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Published in: Skeletal Radiology 7/2012

01-07-2012 | Scientific Article

Ankle post-traumatic osteoarthritis: a CT arthrography study in patients with bi- and trimalleolar fractures

Authors: Pantelis Kraniotis, Spyridon Maragkos, Minos Tyllianakis, Theodore Petsas, Apostolos H. Karantanas

Published in: Skeletal Radiology | Issue 7/2012

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Abstract

Purpose

To detect radiographically occult cartilage lesions using CT arthrography (CTa) in patients with malleolar fractures treated with open reduction internal fixation and to correlate the lesions with the functional outcome score.

Materials and methods

Twenty-one patients (13 men and 8 women, mean age 35 years, range 16–55) underwent ankle CTa after a mean postoperative period of 565 days (range 271–756). CTa images were analyzed by two radiologists. Articular surface post-traumatic collapse and subsequent cartilage defects or erosions were recorded in millimeters and in a binary mode (i.e., present if >50% of cartilage thickness) respectively. The functional outcome was assessed using the American Orthopedic Foot and Ankle Society (AOFAS) score by two orthopaedic surgeons. The statistical analysis correlated the AOFAS score with both imaging parameters and was performed with ANOVA using the MedCalc statistical package, version 11.3.

Results

Of the total of 12 articular surface steps recorded, 2/12 (16.67%) were anterolateral, 4/12 (33.33%) posterolateral, 5/12 (41.67%) anteromedial, and 1/12(8.33%) posteromedial. Of the total of 42 cartilage lesions, 7/42 (16.67%) were anterolateral, 14/42 (33.33%) posterolateral, 12/42 (28.57%) anteromedial, and 9/42 (21.43%) posteromedial. The mean AOFAS score was 8.67 (range 5.95–9.70). There was no statistically significant correlation between the AOFAS score and the post-traumatic internal derangement of the ankle joint (p = 0.524).

