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Conventional Measurements of OLTS with CT Grossly Overestimate the Size of Lesions

When orthopedic surgeons attempt to evaluate and manage osteochondral lesions of the talus (OLTs) using conventional computed tomography (CT), they may overestimate their size. This, in turn, influences treatment strategies. Therefore, OLTs often warrant advanced imaging studies, especially in revision or cases with cystic defects. To determine the effectiveness of these techniques, a study, “Value of 3D Reconstructions of CT Scans for Calcaneal Fracture Assessment,” was performed by Foot & Ankle International (FAI).

Understanding the True Anatomy and Size of OLTs May Help Guide Treatment

OLTs are defined as localized irregularities in the articular chondral surface also involving the subchondral bone. The exact cause of these lesions is unclear, but they are likely the result of a rotational ankle injury, such as a ligamentous sprain or bony fracture. OLTs are a common issue in orthopedic medicine; however, treatment remains a clinical challenge. Most OLTs can initially be managed with nonoperative treatment. When this approach fails, surgery is often indicated. Surgical intervention depends on the chronicity of the lesion, size of the lesion, presence of cystic lesions, and the stability of the cartilage. Many procedures for larger lesions require autograft or allograft tissue to fill the void, but these procedures can be very costly and do not always address the problem effectively. Understanding the true anatomy and size of these lesions may help better guide treatment, allowing for accurate preoperative planning and potential cost savings.

Conventional CT Scans Overestimate OLT Size

The results of the FAI study showed that conventional measurements of OLTs with CT scans grossly overestimated the size of the lesion. The average approximate OLT volumes from 10 independent observer CT measurements comprised of a rectangular prism (Vrec), a right cylinder (Vcyl), and right cone (Vcone) were compared to morphometric true-volume (MTV) via 3D reconstruction. On average, the Vrec, Vcyl, and Vcone estimates were 303%, 864%, and 285% greater, respectively, than the MTV. The FAI study demonstrates that volume measurements of OLTs using conventional CT typically overestimate true-volume approximations when compared to OLTs created with 3D reconstructions.

CurveBeam Imaging Provides Valuable Insights to Orthopedic Surgeons

3D reconstructions of CT scans are used frequently in orthopedic surgery; however, the usefulness of this technique in OLTs has not been reported in the literature. 3D CT scans, such as those created using CurveBeam Cone Beam CT imaging technology, provide insight previously unavailable through either 2D and plain radiography. These detailed images, like those seen below, provide more precise measurements that can assist surgeons in both accurate diagnosing and preoperative planning.

Bilateral – Talar Head Exposed Sharp Filter: CubeVue, CurveBeam’s custom visualization software, can segment a volume to reveal joint surfaces, such as the talar head.

bilateral

Talus Navicular Cluster: CurveBeam’s proprietary segmentation tools (under development) are demonstrated here using third-party viewing software.

talus

CurveBeam designs and manufactures Cone Beam CT imaging equipment for the orthopedic and podiatric specialties. CurveBeam’s pedCAT system and CubeVue custom visualization software have been installed in facilities across the United States, Europe, Australia, and China. More recently, CurveBeam’s InReach system, a multi-extremity CT optimized for hand, wrist, and elbow imaging, and LineUP system, a weight-bearing multi-extremity CT for imaging of the foot, ankle, and knee, have been added to the product line. Today, CurveBeam Cone Beam CT scans are setting new standards in orthopedic 3D imaging worldwide.

To find out more, visit https://www.curvebeam.com/about/about-curvebeam/.

 

[1] https://www.researchgate.net/publication/324808166_The_Role_of_3D_Reconstruction_True-Volume_Analysis_in_Osteochondral_Lesions_of_the_Talus_A_Case_Series

CurveBeam Plays an Important Role in the Best Research Awards at the EFAS Congress

Dr. Francois Lintz posted about being nominated for best research award at EFAS 2018 and congratulated Dr. Cesar de Cesar Netto for winning the award with his paper on Weight Bearing CT.
Dr. Francois Lintz posted about being nominated for best research award at EFAS 2018 and congratulated Dr. Cesar de Cesar Netto for winning the award with his paper on weight bearing ct.

 

The 12th annual European Foot and Ankle Society (EFAS) Congress was recently held in Geneva. As a part of this prestigious event, Dr. Cesar de Cesar Netto and Dr. Francois Lintz presented papers that were both nominated for research awards. CurveBeam is proud to have played a part in both of these important projects.

Dr. Cesar de Cesar Netto Wins Awards for Research and Best Oral Presentation

 Dr. Cesar de Cesar Netto, Clinical Fellow of Foot and Ankle Surgery at MedStar Union Memorial Hospital, was nominated and won a distinguished research award for his paper titled, “Weightbearing CT and MRI findings of Stage II Flatfoot Deformity: Can We Predict Patients at High-Risk for Foot Collapse?” Earlier in the year, he also won the best oral presentation at the FLAMeCiPP meeting, organized by the Latin American Foot and Ankle Federation.

Dr. de Cesar Netto’s research involved the prediction of soft tissue failure using weight bearing cone beam computed tomography (WBCT), an imaging modality that allows excellent evaluation of the relative three-dimensional positioning of the tarsal bones in dynamic deformities such as Acquired Adult Flatfoot Deformity (AAFD). The study indicated that WBCT can predict ligamentous injuries and dynamic bone deformity in AAFD patients.

Dr. Francois Lintz was Nominated for his Research

 Dr. Francois Lintz an orthopedic Surgeon specializing in Foot & Ankle Surgery in Toulouse, France, was also nominated for a research award for his paper, “3D Biometrics: A Prospective Comparative Evaluation of the Foot Ankle Offset Using Weight Bearing CT Semi Automatic Software.” The objective of Dr. Lintz’s study was to prospectively assess the clinical relevance and reproducibility of the Foot and Ankle Offset (FAO) value for hindfoot alignment, which requires WBCT for measurement, and compare it with previous findings. The study concluded that hindfoot alignment can be measured reliably using WBCT and demonstrated that FAO has good repeatability, and correlates well with clinical examination, 2D findings, and previous literature.

The EFAS Congress  

 The EFAS Congress provides a platform for professionals of all disciplines dealing with foot and ankle surgery and research to share their knowledge and advance the specialty. This year’s program, themed “State of the Art Foot and Ankle Surgery,” included a line-up of internationally renowned surgeons and scientists in the foot and ankle community. For this year’s gathering, the EFAS also invited representatives from two established national foot and ankle societies—the SFAS (Swiss Foot and Ankle Society) and the KFAS (Korean Foot and Ankle Society)—to share their expertise and innovative approaches in foot and ankle pathologies and treatments. The result was a program that provided a multidisciplinary, comprehensive overview of the latest scientific and clinical findings in foot and ankle surgery, state of the art surgical techniques, biomechanics, efficient conservative treatments, and the most recent imaging modalities in the field.

To watch a recording of the Weight Bearing CT International Study Group’s open scientific meeting at EFAS, click here.