pathologic feature of early ankle arthritis.
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1 Joint space widening may be a paradoxical pathologic Ji-Beom Kim, MD Young Yi, MD Woo-Chun, Lee Seoul Foot & Ankle Center, Dubalo Orthopaedic Clinic.
2 Disclosure NO CONFLICT TO DISCLOSURE Joint space widening may be a paradoxical pathologic Ji-Beom Kim, MD Young Yi, MD Woo-Chun, Lee Our disclosures are in the Final AOFAS Mobile APP. We have no potential conficts with this presentation.
3 Joint space narrowing? Typical pathologic feature of ankle osteoarthritis. Joint space widening? Never been discussed. Some ankles showed joint space widening with bony spur.
4 Our hypothesis Joint space widening is related with anterior subluxation of the talus and multiple bony spur. Congruent talus Anterior Subluxation of talus Normal joint space Wide joint space Purpose of this study Investigate abnormalities in ankles with joint space widening by using radiographic studies.
5 Materials and methods. Study design: Retrospective study. Control group From September 2014 to August 2014 Took plain weight-bearing radiography and CT Without ankle abnormality in radiographic study. Patient group Spur excision between April 2009 and April 2014 Took plain weight-bearing radiography and CT With joint space widening
6 Define normal range of joint space width Plain weight-bearing AP radiograph 95% prediction interval in the control group = normal range Normal range of joint space width: mm Joint space widening: joint space > 4.2 mm Patient group including criteria Define anterior subluxation of the talus Plain weight-bearing lateral radiograph Measuring lateral talar station (LTS) 95% prediction interval in the control group = normal range Anterior subluxation of the talus = LTS > normal range
7 Investigate location of bone spurs Three dimensional CT of ankle. Count locations of spur 4 areas Define ankle instability Anterior and varus stress radiograph Anterior ankle instability Posterior joint space > 6mm in stress radiograph Varus ankle instability Talar tilt > 6 in stress radiograph
8 Control group 73 ankles (63 patients) with no abnormality in radiographic studies (plain radiographs and CT) Patient group 32 ankles (29 patients) with joint space width > 4.2mm Ankle abnormalities which investigated in the patient group. Anterior subluxation of the talus location of bony spurs Ankle instability
9 1. Anterior subluxation of the talus in the patient group Lateral talar station (LTS) Normal range: ~ 3.80 mm (95% prediction in control group) Patients group LTS range: 3.91 ~ mm 2. Location of bone spurs in the patient group All patients have spurs on 4 areas Medial, lateral, anterior, posterior
10 3. Ankle instability in the patient group Anterior instability : 31 ankle (97%) One ankle which do not have anterior instability Anterior instability blocked by anterior spur Varus instability : 24 ankle (75%) 1. All ankles with joint space widening showed anterior subluxation of the talus. 2. All ankles with joint space widening showed multiple spur on all 4 sides of ankle % of ankles with joint space wideing showed anterior ankle instability and 75% of the ankles showed varus ankle instability.
11 Conclusion The joint space widening is a real pathology of ankle. The present study showed that the ankles with joint space widening commonly occured with anterior subluxation of the talus, multiple spurs and ankle instability. The anterior subluxation of talus and ankle instability are cause of ankle arthritis, and bone spur is a typical pathologic feature of ankle arthritis. Therefore, joint space widening may be a early feature of ankle osteoarthritis.
12 Reference Lee, Woo-Chun, et al. "Alignment of ankle and hindfoot in early stage ankle osteoarthritis." Foot & ankle international 32.7 (2011): Kile, T. A., and M. Bouchard. "Degenerative joint disease of the ankle and hindfoot." Foot and ankle. Lippincott Williams & Wilkins, Philadelphia, Scranton, Pierce E., John E. McDermott, and James V. Rogers. "The relationship between chronic ankle instability and variations in mortise anatomy and impingement spurs." Foot & ankle international 21.8 (2000):
Duration of Follow-up (mo)
Page 1 of 7 Fig. E-1 Fig. E-2 Fig. E-1 Medial ankle arthritis with medial translation of the talus and mortise widening. Note the shape of the medial malleolus (white arrow). Fig. E-2 Measurement of mortise
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