The Talar-Tilt Angle and the Fibular Collateral Ligaments

Background: Osteochondral lesion of the talus (OLT) is commonly found as a concomitant pathologic lesion in a large proportion of patients with chronic lateral ankle instability (CLAI). This study investigated which characteristics in a patient with CLAI increase the risk for OLT. Methods: Three hundred sixty-four patients who underwent a modified Broström operation for their CLAI were reviewed retrospectively. The characteristics of each patient and variables associated with OLTs were investigated. Statistical analyses were performed to determine the effect of each potential predictor on the incidence of OLT, and to evaluate the associations between the patient characteristics and variables associated with OLTs. Results: Patients with OLTs were more frequently female (female vs male: 63.1% vs 43.9%, P = .003). In addition, the lesion sizes were larger in female patients (female vs male: 113.9 ± 24.9 mm2 vs 100.7 ± 18.0 mm2, P = .002), and medial lesions were more common in female patients (female vs male; 93.3% vs 81.8%, P = .036). The lesion sizes were larger in patients with a wider talar tilt angle ( P < .001), and patients with a medial OLT showed a wider talar tilt angle (12.0 ± 2.0 degrees vs 10.3 ± 2.2 degrees, P = .002). Conclusion: In this CLAI patient cohort, we found female patients to be at greater risk for OLTs than male patients. Furthermore, CLAI female patients with concomitant OLT had on average a larger lesion size, more frequent OLT medial position, and were associated with wider talar tilt angles, suggesting that females had more intrinsic ankle instability than males. Level of Evidence: Level IV, retrospective case series.

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MRI Analysis for Clarification of Mechanism of Ankle Osteoarthritis: When the Talar Tilt Exceeds 15 Degrees, the BME Pattern of the Ankle Are Changes

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00309 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0030

Author(s):

Hiroyuki Mitsui ◽

Takaaki Hirano ◽

Yui Akiyama ◽

Wataru Endo ◽

Tomoko Karube ◽

...

Keyword(s):

Tilt Angle ◽

Subtalar Joint ◽

Pathological Condition ◽

Incidence Rates ◽

Outer Side ◽

Ankle Osteoarthritis ◽

Poor Prognostic Factor ◽

Exact Test ◽

Talar Tilt ◽

Group 5

Category: Ankle Arthritis Introduction/Purpose: In recent years, total ankle arthroplasty (TAA) has been widely performed for severe ankle osteoarthritis (OA). However, TAA is not always successful in cases of advanced varus; in fact, some researchers have stated caution regarding its indication. Previously, to elucidate the pathological condition of ankle OA using MRI, we investigated that confirmed the existence of an association among the Takakura–Tanaka classification, foot and ankle alignment, and bone marrow edema (BME). In this study, we focused on the talar tilt angle and compared the cases of terminal ankle OA as per Takakura– Tanaka classification (stage 3b and 4) wherein this angle exceeded 15° with those wherein it did not exceed in terms of the mode of BME onset. Methods: Of 616 cases of ankle OA diagnosed in our hospital between May 2009 and January 2018, we examined the MRI images of 52 feet of 50 patients diagnosed with severe ankle OA. The talar tilt angle with the ankle under load was measured using frontal X-ray, following which the presence/absence of BME was determined by dividing the talus, subtalar, and Chopart’s joints into 22 regions (areas 1–11 and 1’–11’). In statistical analysis, we first obtained the total number of BME incidences for each case. Then, after dividing this disease group into severe varus (SV; talar tilt angle = 15° or more) and mild varus (MV; talar tilt angle < 15°) groups, we compared t-test scores for the respective BME incidence rates. Furthermore, we used Fisher’s exact test to examine differences in terms of BME incidence rates between the two groups for each subdivided region. Results: No significant differences were found between the two groups in terms of BME incidence rates for each case. However, the rates in each area were significantly lower in the SV group than in the MV group for area 2 (SV group, 14%; MV group, 57%) and area 4 (SV group, 7%; MV group, 39%), i.e. the SV groups corresponding to the outer surface of the trochlea talar. Conversely, in the subtalar joint, the rates were significantly higher in the SV group than in the MV group for area 10 (SV group, 36%; MV group, 11%) and area 10’ (SV group, 29%; MV group, 5%), i.e. the medial surface of the calcaneus. Conclusion: In cases of severe ankle OA wherein the talar tilt angle exceeds 15°, the load exerted on the outer side of the talus decreases in the talar joint, whereas a greater load is exerted on the medial subtalar joint located at the innermost side in the subtalar joint. Differences in terms of the mode of BME incidence in the subtalar joint, which is not replaced with normal TAA, may be a poor prognostic factor for postoperative TAA.

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A Review of Lateral Ankle Ligamentous Reconstructions

Foot & Ankle ◽

10.1177/107110078200300211 ◽

1982 ◽

Vol 3 (2) ◽

pp. 114-123 ◽

Cited By ~ 58

Author(s):

Rick St. Pierre ◽

Fred Allman ◽

Frank H. Bassett ◽

J. Leonard Goldner ◽

Lamar L. Fleming

Keyword(s):

Tilt Angle ◽

Clinical Results ◽

Grading System ◽

Chi Square ◽

Reconstructive Procedures ◽

Lateral Ankle ◽

Institutional Review ◽

Significant Difference ◽

Talar Tilt

We have performed an ongoing retrospective and prospective multi-institutional review of 50 patients who underwent 53 lateral ligamentous reconstructive procedures of the ankle. The point grading system used for postoperative evaluation of our patients allowed for classification of functional activity. The grading system included evaluation of the patient's return to preinjury activities and athletics, degree of pain, degree of swelling, number of recurrent sprains, and any disability that the patient incurred secondary to the tendon transfer. Preoperative and postoperative stress radiographs were obtained to evaluate the talar tilt angle. Of our 53 lateral ankle ligamentous reconstructions, we consider 45 to be excellent, with the patients returning to full activity and athletics. Our results show no statistically significant difference in long-term function among the five ligamentous repairs employed in this series (Pearson Chi-square test; χ2 = 2.30, df = 4, P = 0.68). No correlation could be made between the long-term clinical response of the various procedures and the postoperative talar tilt angle. We conclude that lateral ligamentous reconstructive repairs of the ankle are indicated, and that good or excellent clinical results, greater than 91 %, can be obtained with any of the five reconstructive procedures, performed correctly.

