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Subluxation of the Middle Facet of the Subtalar Joint as a Marker of Peritalar Subluxation in Adult Acquired Flatfoot Deformity: A Case-Control Study.
J Bone Joint Surg Am. 2019 Oct 16; 101(20):1838-1844.JB

Abstract

BACKGROUND

Progressive peritalar subluxation (PTS) is part of adult acquired flatfoot deformity (AAFD). We investigated the use of the middle facet as an indicator of PTS using standing, weight-bearing computed tomography (CT) images. We hypothesized that weight-bearing CT would be an accurate method of measuring increased subluxation ("uncoverage") and incongruence of the middle-facet among patients with AAFD.

METHODS

We included 30 patients with stage-II AAFD (20 female and 10 male; mean age, 57.4 years [range, 24 to 78 years]) and 30 matched controls (20 female and 10 male; mean age, 51.8 years [range, 19 to 81 years]) who underwent standing, weight-bearing CT. Two independent and blinded fellowship-trained foot and ankle surgeons measured the amount of subluxation (percentage of uncoverage) and the incongruence angle of the middle facet at the midpoint of its longitudinal length, using coronal-plane, weight-bearing, cone-beam CT images. Intraobserver and interobserver reliabilities were assessed using intraclass correlation coefficients (ICCs). Comparisons were performed using independent t tests or Wilcoxon tests. P values of <0.05 were considered significant.

RESULTS

Substantial to almost perfect intraobserver and interobserver reliability was observed for both measurements. We found that the middle facet demonstrated significantly increased PTS in patients with AAFD, with a mean value for joint uncoverage of 45.3% (95% confidence interval [CI], 38.5% to 52.1%) compared with 4.8% (95% CI, 3.2% to 6.4%) in controls (p < 0.0001). A significant difference was also found for the incongruence angle, with a mean value of 17.3° (95% CI, 14.7° to 19.9°) in the AAFD group and 0.3° (95% CI, 0.1° to 0.5°) in controls (p < 0.0001). A joint incongruence angle of >8.4° was found to be diagnostic for symptomatic stage-II AAFD.

CONCLUSIONS

We investigated the use of the middle facet of the subtalar joint as a marker for PTS in patients with AAFD. We confirmed that standing, weight-bearing CT images allowed accurate measurements and that significant differences were found in the percentage of joint uncoverage and the incongruence angle compared with controls.

CLINICAL RELEVANCE

The assessment of the amount of subluxation and incongruence of the middle facet of the subtalar joint represents an accurate diagnostic tool for symptomatic adult acquired flatfoot deformity.

Authors+Show Affiliations

The Hospital for Special Surgery, New York, NY. Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, Iowa.The Hospital for Special Surgery, New York, NY. School of Medicine, University of Sao Paulo, Sao Paulo, Brazil.The Hospital for Special Surgery, New York, NY.Ramsay GDS-Clinique de L'Union, Saint Jean, France.Drexel University, Philadelphia, Pennsylvania.The Hospital for Special Surgery, New York, NY.The Hospital for Special Surgery, New York, NY.The Hospital for Special Surgery, New York, NY.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31626008

