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Ankle morphometry based on computerized tomography
Abstracts from the 6th IFFAS Triennial Meeting / Foot and Ankle Surgery 23(S1) (2017) 29–154
surface. The kinematic rotational axis was defined to be the axis of this cone. Results: The determination of the kinematic rotational axis showed a high inter- and intrarater reliability. The kinematic rotational axis of the talocrural joint is orientated from lateraldistal to medial-proximal (84.9◦ ± 8.5 compared to mechanical tibial axis in frontal plane), from dorsal-proximal to anterior-distal (93.1◦ ± 42.3 compared to mechanical tibial axis in sagittal plane) and from dorsal-lateral to anterior-medial (169.0◦ ± 6.7 compared to mechanical tibial axis in axial plane). A high standard deviation especially in the sagittal plane was noteworthy. Conclusions: With the present study we present a new reproducable single-axis model of the talocrural joint. Our data showed relevant interindividual variations. The consideration of these variations might support the development of patient-specific TAR implantation techniques. http://dx.doi.org/10.1016/j.fas.2017.07.455
367 Ankle morphometry based on computerized tomography L. Claassen 1,∗ , P. Luedtke 1 , D. Yao 1 , S. Ettinger 1 , K. Daniilidis 1 , A.M. Nowakowski 2 , M. Müller-Gerbl 3 , C. Stukenborg-Colsman 1 , C. Plaass 1 1 Hannover Medical School, Orthopedic Department, Germany 2 University Hospital Basel, Orthopedic Department, Switzerland 3 University of Basel, Department of Biomedicine, Switzerland
Background: Understanding the morphometry of the ankle joint is crucial to improve total ankle replacement (TAR). Despite improvements of the implant material TAR did not reach comparable success rates to total hip or knee arthroplasty. Recent studies queried whether current designs match with the articular geometry. Aim: The present study was performed to evaluate the ankle morphometry and thereby gain information about the joint axis. Material and methods: We analyzed 96 high-resolution CTscans of complete caucasian cadaver legs. Using the software Mimics and 3-Matic (Materialize) 22 anatomic parameters of the talocrural joint were assessed, including the length, width and surface area of the tibial and talar bearing areas. Additionally the radii of the bearing areas, the medial distal tibial angle and the height of the talar dome were determined. Therefore we analyzed defined sagittal, axial and frontal planes. Results: The radius of the central trochlea tali was 44.6 ± 4.1 mm (mean ± SD). The central trochlea tali arc length was 40.8 ± 3.0 mm and its width was 27.4 ± 2.5 mm. Additionally we determined 47.0 ± 4.4 mm for the tibial sagittal radius, 27.6 ± 3.0 mm for the tibial arc length and 27.4 ± 2.5 mm for the central tibial width. Conclusion: The present study describes the three-dimensional morphometry of the caucasian ankle joint. Our results might be considered for the development of total ankle replacements. http://dx.doi.org/10.1016/j.fas.2017.07.456
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368 Professional soccer players; Return to play and performance after Achilles tendon ruptures D. Trofa, P. Noback, C. Ahmad, J. Greisberg, J. Turner Vosseller ∗ Columbia University Medical Center, United States Introduction: Most Achilles tendon ruptures are sports-related; however, no study has examined the impact of surgical repair for complete ruptures on professional soccer players. Our purpose was to examine the return-to-play (RTP), playtime, and performance of professional soccer players following Achilles tendon repair. Methods: Union of European Football Associations and Major League Soccer athletes who sustained a primary complete Achilles tendon rupture treated surgically between 1989 and 2014 were identified via public injury reports. Demographic information and performance-related statistics were recorded for the season before and two seasons after surgery. Results: Of 29 athletes screened, 23 met inclusion criteria. 19 (82.6%) athletes with an isolated Achilles rupture were able to RTP. Players who ruptured their Achilles tendon had played professionally for an average 8.3 years. Among athletes that successfully returned to play, game participation averaged 83.6% (p > 0.05) and 76.1% (p = 0.049) of the total games played the season prior to injury at 1 and 2 years post-operatively, respectively. Minutes played at 1 and 2 years post-injury was 77.1% (p > 0.05) and 65.1% (p = 0.024), respectively. There was no difference in games started or goals scored at 1 or 2 years post-injury compared to the index season. Conclusions: An Achilles rupture is a rare yet devastating injury among professional soccer players; however, 82.6% of professional soccer players in Europe and America are able to RTP after surgical treatment. Professional athletes that do RTP have statistically significant reduced playtime 2 years after surgical management. http://dx.doi.org/10.1016/j.fas.2017.07.457
369 Prospective study matching minimally invasive and open surgery calcaneal osteotomies in terms of intra- and postoperative parameters V. Andric ∗ , H. Waizy Hessing Stiftung, Germany Introduction: The indication for a calcaneal osteotomy is the pathology of the hindfoot which can be corrected by the open surgery procedure or minimally invasive calcaneal osteotomy (MICO). The current literature describes very promising results and clinical outcome after minimally invasive surgery. In a prospective study we are matching minimally invasive and open surgery calcaneal osteotomies and evaluate different intra- and postoperative parameters and compare them with the results in the literature. This is the first study that evaluates intraoperative parameters just isolated for the calcaneal osteotomy without any additional procedures. Methods: The present study was performed between 01 July 2015 and 31 December 2016. We treated 60 patients in total with a calcaneal osteotomy: For 33 patients we used the lateral incision approach. 27 patients were treated by MICO. Intraoperatively we measured the operation time, the fluoroscopy time and the radiation dose – postoperatively the length of the lateral incision. Conclusion: Our results support the MICO-technique:
