Skip to main content

Advertisement

SpringerLink
Log in

Arthroscopic defect size measurement in osteochondral lesions of the talus underestimates the exact defect size and size measurement with arthro-MRI (MR-A) and high-resolution flat-panel CT-arthro imaging (FPCT-A)

  • Ankle
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The size of osteochondral lesions of the talus (OLTs) is highly relevant for their treatment. In addition to intraoperative measurement of defect size, preoperative planning by means of magnetic resonance imaging (MRI) or computed tomography (CT) is crucial.

Methods

Four defects of different sizes and depths were created on the talar joint surface in 14 cadaver feet. All defects were evaluated, both arthroscopically and via arthrotomy with a probe. Arthro-MRI (MR-A) and high-resolution flat-panel CT arthro scans (FPCT-A) were acquired. Length, width, and depth were measured for every defect and the defect volume was calculated. To determine the exact defect size, each talar defect was filled with plastic pellets to form a cast and the casts were scanned using FPCT to create a 3D multiplanar reconstruction data set. Finally, the surgically measured values were compared with the radiological values and the exact defect size.

Results

Overall, the surgically measured values (both arthroscopic and open) underestimated the exact defect size (p < 0.05). Arthroscopically determined defect length and width showed the largest deviation (p < 0.05) and underestimated the size in comparison with MR-A and FPCT-A. The FPCT-A measurements demonstrated higher correlation with both the arthroscopic and open surgical measurements than did the MR-A measurements (p < 0.05).

Conclusion

The exact defect size is underestimated on intraoperative measurement, in both arthroscopic and open approaches. Arthroscopic defect size measurement underestimates defect size in comparison with MR-A and FPCT-A. FPCT-A was shown to be a reliable imaging technique that allows free image reconstruction in every plane and could be considered as the new reference standard for preoperative evaluation of defect size in OLT.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Becher C, Malahias MA, Ali MM, Maffulli N, Thermann H (2019) Arthroscopic microfracture vs. arthroscopic autologous matrix-induced chondrogenesis for the treatment of articular cartilage defects of the talus. Knee Surg Sports Traumatol Arthrosc 27:2731–2736

    Article  Google Scholar 

  2. Choi WJ, Park KK, Kim BS, Lee JW (2009) Osteochondral lesion of the talus: is there a critical defect size for poor outcome? Am J Sports Med 37:1974–1980

    Article  Google Scholar 

  3. Conti MS, Ellington JK, Behrens SB (2020) Osteochondral defects of the talus: how to treat without an osteotomy. Clin Sports Med 39:893–909

    Article  Google Scholar 

  4. Corr D, Raikin J, O’Neil J, Raikin S (2021) Long-term outcomes of microfracture for treatment of osteochondral lesions of the talus. Foot Ankle Int 42:833–840

    Article  Google Scholar 

  5. D’Ambrosi R, Maccario C, Ursino C, Serra N, Usuelli FG (2018) The role of bone marrow edema on osteochondral lesions of the talus. Foot Ankle Surg 24:229–235

    Article  Google Scholar 

  6. Deng E, Gao L, Shi W, Xie X, Jiang Y, Yuan H et al (2020) Both magnetic resonance imaging and computed tomography are reliable and valid in evaluating cystic osteochondral lesions of the talus. Orthop J Sports Med 8:2325967120946697

    Article  Google Scholar 

  7. Dipaola JD, Nelson DW, Colville MR (1991) Characterizing osteochondral lesions by magnetic resonance imaging. Arthroscopy 7:101–104

    Article  CAS  Google Scholar 

  8. Flanigan DC, Carey JL, Brophy RH, Graham WC, DiBartola AC, Hamilton D et al (2017) Interrater and intrarater reliability of arthroscopic measurements of articular cartilage defects in the knee. J Bone Joint Surg Am 99:979–988

    Article  Google Scholar 

  9. Geyer S, Mattes J, Petersen W, Imhoff AB, Achtnich AE (2022) Arthroscopic one-step matrix-assisted bone marrow stimulation for the treatment of osteochondral defects of the talus. Oper Orthop Traumatol 34:295–302

    Article  Google Scholar 

  10. Guggenberger R, Winklhofer S, Spiczak JV, Andreisek G, Alkadhi H (2013) In vitro high-resolution flat-panel computed tomographic arthrography for artificial cartilage defect detection: comparison with multidetector computed tomography. Invest Radiol 48:614–621

    Article  CAS  Google Scholar 

  11. Hembree WC, Wittstein JR, Vinson EN, Queen RM, Larose CR, Singh K et al (2012) Magnetic resonance imaging features of osteochondral lesions of the talus. Foot Ankle Int 33:591–597

