Browsing by Author "de Cesar Netto, Cesar"
Now showing 1 - 18 of 18
Results Per Page
Sort Options
Item Open Access An Objective Computational Method to Quantify Ankle Osteoarthritis From Low-Dose Weightbearing Computed Tomography.(Foot & ankle orthopaedics, 2022-07) Tazegul, Tutku E; Anderson, Donald D; Barbachan Mansur, Nacime S; Kajimura Chinelati, Rogerio Marcio; Iehl, Caleb; VandeLune, Christian; Ahrenholz, Samuel; Lalevee, Matthieu; de Cesar Netto, CesarBackground
The treatment of ankle osteoarthritis (OA) varies depending on the severity and distribution of the associated joint degeneration. Disease staging is typically based on subjective grading of appearance on conventional plain radiographs, with reported subpar reproducibility and reliability. The purpose of this study was to develop and describe computational methods to objectively quantify radiographic changes associated with ankle OA apparent on low-dose weightbearing CT (WBCT).Methods
Two patients with ankle OA and 1 healthy control who had all undergone WBCT of the foot and ankle were analyzed. The severity of OA in the ankle of each patient was scored using the Kellgren-Lawrence (KL) classification using plain radiographs. For each ankle, a volume of interest (VOI) was centered on the tibiotalar joint. Initial computation analysis used WBCT image intensity (Hounsfield units [HU]) profiles along lines perpendicular to the subchondral bone/cartilage interface of the distal tibia extending across the entire VOI. Graphical plots of the HU distributions were generated and recorded for each line. These plots were then used to calculate the joint space width (JSW) and HU contrast.Results
The average JSW was 3.89 mm for the control ankle, 3.06 mm for mild arthritis (KL 2), and 1.57 mm for severe arthritis (KL 4). The average HU contrast was 72.31 for control, 62.69 for mild arthritis, and 33.98 for severe arthritis. The use of 4 projections at different locations throughout the joint allowed us to visualize specifically which quadrants have reduced joint space width and contrast.Conclusion
In this technique report, we describe a novel methodology for objective quantitative assessment of OA using JSW and HU contrast.Clinical relevance
Objective, software-based measurements are generally more reliable than subjective qualitative evaluations. This method may offer a starting point for the development of a more robust OA classification system or deeper understanding of the pathogenesis and response to ankle OA treatment.Item Open Access Ankle Osteoarthritis.(Revista brasileira de ortopedia, 2021-12) Godoy-Santos, Alexandre Leme; Fonseca, Lucas Furtado; de Cesar Netto, Cesar; Giordano, Vincenzo; Valderrabano, Victor; Rammelt, StefanOsteoarthritis (OA) is characterized by a chronic, progressive and irreversible degradation of the joint surface associated with joint inflammation. The main etiology of ankle OA is post-traumatic and its prevalence is higher among young and obese people. Despite advances in the treatment of fractures around the ankle, the overall risk of developing post-traumatic ankle OA after 20 years is almost 40%, especially in Weber type B and C bimalleolar fractures and in fractures involving the posterior tibial border. In talus fractures, this prevalence approaches 100%, depending on the severity of the lesion and the time of follow-up. In this context, the current understanding of the molecular signaling pathways involved in senescence and chondrocyte apoptosis is fundamental. The treatment of ankle OA is staged and guided by the classification systems and local and patient conditions. The main problems are the limited ability to regenerate articular cartilage, low blood supply, and a shortage of progenitor stem cells. The present update summarizes recent scientific evidence of post-traumatic ankle OA with a major focus on changes of the synovia, cartilage and synovial fluid; as well as the epidemiology, pathophysiology, clinical implications, treatment options and potential targets for therapeutic agents.Item Open Access Combined Lag Screw and Cerclage Wire Fixation for Calcaneal Tuberosity Avulsion Fractures.