surface. The kinematic rotational axis was defined to be the axis of this cone. Results: The determination of the kinematic rotational axis showed a high inter- and intrarater reliability. The kinematic rotational axis of the talocrural joint is orientated from lateraldistal to medial-proximal (84.9◦ ± 8.5 compared to mechanical tibial axis in frontal plane), from dorsal-proximal to anterior-distal (93.1◦ ± 42.3 compared to mechanical tibial axis in sagittal plane) and from dorsal-lateral to anterior-medial (169.0◦ ± 6.7 compared to mechanical tibial axis in axial plane). A high standard deviation especially in the sagittal plane was noteworthy. Conclusions: With the present study we present a new reproducable single-axis model of the talocrural joint. Our data showed relevant interindividual variations. The consideration of these variations might support the development of patient-specific TAR implantation techniques. http://dx.doi.org/10.1016/j.fas.2017.07.455
367 Ankle morphometry based on computerized tomography L. Claassen 1,∗ , P. Luedtke 1 , D. Yao 1 , S. Ettinger 1 , K. Daniilidis 1 , A.M. Nowakowski 2 , M. Müller-Gerbl 3 , C. Stukenborg-Colsman 1 , C. Plaass 1 1 Hannover Medical School, Orthopedic Department, Germany 2 University Hospital Basel, Orthopedic Department, Switzerland 3 University of Basel, Department of Biomedicine, Switzerland
Background: Understanding the morphometry of the ankle joint is crucial to improve total ankle replacement (TAR). Despite improvements of the implant material TAR did not reach comparable success rates to total hip or knee arthroplasty. Recent studies queried whether current designs match with the articular geometry. Aim: The present study was performed to evaluate the ankle morphometry and thereby gain information about the joint axis. Material and methods: We analyzed 96 high-resolution CTscans of complete caucasian cadaver legs. Using the software Mimics and 3-Matic (Materialize) 22 anatomic parameters of the talocrural joint were assessed, including the length, width and surface area of the tibial and talar bearing areas. Additionally the radii of the bearing areas, the medial distal tibial angle and the height of the talar dome were determined. Therefore we analyzed defined sagittal, axial and frontal planes. Results: The radius of the central trochlea tali was 44.6 ± 4.1 mm (mean ± SD). The central trochlea tali arc length was 40.8 ± 3.0 mm and its width was 27.4 ± 2.5 mm. Additionally we determined 47.0 ± 4.4 mm for the tibial sagittal radius, 27.6 ± 3.0 mm for the tibial arc length and 27.4 ± 2.5 mm for the central tibial width. Conclusion: The present study describes the three-dimensional morphometry of the caucasian ankle joint. Our results might be considered for the development of total ankle replacements. http://dx.doi.org/10.1016/j.fas.2017.07.456
121
368 Professional soccer players; Return to play and performance after Achilles tendon ruptures D. Trofa, P. Noback, C. Ahmad, J. Greisberg, J. Turner Vosseller ∗ Columbia University Medical Center, United States Introduction: Most Achilles tendon ruptures are sports-related; however, no study has examined the impact of surgical repair for complete ruptures on professional soccer players. Our purpose was to examine the return-to-play (RTP), playtime, and performance of professional soccer players following Achilles tendon repair. Methods: Union of European Football Associations and Major League Soccer athletes who sustained a primary complete Achilles tendon rupture treated surgically between 1989 and 2014 were identified via public injury reports. Demographic information and performance-related statistics were recorded for the season before and two seasons after surgery. Results: Of 29 athletes screened, 23 met inclusion criteria. 19 (82.6%) athletes with an isolated Achilles rupture were able to RTP. Players who ruptured their Achilles tendon had played professionally for an average 8.3 years. Among athletes that successfully returned to play, game participation averaged 83.6% (p > 0.05) and 76.1% (p = 0.049) of the total games played the season prior to injury at 1 and 2 years post-operatively, respectively. Minutes played at 1 and 2 years post-injury was 77.1% (p > 0.05) and 65.1% (p = 0.024), respectively. There was no difference in games started or goals scored at 1 or 2 years post-injury compared to the index season. Conclusions: An Achilles rupture is a rare yet devastating injury among professional soccer players; however, 82.6% of professional soccer players in Europe and America are able to RTP after surgical treatment. Professional athletes that do RTP have statistically significant reduced playtime 2 years after surgical management. http://dx.doi.org/10.1016/j.fas.2017.07.457
369 Prospective study matching minimally invasive and open surgery calcaneal osteotomies in terms of intra- and postoperative parameters V. Andric ∗ , H. Waizy Hessing Stiftung, Germany Introduction: The indication for a calcaneal osteotomy is the pathology of the hindfoot which can be corrected by the open surgery procedure or minimally invasive calcaneal osteotomy (MICO). The current literature describes very promising results and clinical outcome after minimally invasive surgery. In a prospective study we are matching minimally invasive and open surgery calcaneal osteotomies and evaluate different intra- and postoperative parameters and compare them with the results in the literature. This is the first study that evaluates intraoperative parameters just isolated for the calcaneal osteotomy without any additional procedures. Methods: The present study was performed between 01 July 2015 and 31 December 2016. We treated 60 patients in total with a calcaneal osteotomy: For 33 patients we used the lateral incision approach. 27 patients were treated by MICO. Intraoperatively we measured the operation time, the fluoroscopy time and the radiation dose – postoperatively the length of the lateral incision. Conclusion: Our results support the MICO-technique: