Accessory Talar Facet Impingement

NewsBot · Jun 25, 2014

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Accessory Talar Facet Impingement in Pathologic Conditions of the Peritalar Region in Adults
Hisateru Niki, MD, PhD; Takaaki Hirano, MD, PhD; Yui Akiyama, MD, PhD; Moroe Beppu, MD, PhD
Foot & Ankle International June 24, 2014 1071100714540891

Introduction: Associations between accessory anterolateral talar facet (AALTF) and sinus tarsi pain in adults have not been reported. This study aimed to investigate the clinical and imaging characteristics of pathologic conditions of the peritalar region in adults with painful accessory talar facet impingement (ATFI).
Methods: We included 31 patients (aged 19-75 years) with persistent sinus tarsi pain who underwent surgery and had pathologic conditions of the peritalar region, including adult acquired flatfoot deformity (AAFD; 18 patients), ankle osteoarthritis (8 patients), and ankle instability (5 patients). Continuity between the articular surface of the posterior facet of the talus and AALTF was identified on preoperative computed tomography and magnetic resonance imaging (MRI) of the cartilage. In addition, focal abutting bone marrow edema (FABME) of the talus and calcaneal neck around the AALTF on short TI inversion recovery sequence MRI was confirmed. Subtalar arthroscopy was used to evaluate the AALTF surface characteristics. Pre- and postoperative objective scores were compared. Eight pre- and postoperative radiographic parameters were compared to confirm the effect of foot alignment changes after reconstructions on sinus tarsi pain with ATFI. Pre- and postoperative changes in FABME were compared with 17.1 (7-60) months of follow-up.
Results: Subjects underwent accessory facet resection with balancing reconstruction. Arthroscopically, 66% of patients showed a focal defect on the AALTF cartilage surface, and 83% showed attenuation of the posterior capsular ligament. All x-ray parameters in AAFD patients showed significant improvement postoperatively (P < .001). Mean objective scores improved from 54.0 preoperatively to 91.0 postoperatively (P < .001). Sinus tarsi pain and FABME were absent in all cases at the final follow-up.
Conclusion: AALTF represents a new etiology of subsequent painful intra-articular talocalcaneal impingement. When addressing sinus tarsi pain, it is important to detect the signs of AALTF on MRI of the cartilage and accompanying FABME.
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Admin2 · Jun 25, 2014

Related Threads:
Anterior ankle impingement
TLAP = "too long" anterior process of calcaneus
Palpating the posterior facet of the calcaneus
Morphological Plasticity in the Talus

NewsBot · Jul 15, 2014

The Posterior Impingement View: An Alternative Conventional Projection to Detect Bony Posterior Ankle Impingement
Johannes I. Wiegerinck et al
Arthroscopy; Articles in Press

Purpose
The purpose of the current study was to clinically evaluate the diagnostic value of the new posterior impingement (PIM) view in the detection of an os trigonum, compared with the standard lateral view, using computed tomography (CT) as a reference standard.
Methods
Three observers, 2 experienced (orthopaedic surgeon and radiologist) and one inexperienced (resident), independently scored 142 radiographic images for the presence of an os trigonum. The diagnostic performance was assessed using the computed tomographic scan as the reference standard. Accuracy, sensitivity, specificity, positive predicted value (PPV), and negative predicted value (NPV) were calculated.
Results
The PIM view had significantly superior accuracy compared with the lateral view for each observer: orthopaedic surgeon, PIM view = 90 versus lateral view = 75 (P = .013); radiologist, PIM view = 80 versus lateral view = 64 (P = .019); resident, PIM view = 90 versus lateral view = 79 (P = .039). The mean sensitivity and specificity of the lateral view for all observers was 50% and 81%, respectively. For the PIM view, this was 78% and 89%, respectively. The PPV was 50% for the lateral view and 70% for the PIM view. The NPV was 84% for the lateral view and 93% for the PIM view.
Conclusions
The PIM view has significantly superior diagnostic accuracy compared with the conventional lateral view in the detection of an os trigonum. In cases of symptomatic posterior ankle impingement, we advise that a PIM view be used instead of or in addition to the standard lateral view for detection of posterior talar pathologic conditions.
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