    Article  Google Scholar 

  12. Hurley ET, Stewart SK, Kennedy JG, Strauss EJ, Calder J, Ramasamy A (2021) Current management strategies for osteochondral lesions of the talus. Bone Joint J. 103:207–212

    Article  Google Scholar 

  13. Lee KB, Bai LB, Park JG, Yoon TR (2008) A comparison of arthroscopic and MRI findings in staging of osteochondral lesions of the talus. Knee Surg Sports Traumatol Arthrosc 16:1047–1051

    Article  Google Scholar 

  14. Lenz CG, Tan S, Carey AL, Ang K, Schneider T (2020) Matrix-induced autologous chondrocyte implantation (MACI) grafting for osteochondral lesions of the talus. Foot Ankle Int 41:1099–1105

    Article  Google Scholar 

  15. Leumann A, Valderrabano V, Plaass C, Rasch H, Studler U, Hintermann B et al (2011) A novel imaging method for osteochondral lesions of the talus–comparison of SPECT-CT with MRI. Am J Sports Med 39:1095–1101

    Article  Google Scholar 

  16. Lopez-Alcorocho JM, Guillen-Vicente I, Rodriguez-Inigo E, Navarro R, Caballero-Santos R, Guillen-Vicente M et al (2021) High-density autologous chondrocyte implantation as treatment for ankle osteochondral defects. Cartilage 12:307–319

    Article  CAS  Google Scholar 

  17. Malahias MA, Kostretzis L, Megaloikonomos PD, Cantiller EB, Chytas D, Thermann H et al (2020) Autologous matrix-induced chondrogenesis for the treatment of osteochondral lesions of the talus: a systematic review. Orthop Rev (Pavia) 12:8872

    Google Scholar 

  18. Mintz DN, Tashjian GS, Connell DA, Deland JT, O’Malley M, Potter HG (2003) Osteochondral lesions of the talus: a new magnetic resonance grading system with arthroscopic correlation. Arthroscopy 19:353–359

    Article  Google Scholar 

  19. Nakasa T, Ikuta Y, Sawa M, Yoshikawa M, Tsuyuguchi Y, Ota Y et al (2018) Evaluation of articular cartilage injury using computed tomography with axial traction in the ankle joint. Foot Ankle Int 39:1120–1127

    Article  Google Scholar 

  20. Nakasa T, Ikuta Y, Yoshikawa M, Sawa M, Tsuyuguchi Y, Adachi N (2018) Added value of preoperative computed tomography for determining cartilage degeneration in patients with osteochondral lesions of the talar dome. Am J Sports Med 46:208–216

    Article  Google Scholar 

  21. O’Connor MA, Palaniappan M, Khan N, Bruce CE (2002) Osteochondritis dissecans of the knee in children. a comparison of MRI and arthroscopic findings. J Bone Joint Surg Br 84:258–262

    Article  CAS  Google Scholar 

  22. Pagliano S, Chemouni D, Guggenberger R, Pauly V, Guenoun D, Champsaur P et al (2020) Flat-panel CT arthrography for cartilage defect detection in the ankle joint: first results in vivo. Skeletal Radiol 49:1259–1265

    Article  Google Scholar 

  23. Pirimoglu B, Ogul H, Polat G, Kantarci M, Levent A (2019) The comparison of direct magnetic resonance arthrography with volumetric interpolated breath-hold examination sequence and multidetector computed tomography arthrography techniques in detection of talar osteochondral lesions. Acta Orthop Traumatol Turc 53:209–214

    Article  Google Scholar 

  24. Ramponi L, Yasui Y, Murawski CD, Ferkel RD, DiGiovanni CW, Kerkhoffs G et al (2017) Lesion size is a predictor of clinical outcomes after bone marrow stimulation for osteochondral lesions of the talus: a systematic review. Am J Sports Med 45:1698–1705

    Article  Google Scholar 

  25. Rikken QGH, Dahmen J, Stufkens SAS, Kerkhoffs G (2021) Satisfactory long-term clinical outcomes after bone marrow stimulation of osteochondral lesions of the talus. Knee Surg Sports Traumatol Arthrosc 29:3525–3533

    Article  Google Scholar 

  26. Robinson DE, Winson IG, Harries WJ, Kelly AJ (2003) Arthroscopic treatment of osteochondral lesions of the talus. J Bone Joint Surg Br 85:989–993