Citation

de Cesar Netto, Cesar, et al. "Subluxation of the Middle Facet of the Subtalar Joint as a Marker of Peritalar Subluxation in Adult Acquired Flatfoot Deformity: a Case-Control Study." The Journal of Bone and Joint Surgery. American Volume, vol. 101, no. 20, 2019, pp. 1838-1844.
de Cesar Netto C, Godoy-Santos AL, Saito GH, et al. Subluxation of the Middle Facet of the Subtalar Joint as a Marker of Peritalar Subluxation in Adult Acquired Flatfoot Deformity: A Case-Control Study. J Bone Joint Surg Am. 2019;101(20):1838-1844.
de Cesar Netto, C., Godoy-Santos, A. L., Saito, G. H., Lintz, F., Siegler, S., O'Malley, M. J., Deland, J. T., & Ellis, S. J. (2019). Subluxation of the Middle Facet of the Subtalar Joint as a Marker of Peritalar Subluxation in Adult Acquired Flatfoot Deformity: A Case-Control Study. The Journal of Bone and Joint Surgery. American Volume, 101(20), 1838-1844. https://doi.org/10.2106/JBJS.19.00073
de Cesar Netto C, et al. Subluxation of the Middle Facet of the Subtalar Joint as a Marker of Peritalar Subluxation in Adult Acquired Flatfoot Deformity: a Case-Control Study. J Bone Joint Surg Am. 2019 Oct 16;101(20):1838-1844. PubMed PMID: 31626008.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Subluxation of the Middle Facet of the Subtalar Joint as a Marker of Peritalar Subluxation in Adult Acquired Flatfoot Deformity: A Case-Control Study. AU - de Cesar Netto,Cesar, AU - Godoy-Santos,Alexandre Leme, AU - Saito,Guilherme H, AU - Lintz,Francois, AU - Siegler,Sorin, AU - O'Malley,Martin J, AU - Deland,Jonathan T, AU - Ellis,Scott J, PY - 2019/10/19/entrez PY - 2019/10/19/pubmed PY - 2020/3/3/medline SP - 1838 EP - 1844 JF - The Journal of bone and joint surgery. American volume JO - J Bone Joint Surg Am VL - 101 IS - 20 N2 - BACKGROUND: Progressive peritalar subluxation (PTS) is part of adult acquired flatfoot deformity (AAFD). We investigated the use of the middle facet as an indicator of PTS using standing, weight-bearing computed tomography (CT) images. We hypothesized that weight-bearing CT would be an accurate method of measuring increased subluxation ("uncoverage") and incongruence of the middle-facet among patients with AAFD. METHODS: We included 30 patients with stage-II AAFD (20 female and 10 male; mean age, 57.4 years [range, 24 to 78 years]) and 30 matched controls (20 female and 10 male; mean age, 51.8 years [range, 19 to 81 years]) who underwent standing, weight-bearing CT. Two independent and blinded fellowship-trained foot and ankle surgeons measured the amount of subluxation (percentage of uncoverage) and the incongruence angle of the middle facet at the midpoint of its longitudinal length, using coronal-plane, weight-bearing, cone-beam CT images. Intraobserver and interobserver reliabilities were assessed using intraclass correlation coefficients (ICCs). Comparisons were performed using independent t tests or Wilcoxon tests. P values of <0.05 were considered significant. RESULTS: Substantial to almost perfect intraobserver and interobserver reliability was observed for both measurements. We found that the middle facet demonstrated significantly increased PTS in patients with AAFD, with a mean value for joint uncoverage of 45.3% (95% confidence interval [CI], 38.5% to 52.1%) compared with 4.8% (95% CI, 3.2% to 6.4%) in controls (p < 0.0001). A significant difference was also found for the incongruence angle, with a mean value of 17.3° (95% CI, 14.7° to 19.9°) in the AAFD group and 0.3° (95% CI, 0.1° to 0.5°) in controls (p < 0.0001). A joint incongruence angle of >8.4° was found to be diagnostic for symptomatic stage-II AAFD. CONCLUSIONS: We investigated the use of the middle facet of the subtalar joint as a marker for PTS in patients with AAFD. We confirmed that standing, weight-bearing CT images allowed accurate measurements and that significant differences were found in the percentage of joint uncoverage and the incongruence angle compared with controls. CLINICAL RELEVANCE: The assessment of the amount of subluxation and incongruence of the middle facet of the subtalar joint represents an accurate diagnostic tool for symptomatic adult acquired flatfoot deformity. SN - 1535-1386 UR - https://www.unboundmedicine.com/medline/citation/31626008/Subluxation_of_the_Middle_Facet_of_the_Subtalar_Joint_as_a_Marker_of_Peritalar_Subluxation_in_Adult_Acquired_Flatfoot_Deformity:_A_Case_Control_Study_ L2 - https://doi.org/10.2106/JBJS.19.00073 DB - PRIME DP - Unbound Medicine ER -