Conclusion

CTa detects radiographically silent cartilage lesions in patients with fractures of the ankle joint. There is no correlation of the extent of lesions and the patient’s AOFAS score.
Literature
1.
go back to reference Michelson JD. Ankle fractures resulting from rotational injuries. J Am Acad Orthop Surg. 2003;11(6):403–12.PubMed Michelson JD. Ankle fractures resulting from rotational injuries. J Am Acad Orthop Surg. 2003;11(6):403–12.PubMed
2.
go back to reference van den Bekerom MP, Lamme B, Hogervorst M, Bolhuis HW. Which ankle fractures require syndesmotic stabilization? J Foot Ankle Surg. 2007;46(6):456–63.PubMedCrossRef van den Bekerom MP, Lamme B, Hogervorst M, Bolhuis HW. Which ankle fractures require syndesmotic stabilization? J Foot Ankle Surg. 2007;46(6):456–63.PubMedCrossRef
3.
go back to reference McKenna PB, O’Shea K, Burke T. Less is more: lag screw only fixation of lateral malleolar fractures. Int Orthop. 2007;31(4):497–502.PubMedCrossRef McKenna PB, O’Shea K, Burke T. Less is more: lag screw only fixation of lateral malleolar fractures. Int Orthop. 2007;31(4):497–502.PubMedCrossRef
4.
go back to reference Lahm A, Erggelet C, Steinwachs M, Reichelt A. Arthroscopic management of osteochondral lesions of the talus: results of drilling and usefulness of magnetic resonance imaging before and after treatment. Arthroscopy. 2000;16(3):299–304.PubMedCrossRef Lahm A, Erggelet C, Steinwachs M, Reichelt A. Arthroscopic management of osteochondral lesions of the talus: results of drilling and usefulness of magnetic resonance imaging before and after treatment. Arthroscopy. 2000;16(3):299–304.PubMedCrossRef
5.
go back to reference Schmid MR, Pfirrmann CW, Hodler J, Vienne P, Zanetti M. Cartilage lesions in the ankle joint: comparison of MR arthrography and CT arthrography. Skeletal Radiol. 2003;32(5):259–65.PubMedCrossRef Schmid MR, Pfirrmann CW, Hodler J, Vienne P, Zanetti M. Cartilage lesions in the ankle joint: comparison of MR arthrography and CT arthrography. Skeletal Radiol. 2003;32(5):259–65.PubMedCrossRef
6.
go back to reference Stufkens SA, Knupp M, Horisberger M, Lampert C, Hintermann B. Cartilage lesions and the development of osteoarthritis after internal fixation of ankle fractures: a prospective study. J Bone Joint Surg Am. 2010;92(2):279–86.PubMedCrossRef Stufkens SA, Knupp M, Horisberger M, Lampert C, Hintermann B. Cartilage lesions and the development of osteoarthritis after internal fixation of ankle fractures: a prospective study. J Bone Joint Surg Am. 2010;92(2):279–86.PubMedCrossRef
7.
go back to reference De Smet AA, Ilahi OA, Graf BK. Reassessment of the MR criteria for stability of osteochondritis dissecans in the knee and ankle. Skeletal Radiol. 1996;25(2):159–63.PubMedCrossRef De Smet AA, Ilahi OA, Graf BK. Reassessment of the MR criteria for stability of osteochondritis dissecans in the knee and ankle. Skeletal Radiol. 1996;25(2):159–63.PubMedCrossRef
8.
go back to reference Shepherd DE, Seedhom BB. Thickness of human articular cartilage in joints of the lower limb. Ann Rheum Dis. 1999;58(1):27–34.PubMedCrossRef Shepherd DE, Seedhom BB. Thickness of human articular cartilage in joints of the lower limb. Ann Rheum Dis. 1999;58(1):27–34.PubMedCrossRef
9.
go back to reference Tan TC, Wilcox DM, Frank L, Shih C, Trudell DJ, Sartoris DJ, et al. MR imaging of articular cartilage in the ankle: comparison of available imaging sequences and methods of measurement in cadavers. Skeletal Radiol. 1996;25(8):749–55.PubMedCrossRef Tan TC, Wilcox DM, Frank L, Shih C, Trudell DJ, Sartoris DJ, et al. MR imaging of articular cartilage in the ankle: comparison of available imaging sequences and methods of measurement in cadavers. Skeletal Radiol. 1996;25(8):749–55.PubMedCrossRef
10.
go back to reference Gagliardi JA, Chung EM, Chandnani VP, Kesling KL, Christensen KP, Null RN, et al. Detection and staging of chondromalacia patellae: relative efficacies of conventional MR imaging, MR arthrography, and CT arthrography. AJR Am J Roentgenol. 1994;163(3):629–36.PubMed Gagliardi JA, Chung EM, Chandnani VP, Kesling KL, Christensen KP, Null RN, et al. Detection and staging of chondromalacia patellae: relative efficacies of conventional MR imaging, MR arthrography, and CT arthrography. AJR Am J Roentgenol. 1994;163(3):629–36.PubMed
11.
go back to reference Kramer J, Recht MP, Imhof H, Stiglbauer R, Engel A. Postcontrast MR arthrography in assessment of cartilage lesions. J Comput Assist Tomogr. 1994;18(2):218–24.PubMedCrossRef Kramer J, Recht MP, Imhof H, Stiglbauer R, Engel A. Postcontrast MR arthrography in assessment of cartilage lesions. J Comput Assist Tomogr. 1994;18(2):218–24.PubMedCrossRef
12.
go back to reference Rand T, Brossmann J, Pedowitz R, Ahn JM, Haghigi P, Resnick D. Analysis of patellar cartilage. Comparison of conventional MR imaging and MR and CT arthrography in cadavers. Acta Radiol. 2000;41(5):492–7.PubMed Rand T, Brossmann J, Pedowitz R, Ahn JM, Haghigi P, Resnick D. Analysis of patellar cartilage. Comparison of conventional MR imaging and MR and CT arthrography in cadavers. Acta Radiol. 2000;41(5):492–7.PubMed
13.
go back to reference Bredella MA, Tirman PF, Peterfy CG, Zarlingo M, Feller JF, Bost FW, et al. Accuracy of T2-weighted fast spin-echo MR imaging with fat saturation in detecting cartilage defects in the knee: comparison with arthroscopy in 130 patients. AJR Am J Roentgenol. 1999;172(4):1073–80.PubMed Bredella MA, Tirman PF, Peterfy CG, Zarlingo M, Feller JF, Bost FW, et al. Accuracy of T2-weighted fast spin-echo MR imaging with fat saturation in detecting cartilage defects in the knee: comparison with arthroscopy in 130 patients. AJR Am J Roentgenol. 1999;172(4):1073–80.PubMed
14.
go back to reference Disler DG, McCauley TR, Kelman CG, Fuchs MD, Ratner LM, Wirth CR, et al. Fat-suppressed three-dimensional spoiled gradient-echo MR imaging of hyaline cartilage defects in the knee: comparison with standard MR imaging and arthroscopy. AJR Am J Roentgenol. 1996;167(1):127–32.PubMed Disler DG, McCauley TR, Kelman CG, Fuchs MD, Ratner LM, Wirth CR, et al. Fat-suppressed three-dimensional spoiled gradient-echo MR imaging of hyaline cartilage defects in the knee: comparison with standard MR imaging and arthroscopy. AJR Am J Roentgenol. 1996;167(1):127–32.PubMed
15.
go back to reference Murphy BJ. Evaluation of grades 3 and 4 chondromalacia of the knee using T2*-weighted 3D gradient-echo articular cartilage imaging. Skeletal Radiol. 2001;30(6):305–11.PubMedCrossRef Murphy BJ. Evaluation of grades 3 and 4 chondromalacia of the knee using T2*-weighted 3D gradient-echo articular cartilage imaging. Skeletal Radiol. 2001;30(6):305–11.PubMedCrossRef
16.
go back to reference Recht MP, Piraino DW, Paletta GA, Schils JP, Belhobek GH. Accuracy of fat-suppressed three-dimensional spoiled gradient-echo FLASH MR imaging in the detection of patellofemoral articular cartilage abnormalities. Radiology. 1996;198(1):209–12.PubMed Recht MP, Piraino DW, Paletta GA, Schils JP, Belhobek GH. Accuracy of fat-suppressed three-dimensional spoiled gradient-echo FLASH MR imaging in the detection of patellofemoral articular cartilage abnormalities. Radiology. 1996;198(1):209–12.PubMed
17.
go back to reference Vande Berg BC, Lecouvet FE, Poilvache P, Jamart J, Materne R, Lengele B, et al. Assessment of knee cartilage in cadavers with dual-detector spiral CT arthrography and MR imaging. Radiology. 2002;222(2):430–6.PubMedCrossRef Vande Berg BC, Lecouvet FE, Poilvache P, Jamart J, Materne R, Lengele B, et al. Assessment of knee cartilage in cadavers with dual-detector spiral CT arthrography and MR imaging. Radiology. 2002;222(2):430–6.PubMedCrossRef
18.
go back to reference Vande Berg BC, Lecouvet FE, Poilvache P, Maldague B, Malghem J. Spiral CT arthrography of the postoperative knee. Semin Musculoskelet Radiol. 2002;6(1):47–55.PubMedCrossRef Vande Berg BC, Lecouvet FE, Poilvache P, Maldague B, Malghem J. Spiral CT arthrography of the postoperative knee. Semin Musculoskelet Radiol. 2002;6(1):47–55.PubMedCrossRef
19.
go back to reference White LM, Buckwalter KA. Technical considerations: CT and MR imaging in the postoperative orthopedic patient. Semin Musculoskelet Radiol. 2002;6(1):5–17.PubMedCrossRef White LM, Buckwalter KA. Technical considerations: CT and MR imaging in the postoperative orthopedic patient. Semin Musculoskelet Radiol. 2002;6(1):5–17.PubMedCrossRef
20.
go back to reference Vande Berg B, Malghem J, Maldague B, Lecouvet F. Multi-detector CT imaging in the postoperative orthopedic patient with metal hardware. Eur J Radiol. 2006;60(3):470–9.PubMedCrossRef Vande Berg B, Malghem J, Maldague B, Lecouvet F. Multi-detector CT imaging in the postoperative orthopedic patient with metal hardware. Eur J Radiol. 2006;60(3):470–9.PubMedCrossRef
21.
go back to reference Disler DG, Recht MP, McCauley TR. MR imaging of articular cartilage. Skeletal Radiol. 2000;29(7):367–77.PubMedCrossRef Disler DG, Recht MP, McCauley TR. MR imaging of articular cartilage. Skeletal Radiol. 2000;29(7):367–77.PubMedCrossRef
22.