    Article  CAS  Google Scholar 

  27. Rothrauff BB, Murawski CD, Angthong C, Becher C, Nehrer S, Niemeyer P et al (2018) Scaffold-based therapies proceedings of the international consensus meeting on cartilage repair of the ankle. Foot Ankle Int 39:41–47

    Article  Google Scholar 

  28. Schafer D, Boss A, Hintermann B (2003) Accuracy of arthroscopic assessment of anterior ankle cartilage lesions. Foot Ankle Int 24:317–320

    Article  Google Scholar 

  29. Schmid MR, Pfirrmann CW, Hodler J, Vienne P, Zanetti M (2003) Cartilage lesions in the ankle joint: comparison of MR arthrography and CT arthrography. Skeletal Radiol 32:259–265

    Article  CAS  Google Scholar 

  30. Seow D, Shimozono Y, Gianakos AL, Chiarello E, Mercer N, Hurley ET et al (2021) Autologous osteochondral transplantation for osteochondral lesions of the talus: high rate of return to play in the athletic population. Knee Surg Sports Traumatol Arthrosc 29:1554–1561

    Article  Google Scholar 

  31. Siston RA, Geier D, Bishop JY, Jones GL, Kaeding CC, Granger JF et al (2013) The high variability in sizing knee cartilage defects. J Bone Joint Surg Am 95:70–75

    Article  Google Scholar 

  32. Sonnow L, Koennecker S, Luketina R, Werncke T, Hinrichs JB, Meyer BC et al (2019) High-resolution flat panel CT versus 3-T MR arthrography of the wrist: initial results in vivo. Eur Radiol 29:3233–3240

    Article  CAS  Google Scholar 

  33. Sripanich Y, Dekeyser G, Steadman J, Rungprai C, Haller J, Saltzman CL et al (2021) Limitations of accessibility of the talar dome with different open surgical approaches. Knee Surg Sports Traumatol Arthrosc 29:1304–1317

    Article  Google Scholar 

  34. Tamam C, Tamam MO, Yildirim D, Mulazimoglu M (2015) Diagnostic value of single-photon emission computed tomography combined with computed tomography in relation to MRI on osteochondral lesions of the talus. Nucl Med Commun 36:808–814

    Article  Google Scholar 

  35. Usuelli FG, de Girolamo L, Grassi M, D’Ambrosi R, Montrasio UA, Boga M (2015) All-arthroscopic autologous matrix-induced chondrogenesis for the treatment of osteochondral lesions of the talus. Arthrosc Tech 4:e255-259

    Article  Google Scholar 

  36. Verhagen RA, Maas M, Dijkgraaf MG, Tol JL, Krips R, van Dijk CN (2005) Prospective study on diagnostic strategies in osteochondral lesions of the talus. Is MRI superior to helical CT? J Bone Joint Surg Br 87:41–46

    Article  CAS  Google Scholar 

  37. Yasui Y, Hannon CP, Fraser EJ, Ackermann J, Boakye L, Ross KA et al (2019) Lesion size measured on mri does not accurately reflect arthroscopic measurement in talar osteochondral lesions. Orthop J Sports Med 7:2325967118825261

    Article  Google Scholar 

Download references

Author information

Author notes

  1. Sarah Ettinger and Lena Sonnow contributed equally to this paper and share first authorship.

Authors and Affiliations

  1. Department of Orthopedic Surgery, Hannover Medical School at Diakovere Annastift, Anna-Von-Borries-Street 1-7, 30625, Hannover, Germany

    Sarah Ettinger, Christian Plaass, Alexandra Rahn & Christina Stukenborg-Colsman

  2. Institute of Radiology, Hannover Medical School, Hannover, Germany

    Lena Sonnow, Christian von Falck & Gesa Poehler

  3. International Center for Orthopedics, ATOS Clinic Heidelberg, Bismarckstr. 9-15, 69115, Heidelberg, Germany

    Christoph Becher

Authors
  1. Sarah Ettinger
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lena Sonnow
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Christian Plaass
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alexandra Rahn
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Christina Stukenborg-Colsman
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Christian von Falck
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Gesa Poehler
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Christoph Becher
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christoph Becher.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ettinger, S., Sonnow, L., Plaass, C. et al. Arthroscopic defect size measurement in osteochondral lesions of the talus underestimates the exact defect size and size measurement with arthro-MRI (MR-A) and high-resolution flat-panel CT-arthro imaging (FPCT-A). Knee Surg Sports Traumatol Arthrosc 31, 716–723 (2023). https://doi.org/10.1007/s00167-022-07241-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-022-07241-7

Keywords

Search

Navigation