(Case reports in orthopedics, 2018-01) Giordano, Vincenzo; Godoy-Santos, Alexandre Leme; de Souza, Felipe Serrão; Koch, Hilton Augusto; de Cesar Netto, Cesar; Rammelt, StefanAvulsion fractures of the calcaneal tuberosity represent a rare injury pattern that is caused by a powerful tension force from the Achilles tendon and is usually seen following minor trauma, especially in elderly patients. The objective of this study is to describe a surgical technique using cerclage wiring through cannulated screws in the treatment of extra- and intra-articular avulsion fractures of the calcaneal tuberosity and to present our results in a small patient's cohort. Through a 5.0 cm longitudinal skin incision over the posterolateral aspect of the calcaneus, after adequate debridement of the fracture fragments and while keeping the ankle in plantarflexion, the calcaneal tuberosity is anatomically reduced with the help of a periarticular reduction clamp and an accessory plantar longitudinal approach. Provisionally fixation is performed with K-wires. Definitive fixation is achieved with two parallel partially threaded 7.0 cannulated screws, which are positioned from the superior and posterior aspect of the tuberosity to the inferior and anterior aspect of the plantar surface of the calcaneus, and 1.5 mm cerclage wires that are pulled epiperiosteally to the plantar aspect of the calcaneus to avoid damage to local soft tissues. Alternatively, for smaller fracture fragments, two 3.5 mm partially threaded cannulated screws and 1.25 mm cerclage wires can be used. We also report the results of the procedure in a small cohort of four patients. All fractures healed in an anatomic position. There was no failure of fixation, loss of reduction, or need for secondary surgery, including hardware removal. At final follow-up, all patients had regained full plantar flexion range of motion and strength, with no gait or weight-bearing restrictions. In conclusion, the combination of cerclage wire and large diameter cannulated screws represents a promising option in the treatment of avulsion fractures of the calcaneal tuberosity, demonstrating good functional and radiographic results in our cohort of patients.Item Open Access Correction to: Flexor tenodesis procedure in the treatment of lesser toe deformities.(Archives of orthopaedic and trauma surgery, 2022-11) de Cesar Netto, Cesar; Schmidt, Eli L; Lalevee, Matthieu; Mansur, Nacime Salomao BarbachanThe article Flexor tenodesis procedure in the treatment of lesser toe deformities, written by Cesar de Cesar Netto, Eli L. Schmidt, Matthieu Lalevee and Nacime Salomao Barbachan Mansur, was originally published electronically on the publisher’s internet portal on 11 May 2021 without open access. With the author(s)’ decision to opt for Open Choice the copyright of the article changed on 30 June 2021 to © The Author(s) 2021 and this article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http:// creat iveco mmons. org/ licen ses/ by/4. 0/. The original article has been corrected.Item Open Access Coverage maps demonstrate 3D Chopart joint subluxation in weightbearing CT of progressive collapsing foot deformity.(Scientific reports, 2022-11) Behrens, Andrew; Dibbern, Kevin; Dibbern, Kevin; Lalevée, Matthieu; Alencar Mendes de Carvalho, Kepler; Lintz, Francois; Barbachan Mansur, Nacime Salomao; de Cesar Netto, CesarA key element of the peritalar subluxation (PTS) seen in progressive collapsing foot deformity (PCFD) occurs through the transverse tarsal joint complex. However, the normal and pathological relations of these joints are not well understood. The objective of this study to compare Chopart articular coverages between PCFD patients and controls using weight-bearing computed tomography (WBCT). In this retrospective case control study, 20 patients with PCFD and 20 matched controls were evaluated. Distance and coverage mapping techniques were used to evaluate the talonavicular and calcaneocuboid interfaces. Principal axes were used to divide the talar head into 6 regions (medial/central/lateral and plantar/dorsal) and the calcaneocuboid interface into 4 regions. Repeated selections were performed to evaluate reliability of joint interface identification. Surface selections had high reliability with an ICC > 0.99. Talar head coverage decreases in plantarmedial and dorsalmedial (- 79%, p = 0.003 and - 77%, p = 0.00004) regions were seen with corresponding increases in plantarlateral and dorsolateral regions (30%, p = 0.0003 and 21%, p = 0.002) in PCFD. Calcaneocuboid coverage decreased in plantar and medial regions (- 12%, p = 0.006 and - 9%, p = 0.037) and increased in the lateral region (13%, p = 0.002). Significant subluxation occurs across the medial regions of the talar head and the plantar medial regions of the calcaneocuboid joint. Coverage and distance mapping provide a baseline for understanding Chopart joint changes in PCFD under full weightbearing conditions.Item Open Access Distance mapping and volumetric assessment of the ankle and syndesmotic joints in progressive collapsing foot deformity.(Scientific reports, 2023-03) Dibbern, Kevin; Vivtcharenko, Victoria; Salomao Barbachan Mansur, Nacime; Lalevée, Matthieu; Alencar Mendes de Carvalho, Kepler; Lintz, François; Barg, Alexej; Goldberg, Andrew J; de Cesar Netto, CesarThe early effects of progressive collapsing foot deformity (PCFD) on the ankle and syndesmotic joints have not been three-dimensionally quantified. This case-control study focused on using weight bearing CT (WBCT) distance (DM) and coverage maps (CM) and volumetric measurements as 3D radiological markers to objectively characterize early effects of PCFD on the ankle and syndesmotic joints. Seventeen consecutive patients with symptomatic stage I flexible PCFD and 20 matched controls that underwent foot/ankle WBCT were included. Three-dimensional DM and CM of the ankle and syndesmotic joints, as well volumetric assessment of the distal tibiofibular syndesmosis was performed as possible WBCT markers of early PCFD. Measurements were compared between PCFD and controls. Significant overall reductions in syndesmotic incisura distances were observed in PCFD patients when compared to controls, with no difference in the overall syndesmotic incisura volume at 1, 3, 5 and 10 cm proximally to the ankle joint. CMs showed significantly decreased articular coverage of the anterior regions of the tibiotalar joint as well as medial/lateral ankle joint gutters in PCFD patients. This study showed syndesmotic narrowing and decreased articular coverage of the anterior aspect of the ankle gutters and talar dome in stage I PCFD patients when compared to controls. These findings are consistent with early plantarflexion of the talus within the ankle Mortise, and absence of true syndesmotic overload in early PCFD, and support DM and CM as early 3D PCFD radiological markers.Item Open Access Early results and complication rate of the LapiCotton procedure in the treatment of medial longitudinal arch collapse: a prospective cohort study.(Archives of orthopaedic and trauma surgery, 2023-05) de Cesar Netto, Cesar; Ehret, Amanda; Walt, Jennifer; Chinelati, Rogerio Marcio Kajimura; Dibbern, Kevin; Dibbern, Kevin; de Carvalho, Kepler Alencar Mendes; Tazegul, Tutku Erim; Lalevee, Matthieu; Mansur, Nacime Salomão BarbachanIntroduction
Instability/collapse of the medial column has been associated with many conditions, particularly progressive collapsing foot deformity (PCFD), hallux valgus (HV), and midfoot arthritis (MA). Restoration of first ray length and sagittal plane alignment to restore the foot tripod is essential when treating these deformities. This study aimed to assess early results, healing, and complication rate of a distraction dorsal opening plantarflexion wedge allograft first tarsometatarsal joint fusion (LapiCotton Procedure) in patients with collapse/instability of the medial column.Methods
In this prospective cohort study, we included PCFD, HV, and MA patients that underwent a LapiCotton procedure. Fusion site healing was defined by > 50% bone bridging in both interfaces between allograft wedge and host bone using weight-bearing computed tomography (WBCT) after 3 months. First ray collapse radiographic correction and minor and major complications (deep dehiscence, deep infection, and reoperation) were assessed.Results
A total of 22 patients (22 feet) were included (11 PCFD, 6 MA, and 5 of HV patients). Mean follow-up was 5.9 months (range 3-12) and median allograft size was 8 mm (range 5-19 mm). Bone healing was observed in 91% of cases. Two minor complications (9%, both superficial dehiscence) and one major complication (4.5%, deep infection) were observed. Statistically significant improvement of the sagittal plane talus-first metatarsal angle was observed, with mean improvement of 9.4° (95% CI 6.7-12.1°; p < 0.0001).Conclusion
In this prospective cohort study of 22 patients treated with the LapiCotton procedure for medial longitudinal arch collapse/instability, we observed a low complication rate (9% minor, 4.5% major), high healing rate after 3 months (91%), one clinically stable radiographic non-union (4.5%) and one unstable non-union (4.5%) needing reoperation. Our results demonstrate promising initial results for LapiCotton technique in treating collapse of the medial longitudinal arch in patients with PCFD, MA and HV deformities. Long-term results are needed to confirm these promising results.Level of evidence
Level II, prospective cohort study.Item Open Access Flexor tenodesis procedure in the treatment of lesser toe deformities.(Archives of orthopaedic and trauma surgery, 2022-11) de Cesar Netto, Cesar; Schmidt, Eli L; Lalevee, Matthieu; Mansur, Nacime Salomao BarbachanIn this technical report study, we describe the use of a flexor tenodesis procedure in the treatment of lesser toe deformities (LTD). Using a specific implant, both the flexor digitorum longus and brevis tendons are attached to the plantar aspect of the proximal phalanx, allowing dynamic correction of flexible deformities of metatarsophalangeal and interphalangeal joints. Good clinical results and absence of complications were observed in a series of 3 patients, with considerable correction of the LTD, and absence of substantial residual floating toe or metatarsophalangeal joint stiffness. LEVEL OF EVIDENCE: V - Technical Report/Case Report/Expert Opinion.Item Open Access Foot Alignment in Symptomatic National Basketball Association Players Using Weightbearing Cone Beam Computed Tomography.(Orthopaedic journal of sports medicine, 2019-02) de Cesar Netto, Cesar; Bernasconi, Alessio; Roberts, Lauren; Pontin, Pedro Augusto; Lintz, Francois; Saito, Guilherme Honda; Roney, Andrew; Elliott, Andrew; O'Malley, MartinBackground
Weightbearing cone beam computed tomography (WB CBCT) allows detailed 3-dimensional imaging of the foot and ankle in a weightbearing state and provides improved accuracy and reliability of foot alignment measures, especially when compared with conventional radiographic views.Purpose
To describe the foot alignment in National Basketball Association (NBA) players with different symptomatic foot and ankle injuries using WB CBCT and to determine if any predominant morphotype would be identified.Study design
Cross-sectional study; Level of evidence, 3.Methods
A total of 45 active NBA players (mean age, 24.4 years [range, 20-34 years]; N = 54 feet [29 right, 25 left]) were assessed using WB CBCT. Measurements included the following: (1) foot and ankle offset (FAO), (2) calcaneal offset (CO), (3) hindfoot alignment angle (HAA), (4) angle between the inferior and superior facets of the talus (Inftal-Suptal), (5) angle between the inferior facet of the talus and the horizontal floor line (Inftal-Hor), (6) forefoot arch angle (FAA), (7) navicular-to-floor distance, and (8) medial cuneiform-to-floor distance. Measurements were then compared with values available in the literature for a "normal" foot morphotype.Results
Among the 54 feet, the mean FAO was 0.48% (95% CI, -0.25% to 1.21%), the mean CO was 1.18 mm (95% CI, -0.50 to 2.87 mm), and the mean HAA was 1.42° (95% CI, -0.80° to 3.65°). The mean Inftal-Suptal angle was 5.31° (95% CI, 3.50°-7.12°), while the mean Inftal-Hor angle was 4.04° (95% CI, 2.56°-5.51°). The mean FAA was 15.84° (95% CI, 14.73°-16.92°), the mean navicular-to-floor distance was 38.30 mm (95% CI, 36.19-40.42 mm), and the mean medial cuneiform-to-floor distance was 26.79 mm (95% CI, 25.30-28.28 mm). None of these values were found to be significantly different when comparing forwards, guards, and centers.Conclusion
NBA players presenting with symptomatic foot and ankle injuries had a fairly "normal" foot morphology, with a tendency toward a varus hindfoot and a high-arched morphotype. No significant differences were found between players based on their position on the court. WB CBCT may help to shed light on anatomic risk factors for common injuries in professional players and may aid in the planning of specific prevention programs.Item Open Access Histoarchitecture of the fibrillary matrix of human fetal posterior tibial tendons.(Scientific reports, 2022-10) Macedo, Rodrigo Sousa; Teodoro, Walcy Rosolia; Capellozzi, Vera Luiza; Rosemberg, Dov Lagus; Sposeto, Rafael Barban; de Cesar Netto, Cesar; Deland, Jonathan T; Maffulli, Nicola; Ellis, Scott J; Godoy-Santos, Alexandre LemeAdult tendons are highly differentiated. In mature individuals, tendon healing after an injury occurs through fibrotic tissue formation. Understanding the intrinsic reparative properties of fetal tendons would help to understand the maturation tissue process and tendon tissue repair. The present study evaluated the evolution of histoarchitecture, cellularity and the distribution of collagens I, III and V in the posterior tibial tendon in human fetuses at different gestational ages. Morphological profiles were assessed in nine fresh spontaneously aborted fetuses (Group I: five fetuses aged between 22 and 28 weeks of gestation; Group II: four fetuses aged between 32 and 38 weeks of gestation), characterized by a combination of histology, fluorescence and immunohistochemistry. In Group I, the posterior tibial tendon showed statistically significant greater cellularity and presence of collagen III and V than in Group II tendon, which showed a predominance of collagenous I and a better organization of the extracellular matrix compared with Group I tendons. In addition, a statistically significant higher rate of CD90, a marker of mesenchymal cells, was found in Group I tendons. In fetuses with gestational age between 22 and 28 weeks, the posterior tibialis tendons showed a thin and disorganized fibrillar structure, with an increase in collagen III and V fibers and mesenchymal cells. In the posterior tibialis tendons of fetuses with gestational age between 32 and 38 weeks, the fibrillar structure was thicker with a statistically significant increase in type I collagen and decreased cellularity.Item Open Access Impact of COVID-19 Pandemic on Patients' Perceptions of Safety and Need for Elective Foot and Ankle Surgery in the United States.(Foot & ankle orthopaedics, 2021-04) Chan, Jimmy J; Chen, Kevin K; Choi, Peter; Rojas, Edward O; Schipper, Oliver N; Aiyer, Amiethab; de Cesar Netto, Cesar; Haleem, Amgad M; Kadakia, Anish R; Vulcano, EttoreBackground
With the development of the COVID-19 pandemic, elective foot and ankle surgeries were delayed throughout the United States to divert health care resources and limit exposure. Little is known about the impact of COVID-19 on patient's willingness to proceed with elective procedures once restrictions are lifted and factors contributing to such decision.Methods
Patients across 6 US orthopedic institutions who had their elective foot and ankle surgeries cancelled secondary to the pandemic were given a questionnaire. Specifically, patients were asked about their willingness to move forward with surgery once restrictions were lifted and if not why. Pain-level and pain medication use were also assessed. Univariate analysis was used to identify factors that contribute to patient's decisions.Results
A total of 150 patients participated in this study. Twenty-one (14%) opted not to proceed with surgery once restrictions were lifted. Forty-three percent (n = 9) listed concern for COVID infection as the reason; however, 14% of them would proceed if procedures were performed in surgery center. Twenty-nine (19% of the total cohort) patients had increased pain and 11% of patients were taking more pain meds because of the delay to their procedure. Patients who decided not to proceed with surgery reported pain reduction (3% vs 14%) and lower increase in pain medication used (5% vs 12%).Conclusion
COVID-19 has made a significant impact on the health care system. Delay of elective foot and ankle procedures impact patient quality of life and outcomes. Access to surgery centers may provide a partial solution during the pandemic.Level of evidence
Level III.Item Open Access Joystick of the Talus for Correcting Malalignment During Arthroscopic Ankle Arthrodesis: A Surgical Tip.(Arthroscopy techniques, 2018-05) Bernasconi, Alessio; Mehdi, Nazim; Laborde, Julien; de Cesar Netto, Cesar; Dagneaux, Louis; Lintz, FrançoisAnkle arthrodesis has been widely reported as an effective solution in treating tibiotalar joint osteoarthritis. The arthroscopic tibiotalar approach for arthrodesis has also been proven to give excellent results in terms of bone fusion rates and reduction of wound-related pain and complications. Historically, ankle malalignment has represented one of the main contraindications for the arthroscopic procedure, but interestingly some investigators have shown that the coronal joint deformity may be addressed arthroscopically as well. Other investigators have also demonstrated that part of the valgus/varus is due to malrotation of the talus within the mortise; therefore, controlling the talar position becomes crucial for correcting more severe deformities. We present here a technique for correcting tibiotalar malalignment during arthroscopic arthrodesis in varus or valgus ankles, performed through a K-wire used as a joystick to manage the talar position on both the coronal and axial planes.Item Open Access Novel animal model for Achilles tendinopathy: Controlled experimental study of serial injections of collagenase in rabbits.(PloS one, 2018-01) de Cesar Netto, Cesar; Godoy-Santos, Alexandre Leme; Augusto Pontin, Pedro; Natalino, Renato Jose Mendonça; Pereira, Cesar Augusto Martins; Lima, Francisco Diego de Oliveira; da Fonseca, Lucas Furtado; Staggers, Jackson Rucker; Cavinatto, Leonardo Muntada; Schon, Lew Charles; de Camargo, Olavo Pires; Fernandes, Túlio DinizOur goal was to develop a novel technique for inducing Achilles tendinopathy in animal models which more accurately represents the progressive histological and biomechanical characteristic of chronic Achilles tendinopathy in humans. In this animal research study, forty-five rabbits were randomly assigned to three groups and given bilateral Achilles injections. Low dose (LD group) (n = 18) underwent a novel technique with three low-dose (0.1mg) injections of collagenase that were separated by two weeks, the high dose group (HD) (n = 18) underwent traditional single high-dose (0.3mg) injections, and the third group were controls (n = 9). Six rabbits were sacrificed from each experimental group (LD and HD) at 10, 12 and 16 weeks. Control animals were sacrificed after 16 weeks. Histological and biomechanical properties were then compared in all three groups. At 10 weeks, Bonar score and tendon cross sectional area was highest in HD group, with impaired biomechanical properties compared to LD group. At 12 weeks, Bonar score was higher in LD group, with similar biomechanical findings when compared to HD group. After 16 weeks, Bonar score was significantly increased for both LD group (11,8±2,28) and HD group (5,6±2,51), when compared to controls (2±0,76). LD group showed more pronounced histological and biomechanical findings, including cross sectional area of the tendon, Young's modulus, yield stress and ultimate tensile strength. In conclusion, Achilles tendinopathy in animal models that were induced by serial injections of low-dose collagenase showed more pronounced histological and biomechanical findings after 16 weeks than traditional techniques, mimicking better the progressive and chronic characteristic of the tendinopathy in humans.Item Open Access Reconstruction of the Peroneus Brevis Tendon Tears with Semitendinosus Tendon Autograft.(Case reports in orthopedics, 2019-01) Nishikawa, Danilo Ryuko Cândido; Duarte, Fernando Aires; Saito, Guilherme Honda; de Cesar Netto, Cesar; Monteiro, Augusto César; Prado, Marcelo Pires; de Sousa, Ivan Furlan GravaPeroneal tendon disorders are common causes of lateral and retromalleolar ankle pain. For irreparable tears of the tendon, a salvage procedure is indicated with segmental resection followed by reconstruction with tenodesis, tendon transfer, or bridging the defect using allograft or autograft. Although there is insufficient evidence to guide which of these treatment options provides the best outcomes, reconstruction with tendon allograft has provided satisfactory clinical results and is effective for pain relief and restoration of tendon function. However, there are concerns about the use of tendon allografts which include its cost and availability, disease transmission, delayed incorporation, and stretching of the graft. The aim of this study is to present the surgical technique for the reconstruction of the peroneus brevis tendon tears using semitendinosus tendon autograft as an alternative to the allograft and report the short-term results of three cases.Item Open Access Talar Middle Facet Fracture: A Report of 2 Cases.(Foot & ankle orthopaedics, 2022-07) Sakaki, Marcos Hideyo; Missima, Kenji Maeda; Barbachan Mansur, Nacime Salomão; de Cesar Netto, CesarItem Open Access The Use of Advanced Semiautomated Bone Segmentation in Hallux Rigidus.(Foot & ankle orthopaedics, 2022-10) de Carvalho, Kepler Alencar Mendes; Mallavarapu, Vineel; Ehret, Amanda; Dibbern, Kevin; Lee, Hee Young; Barbachan Mansur, Nacime Salomao; Laleveé, Matthieu; de Cesar Netto, CesarBackground
Weightbearing computed tomography (WBCT) measurements allow evaluation of several anatomical points for a correct clinical-radiographic diagnosis of pathologies, such as hallux rigidus (HR). In addition, a new semiautomatic segmentation software obtains automated 3D measurements from WBCT scan data sets, minimizing errors in reading angular measurements. The study's objective was (1) to evaluate the reliability of WBCT semiautomatic imaging measures in HR, (2) to evaluate correlation and agreement between manual and semiautomatic measures in the setting of HR, and (3) to compare semiautomatic measurements between pathologic (HR) and standard control groups.Methods