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Comparison of Clinical Outcomes in Patients with Generalized Ligamentous Laxity and without Generalized Laxity in the Arthroscopic Modified Broström Operation for Chronic Lateral Ankle Instability

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000261 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0002

Author(s):

YoungKoo Lee ◽

Jungwoo Yoo ◽

Keon Hee Yun ◽

Ji Yong Park

Keyword(s):

Clinical Outcome ◽

Clinical Outcomes ◽

Tilt Angle ◽

Ankle Instability ◽

Lateral Ankle ◽

Chronic Lateral Ankle Instability ◽

Ligamentous Laxity ◽

Lateral Ankle Instability ◽

Talar Tilt

Category: Sports Introduction/Purpose: The arthroscopic modified Broström operation (MBO) has been developed and frequently used to treat chronic lateral ankle instability (CLAI). Clinical outcome of arthroscopic MBO was reported as good or excellent. But there were no report about comparison of clinical outcomes between patients with generalized ligamentous laxity (laxity) and without generalized ligamentous laxity (no laxity). The purpose of this study is to compare the clinical outcomes of the group with generalized ligamentous laxity and without generalized ligamentous laxity in chronic lateral ankle instability. Methods: From January 2013 to November 2015, Arthroscopic MBO was performed in 99 patients for CLAI. We retrospectively analyzed 99 consecutive patients were included in terms of inclusion criteria. All patients had giving way, persistent pain and an inability to resume one’s preinjury activity level for more than 6 months. Patients were divided into 2 groups: laxity group (24 ankles) and no laxity group (75 ankles). Evaluation was performed preoperatively and at a final follow-up a minimum of 12 months postoperatively using the American Orthopedic Foot and Ankle Society (AOFAS) hindfoot ankle score, pain Visual Analogue Scale (VAS)(0~100), and talar tilt angle. Results: In terms of radiological outcomes, the preoperatively talar tilt angle was greater in patients in laxity group than in no laxity group (p < .001). The last follow-up talar tilt angle was the same between in patients in laxity group and in no laxity group (p=0.413). But preoperative-last follow up difference was found between two groups (p=0.03). The variation from preoperative to last follow up talar tilt angle showed significant greater value in laxity group (-6.9 ± 5.2) than in no laxity group (-4.2 ± 4.2)(p=0.03). In terms of clinical outcome, last follow up AOFAS and VAS in all groups were improved than preoperative scores (27.5 ± 23.7, 24.1 ± 18.4, respectively). But preoperative-last follow up differences were not found between two groups (P=0.52). Conclusion: In terms of radiologic outcomes, there was difference outcome variation between two groups, in terms of clinical outcomes, there were no difference outcome variations between two groups. All groups achieved successful clinical and radiological last follow up outcomes even though there was difference outcome variation in talar tilt. Arthroscopic MBO should be considered as a reasonable method in patients who have chronic lateral ankle instability regardless of generalized ligamentous laxity.

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Custom 3D-printed Total Talar Prostheses Restore Normal Joint Anatomy Throughout the Hindfoot

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00125 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0012

Author(s):

Joseph Tracey ◽

Danny Arora ◽

Selene Parekh

Keyword(s):

3D Printing ◽

Tilt Angle ◽

Three Dimensional ◽

Case Series ◽

The United States ◽

Radiographic Measurements ◽

Declination Angle ◽

3D Printed ◽

Talar Tilt ◽

Radiographic Alignment

Category: Hindfoot Introduction/Purpose: Third generation total talar prostheses (TTP) are viable options for talar avascular necrosis (AVN) in the absence of neighboring joint pathology. The use of modern three-dimensional (3D) printing allows for the production of custom implants that exactly mimic the patient’s anatomy. The aim of this study is to determine the accuracy of 3D printing in reproducing a synthetic talus, and in doing so, restoring more normal anatomic relationships. We hypothesize that this mode of replication will restore and maintain normal radiographic alignment of the ankle, subtalar, and forefoot joints in the setting of talar AVN. Methods: A retrospective analysis was performed on all patients undergoing TTP implantation for the treatment of talar AVN between 2016 and 2017. Pertinent demographic and operative factors were recorded. Radiographic measurements were taken pre- and post-operatively to determine native talar dimensions, TTP implant dimensions, and the corresponding radiographic alignment about the forefoot, hindfoot, and ankle. Results: Fourteen patients, treated for AVN between 2016-2017, were identified in our cohort. Talar arc length and width were not found to be significantly changed, however talar height was significantly increased with use of TTP. Five alignment dimensions were measured (tibiotalar alignment, talar tilt angle, Boehler’s angle, talar declination angle, and Meary’s Angle), of which, only talar tilt angle was significantly changed. Instances of Meary’s angle correction were observed in cavus and planus foot deformity. Conclusion: This study represents the largest case series of TTP performed in the United States, and is the first to investigate the 3D printed TTP. As a proof-of-concept, 3D printed TTP was successful in restoring talar height and talar tilt in the setting of AVN. Additionally, the procedure maintained normal alignment in non-pathologic joints. Total talar prosthesis, based on our cohort, is a viable option to restore more normal anatomic alignment.

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