go back to reference Trattnig S, Mlynarik V, Huber M, Ba-Ssalamah A, Puig S, Imhof H. Magnetic resonance imaging of articular cartilage and evaluation of cartilage disease. Invest Radiol. 2000;35(10):595–601.PubMedCrossRef Trattnig S, Mlynarik V, Huber M, Ba-Ssalamah A, Puig S, Imhof H. Magnetic resonance imaging of articular cartilage and evaluation of cartilage disease. Invest Radiol. 2000;35(10):595–601.PubMedCrossRef
23.
go back to reference Waldschmidt JG, Rilling RJ, Kajdacsy-Balla AA, Boynton MD, Erickson SJ. In vitro and in vivo MR imaging of hyaline cartilage: zonal anatomy, imaging pitfalls, and pathologic conditions. Radiographics. 1997;17(6):1387–402.PubMed Waldschmidt JG, Rilling RJ, Kajdacsy-Balla AA, Boynton MD, Erickson SJ. In vitro and in vivo MR imaging of hyaline cartilage: zonal anatomy, imaging pitfalls, and pathologic conditions. Radiographics. 1997;17(6):1387–402.PubMed
24.
go back to reference Reiser M, Karpf PM, Bernett P. Diagnosis of chondromalacia patellae using CT arthrography. Eur J Radiol. 1982;2(3):181–6.PubMed Reiser M, Karpf PM, Bernett P. Diagnosis of chondromalacia patellae using CT arthrography. Eur J Radiol. 1982;2(3):181–6.PubMed
25.
go back to reference Waldt S, Bruegel M, Ganter K, Kuhn V, Link TM, Rummeny EJ, et al. Comparison of multislice CT arthrography and MR arthrography for the detection of articular cartilage lesions of the elbow. Eur Radiol. 2005;15(4):784–91.PubMedCrossRef Waldt S, Bruegel M, Ganter K, Kuhn V, Link TM, Rummeny EJ, et al. Comparison of multislice CT arthrography and MR arthrography for the detection of articular cartilage lesions of the elbow. Eur Radiol. 2005;15(4):784–91.PubMedCrossRef
26.
go back to reference El-Khoury GY, Alliman KJ, Lundberg HJ, Rudert MJ, Brown TD, Saltzman CL. Cartilage thickness in cadaveric ankles: measurement with double-contrast multi-detector row CT arthrography versus MR imaging. Radiology. 2004;233(3):768–73.PubMedCrossRef El-Khoury GY, Alliman KJ, Lundberg HJ, Rudert MJ, Brown TD, Saltzman CL. Cartilage thickness in cadaveric ankles: measurement with double-contrast multi-detector row CT arthrography versus MR imaging. Radiology. 2004;233(3):768–73.PubMedCrossRef
27.
go back to reference Cochet H, Pele E, Amoretti N, Brunot S, Lafenetre O, Hauger O. Anterolateral ankle impingement: diagnostic performance of MDCT arthrography and sonography. AJR Am J Roentgenol. 2010;194(6):1575–1580. Cochet H, Pele E, Amoretti N, Brunot S, Lafenetre O, Hauger O. Anterolateral ankle impingement: diagnostic performance of MDCT arthrography and sonography. AJR Am J Roentgenol. 2010;194(6):1575–1580.
28.
go back to reference Hauger O, Moinard M, Lasalarie JC, Chauveaux D, Diard F. Anterolateral compartment of the ankle in the lateral impingement syndrome: appearance on CT arthrography. AJR Am J Roentgenol. 1999;173(3):685–90.PubMed Hauger O, Moinard M, Lasalarie JC, Chauveaux D, Diard F. Anterolateral compartment of the ankle in the lateral impingement syndrome: appearance on CT arthrography. AJR Am J Roentgenol. 1999;173(3):685–90.PubMed
29.
go back to reference Leontaritis N, Hinojosa L, Panchbhavi VK. Arthroscopically detected intra-articular lesions associated with acute ankle fractures. J Bone Joint Surg Am. 2009;91(2):333–9.PubMedCrossRef Leontaritis N, Hinojosa L, Panchbhavi VK. Arthroscopically detected intra-articular lesions associated with acute ankle fractures. J Bone Joint Surg Am. 2009;91(2):333–9.PubMedCrossRef
30.
go back to reference Stufkens SA, Knupp M, Lampert C, van Dijk CN, Hintermann B. Long-term outcome after supination-external rotation type-4 fractures of the ankle. J Bone Joint Surg Br. 2009;91(12):1607–11.PubMedCrossRef Stufkens SA, Knupp M, Lampert C, van Dijk CN, Hintermann B. Long-term outcome after supination-external rotation type-4 fractures of the ankle. J Bone Joint Surg Br. 2009;91(12):1607–11.PubMedCrossRef
31.
go back to reference Boraiah S, Paul O, Parker RJ, Miller AN, Hentel KD, Lorich DG. Osteochondral lesions of talus associated with ankle fractures. Foot Ankle Int. 2009;30(6):481–5.PubMedCrossRef Boraiah S, Paul O, Parker RJ, Miller AN, Hentel KD, Lorich DG. Osteochondral lesions of talus associated with ankle fractures. Foot Ankle Int. 2009;30(6):481–5.PubMedCrossRef
Metadata
Title
Ankle post-traumatic osteoarthritis: a CT arthrography study in patients with bi- and trimalleolar fractures
Authors
Pantelis Kraniotis
Spyridon Maragkos
Minos Tyllianakis
Theodore Petsas
Apostolos H. Karantanas
Publication date
01-07-2012
Publisher
Springer-Verlag
Published in
Skeletal Radiology / Issue 7/2012
Print ISSN: 0364-2348
Electronic ISSN: 1432-2161
DOI
https://doi.org/10.1007/s00256-011-1292-2

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