A retrospective study of HR patients was performed including 20 feet with HR. WBCT manual and semiautomatic 3D measurements were performed using the following parameters: (1) first metatarsal-proximal phalanx angle (1stMPP), (2) hallux valgus angle (HVA), (3) first to second intermetatarsal angle (IMA), (4) hallux interphalangeal angle (IPA), (5) first metatarsal length (1stML), (6) second metatarsal length (2ndML), (7) first metatarsal declination angle (1stMD), (8) second metatarsal declination angles (2ndMD), and (9) metatarsus primus elevatus (MPE). The differences between pathologic and control cases were assessed with a Wilcoxon test.Results
Interobserver and intraobserver agreement for manual vs semiautomatic WBCT measurements demonstrated excellent reliability. According to the Pearson coefficient, there was a strong positive linear correlation between both methods for the following parameters evaluated: HVA (ρ = 0.96), IMA (ρ = 0.86), IPA (ρ = 0.89), 1stML (ρ = 0.96), 2ndML (ρ = 0.91), 1stMD (ρ = 0.86), 2ndMD (ρ = 0.95), and MPE (ρ = 0.87). Comparison between the pathologic group with HR and the control (standard) group allowed for the differentiating of the pathologic (HR) from the non-pathologic conditions for MPE (p < 0.05).Conclusion
Semiautomatic measurements are reproducible and comparable to measurements performed manually, showing excellent interobserver and intraobserver agreement. The software used differentiated pathologic from nonpathologic conditions when submitted to semiautomatic MPE measurements.Level of evidence
Level III, retrospective comparative study.Item Open Access Weight-bearing cone beam CT scans in the foot and ankle.(EFORT open reviews, 2018-05) Lintz, François; de Cesar Netto, Cesar; Barg, Alexeij; Burssens, Arne; Richter, Martinus; Weight Bearing CT International Study GroupThe 3D anatomical complexity of the foot and ankle and the importance of weight-bearing in diagnosis have required the combination of conventional radiographs and medical CT.Conventional plain radiographs (XR) have demonstrated substantial limitations such as perspective, rotational and fan distortion, as well as poor reproducibility of radiographic installations. Conventional CT produces high levels of radiation exposure and does not offer weight-bearing capabilities.The literature investigating biometrics based on 2D XR has inherent limitations due to the technology itself and thereby can focus only on whether measurements are reproducible, when the real question is whether the radiographs are.Low dose weight-bearing cone beam CT (WBCT) combines 3D and weight-bearing as well as 'built in' reliability validated through industry-standardized processes during production and clinical use (quality assurance testing).Research is accumulating to validate measurements based on traditional 2D techniques, and new 3D biometrics are being described and tested.Time- and cost-efficient use in medical imaging will require the use of automatic measurements. Merging WBCT and clinical data will offer new perspectives in terms of research with the help of modern data analysis techniques. Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170066.Item Open Access Weight-bearing cone-beam computed tomography in the foot and ankle specialty: where we are and where we are going - an update.(Radiologia brasileira, 2021-05) Godoy-Santos, Alexandre Leme; Bernasconi, Alessio; Bordalo-Rodrigues, Marcelo; Lintz, François; Lôbo, Carlos Felipe Teixeira; de Cesar Netto, CesarCone-beam computed tomography (CBCT) has been applied in dentistry and medicine for nearly two decades. Its application in the foot and ankle specialty has grown exponentially in recent years. Weight-bearing CBCT allows clinicians to obtain weight-bearing images that can be viewed in all three planes and to construct three-dimensional models, similar to those constructed from traditional CT scans, as well as exposing patients to less radiation than do traditional CT scans. This technology has revolutionized diagnoses, improving the understanding of various lesions and surgical planning in the foot and ankle specialty. Ongoing studies of the use of weight-bearing CBCT in foot and ankle surgery are focused on fully automated and semi-automated three-dimensional measurements, as well as bone segmentation, mapping of the distances/orientation of the joints, and the production of customized implants. The aims of this review article are to show the evolution of this emerging tool in the foot and ankle specialty, to update those in related specialties on its use in current clinical practice, and to indicate where the research community is heading.