Tarsometatarsal joint communication during fluoroscopy-guided therapeutic joint injections and relationship with patient age and degree of osteoarthritis.

OBJECTIVE: Although the tarsometatarsal joints are separated into three distinct synovial compartments, communications between adjacent compartments are often noted during image-guided injections. This study aims to determine whether abnormal inter-compartment tarsometatarsal joint communication is associated with patient age or degree of tarsometatarsal osteoarthritis. MATERIALS AND METHODS: One hundred forty tarsometatarsal injections were retrospectively reviewed by two radiologists. Extent of inter-compartment communication and degree of osteoarthritis were independently scored. Univariate and multivariable analyses were performed to assess whether the presence of and number of abnormal joint communications were related to age and degree of osteoarthritis. RESULTS: Forty out of 140 tarsometatarsal joints showed abnormal communication with a separate synovial compartment, and 3 of the 40 showed abnormal communication with two separate compartments. On univariate analysis, higher grade osteoarthritis (p \u3c 0.001) and older age (p = 0.014) were associated with an increased likelihood of abnormal inter-compartment tarsometatarsal communication and a greater number of these abnormal communications. On multivariate analysis, the degree of osteoarthritis remained a significant predictor of the presence of (p \u3c 0.001) and number of (p \u3c 0.001) abnormal communications, while the association of age was not statistically significant. There was significant correlation between age and degree of osteoarthritis (p \u3c 0.001). CONCLUSION: Higher grade osteoarthritis increases the likelihood of abnormal inter-compartment tarsometatarsal joint communication and is associated with a greater number of abnormal communications. Diagnostic injection to localize a symptomatic tarsometatarsal joint may be less reliable in the setting of advanced osteoarthritis

PROMIS CAT in SLE Personal non-commercial use only

ABSTRACT. Objective. The aims of this study were to assess the construct validity and the test-retest reliability of Patient Reported Outcomes Measurement Information System (PROMIS) computerized adaptive tests (CAT) in patients with systemic lupus erythematosus (SL

Talar Anatomy and Subtalar Joint Alignment on Weight-Bearing Computed Tomography

Category: Hindfoot Introduction/Purpose: Underlying bony deformities may contribute to the development of adult acquired flatfoot deformity (AAFD), although the exact pathogenesis remains unknown. Subtalar valgus tilt and underlying talar deformity can both be accurately assessed using multiplanar weightbearing computed tomography (MP-WB). On coronal MP-WB images, two angles have been used to reliably evaluate the subtalar joint axis in AAFD: (1) the angle between the inferior facet of the talus and the horizontal (inftal-hor), and (2) the angle between the inferior and superior facets of the talus (inftal-suptal). While previous work showed that these angles differ significantly between AAFD patients and controls, it is not known how they correlate with radiographic measures of flatfoot. We hypothesized that they would correlate strongly with commonly used radiographic measures of AAFD. Methods: 45 patients with stage II AAFD and 17 control patients underwent MP-WB imaging as well as standard weightbearing radiographs. Inftal-hor and inftal-suptal were measured on the coronal MP-WB images of all patients. These measurements were then correlated with standard radiographic measurements used to assess AAFD: talar-first metatarsal angle on antero-posterior (AP) and lateral views, talocalcaneal angle on AP and lateral views, talonavicular coverage angle, calcaneal pitch, medial column height, and hindfoot alignment. Basic demographic data including age, sex, and body mass index (BMI) were also collected. Differences between AAFD and control patients were assessed using independent samples t-tests and Mann-Whitney U tests. To examine the correlation between each MP-WB measurement and each radiographic measurement, a factorial generalized linear model (GLM) was constructed with presence of flatfoot, the radiographic measurement, and their interaction as covariates. Results: The flatfoot group was older than the control group (p=0.049); the two groups did not differ in terms of sex or BMI. The patients with AAFD differed significantly from the controls in all measured angles (p≤0.001 for each). Inftal-hor and inftal- suptal correlated with radiographic measures of flatfoot to the same degree in patients with and without AAFD. After accounting for differences between flatfoot and control patients, inftal-hor did not significantly correlate with any of the radiographic angles. Inftal-suptal, however, did significantly correlate with AP coverage angle, AP talar-first metatarsal angle, calcaneal pitch, Meary’s angle, medial column height, and hindfoot alignment (Figure). Conclusion: As measured on coronal MP-WB images, patients with stage II AAFD had more innate valgus in their talar anatomy as well as more valgus alignment of their subtalar joints than did control patients. The inftal-suptal angle correlated significantly with other measures of flatfoot deformity including arch collapse and forefoot abduction. Though causation cannot be established directly from this study, the data does suggest that AAFD may develop in patients with a valgus inclined subtalar joint axis. This information can be used to identify those patients likely to develop progressive flatfoot deformity and may ultimately guide the approach to surgical reconstruction

