity (maximum 3 points); and (5) bone marrow edema (maximum 1 point), with an overall range of 0 to 17 (most severe). A total of 41 deidentified MRI scans from 40 patients diagnosed with gluteal tendinopathy (mean baseline age, 57.44 ± 25.26 years; 4 male, 36 female) were read and graded according to MHIP criteria by 2 experienced musculoskeletal radiologists. The radiologists were blinded to previous reports, and the scans were read twice within a 2-month period. Statistical analysis using the intraclass correlation coefficient (ICC) was used to determine intra- and interobserver reliability and mean/range for the MHIP scores. Results: Of a total of 123 readings, the mean MHIP score (±SD) was 3.93 ± 2.24 (range, 0-17 points). The MHIP score demonstrated excellent reliability for determining the severity of gluteal tendinopathy on MRI. The ICC for intra- and interobserver reliability was 0.81 (95% CI, 0.67-0.89) and 0.78 (95% CI, 0.62-0.87), respectively. Conclusion: The MHIP score had excellent intra- and interobserver reliability in scoring gluteal tendinopathy. This score allows gluteal tendon pathology to be graded prior to treatment and to be used for standardized comparisons between results in future research undertaking radiological review of gluteal tendinopathy.

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REPRODUCIBILITY OF S2-ALAR ILIAC SCREW MORPHOMETRIC ANALYSIS

Acta Ortopédica Brasileira ◽

10.1590/1413-785220212902236763 ◽

2021 ◽

Vol 29 (2) ◽

pp. 97-100

Author(s):

MARIANA DEMÉTRIO DE SOUSA PONTES ◽

LUCAS AMÉRICO FRANCISCO ◽

LUCAS KLAROSK ISMAEL ◽

CARLOS FERNANDO PEREIRA DA SILVA HERRERO

Keyword(s):

Morphometric Analysis ◽

Sagittal Plane ◽

Interobserver Reliability ◽

Statistical Significance ◽

Intraclass Correlation ◽

Intraobserver Reliability ◽

Axial Plane ◽

Level Of Evidence ◽

Screw Length ◽

Trajectory Angle

ABSTRACT Objective: To evaluate the reproducibility of a S2-alar iliac (S2AI) screw parameters measurement method by inter and intraobserver reliability. Methods: Cross-sectional study, considering computed tomography exams. Morphometric analysis was performed by multiplanar reconstructions. Screw length, diameter and trajectory angles were the studied variables. To analyze the measurements reproducibility, intraclass correlation coefficient (ICC) was used. Results: Interobserver reliability was classified as strong for screw shortest length (ICC: 0.742) and diameter (ICC: 0.699). Interobserver reliability was classified as moderate for screw longest length (ICC: 0.553) and for screw trajectory angles in the axial plane for the longest (ICC: 0.478) and for the shortest lengths (ICC: 0.591). Intraobserver reliability was interpreted as excellent for screw shortest (ICC: 0.932) and longest lengths (ICC: 0.962) and diameter (ICC: 0.770) and screw trajectory angles in the axial plane for the screw longest (ICC: 0.773) and shortest lengths (ICC: 0.862). There were weak interobserver and strong intraobserver reliabilities for trajectory angle in sagittal plane, but no statistical significance was found. Conclusion: Inter and intraobserver reliability of S2AI screw morphometric parameters were interpreted from moderate to excellent in almost all studied variables, except for the screw trajectory angle in the sagittal plane measurement. Level of Evidence IV, Diagnostic Studies - Investigating a Diagnostic Test.

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