Comparison of Coronal Subtalar Alignment between Adult Acquired Flatfoot Deformity Patients and Controls Using Standard CT and Weight-Bearing Multiplanar Imaging

Category: Hindfoot Introduction/Purpose: In a previous study using novel multiplanar weight-bearing imaging (MP-WB), the inferior talus-superior talus (inftal-suptal) angle reliably evaluated the coronal orientation of the subtalar joint axis and was significantly greater in stage II adult-acquired flatfoot deformity (AAFD) patients compared to controls. Since the inftal-suptal angle relies solely on the morphology of the talus, which is theoretically unchanged at the time of flatfoot reconstruction, we hypothesized that it should be similar in pre-operative MP-WB scans compared to post-operative non-weight-bearing standard CT scans of a stage II AAFD group. We secondly hypothesized that the post-operative CT angle of AAFD patients is significantly greater than the pre-operative CT scan angle of controls. Such information could allow for the assessment of AAFD with a less expensive and more readily available tool. Methods: Patients enrolled in the authors’ institution’s Foot and Ankle Registry with a diagnosis of stage II (flexible) AAFD and undergoing flatfoot reconstruction surgery were identified. Both MP-WB scans and post-operative CT scans were obtained in the flatfoot group to assess deformity and healing of the lateral column lengthening or tarsometatarsal fusion, respectively. A control group with pre-operative CT scans for lisfranc injuries (unrelated forefoot pathology) and normal hindfoot alignment on exam after final healing was identified. Standard weight-bearing radiographic imaging was obtained pre-operatively in the AAFD group and after final healing in the control, and 5 previously-established radiographic parameters were measured. The inftal-suptal angle was measured in CT scans of the control and AAFD groups, and in MP-WB scans of the AAFD group. Differences in CT inftal- suptal and radiographic parameters between AAFD and controls were assessed with independent samples t-tests. The correlation between inftal-suptal angles measured by MP-WB and CT in the AAFD group was assessed with Pearson’s correlation coefficients. Results: 38 stage II AAFD patients (38 feet; 53% female; age 56.7±11.7 years) undergoing flatfoot reconstruction surgery from November, 2008 to December, 2014 and with MP-WB scans 61.9±77.5 days pre-operatively and CT scans 51.3±8.6 days post- operatively were identified. 20 patient controls (20 feet; 45% female; age 35.7±13.4 years) with CT scans 13.8±20.5 days pre- operatively from June, 2006 to October, 2013, were evaluated. All plain radiographic parameters differed significantly between AAFD and control groups (Table 1), verifying placement of patients into their respective groups based on previously-established norms. The inftal-suptal CT angle additionally differed between the AAFD and control groups (p < 0.001). The correlation between inftal-suptal angles measured by MP-WB and CT scans was relatively weak (Pearson’s=0.29) and did not reach statistical significance (p = 0.08). Conclusion: In summary, inftal-suptal angles of AAFD patients were significantly greater than those of controls on CT scans, and MP-WB imaging proved more predictive of AAFD than CT imaging. This study confirmed that while CT scans are useful in predicting stage II AAFD, they cannot be used as a surrogate for MP-WB scans, as they do not fully capture the amount of valgus. The most probable explanation of this is the re-formatting of CT scans into sagittal and coronal planes or a difference in the position of the foot during the scan, both leading to a potential difference in the planes of CT imaging and MP-WB imaging

Spatial Variation in Osteonal Bone Properties Relative to Tissue and Animal Age

Little is known about osteonal bone mineral and matrix properties, although these properties are of major importance for the understanding of bone alterations related to age and bone diseases such as osteoporosis. During aging, bone undergoes modifications that compromise their structural integrity as shown clinically by the increase of fracture incidence with age. Based on Fourier transform infrared (FTIR) analysis from baboons between 0 and 32 yr of age, consistent systematic variations in bone properties as a function of tissue age are reported within osteons. The patterns observed were independent of animal age and positively correlated with bone tissue elastic behavior measured by nano-indentation. As long as tissue age is expressed as a percentage of the entire osteon radius, osteonal analyses can be used to characterize disease changes independent of the size of the osteon. These mineral and matrix analyses can be used to explain bone fragility. The mineral content (mineral-to-matrix ratio) was correlated with the animal age in both old (interstitial) and newly formed bone tissue, showing for the first time that age-related changes in BMC can be explain by an alteration in the mineralization process itself and not only by an imbalance in the remodeling process