Exorotated radiographic views have additional diagnostic value in detecting an osseous impediment in patients with posterior ankle impingement

On behalf of the Ankle Platform Study Group

doi:10.1136/jisakos-2019-000272

Exorotated radiographic views have additional diagnostic value in detecting an osseous impediment in patients with posterior ankle impingement

On behalf of the Ankle Platform Study Group

Research output: Contribution to journal › Article › peer-review

1 Scopus citations

Abstract

Objectives A standard lateral radiograph is the first step in the diagnostic workup in patients with posterior ankle pain. Because of overprojection by other structures at suboptimal radiographic projection angle, often an os trigonum is not discovered or erroneously be mistaken for a hypertrophic posterior talar process. The aim of this study was to identify the projection angles at which a radiograph is optimal for detecting bony impediments in patients suffering from posterior ankle impingement. Methods Using ankle CT scans of patients with posterior ankle impingement, digitally reconstructed radiographs (DRRs) simulating 13 different radiographic projection angles were generated. The ankle CT scans served as a reference for the detection of an os trigonum and hypertrophic posterior talar process. Members of the Ankleplatform Study Group were invited to assess the DRRs, for presence or absence of an os trigonum or hypertrophic posterior talar process. Diagnostic accuracy and interobserver reliability were estimated for each projection angle. In addition, the diagnostic accuracy of the standard lateral view in combination with the rotated views was calculated. Results High sensitivity for detecting an os trigonum was found for +15° (90.3%), +20° (81.7%) and +25° (89.7%) degrees of exorotation. Specificity in this range of projection angles was between 89.6% and 97.8%. Regarding the presence of a hypertrophic posterior talar process, increased sensitivity was found for +15° (65.7%), +20° (61.0%), +25° (60.7%), +30° (56.3%) and +35° (54.5%). Specificity ranged from 78.0% to 94.7%. The combination of the standard lateral view in combination with exorotated views showed higher sensitivity. For detecting an os trigonum, a negative predictive value of 94.6% (+15°), 94.1% (+20°) and 96.1% (+25°) was found. Conclusion This study underlines the additional diagnostic value of exorotated views instead of, or in addition to the standard lateral view in detecting an osseous impediment. We recommend to use the 25° exorotated view in combination with the routine standard lateral ankle view in the workup of patients with posterior ankle pain. Level of evidence Level III.

Original language	English
Pages (from-to)	181-187
Number of pages	7
Journal	Journal of ISAKOS
Volume	4
Issue number	4
DOIs	https://doi.org/10.1136/jisakos-2019-000272
State	Published - 1 Jul 2019

Keywords

X-ray
ankle
impingement

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10.1136/jisakos-2019-000272

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@article{f03ae77f0706419abe790557ae5f5b62,

title = "Exorotated radiographic views have additional diagnostic value in detecting an osseous impediment in patients with posterior ankle impingement",

abstract = "Objectives A standard lateral radiograph is the first step in the diagnostic workup in patients with posterior ankle pain. Because of overprojection by other structures at suboptimal radiographic projection angle, often an os trigonum is not discovered or erroneously be mistaken for a hypertrophic posterior talar process. The aim of this study was to identify the projection angles at which a radiograph is optimal for detecting bony impediments in patients suffering from posterior ankle impingement. Methods Using ankle CT scans of patients with posterior ankle impingement, digitally reconstructed radiographs (DRRs) simulating 13 different radiographic projection angles were generated. The ankle CT scans served as a reference for the detection of an os trigonum and hypertrophic posterior talar process. Members of the Ankleplatform Study Group were invited to assess the DRRs, for presence or absence of an os trigonum or hypertrophic posterior talar process. Diagnostic accuracy and interobserver reliability were estimated for each projection angle. In addition, the diagnostic accuracy of the standard lateral view in combination with the rotated views was calculated. Results High sensitivity for detecting an os trigonum was found for +15° (90.3%), +20° (81.7%) and +25° (89.7%) degrees of exorotation. Specificity in this range of projection angles was between 89.6% and 97.8%. Regarding the presence of a hypertrophic posterior talar process, increased sensitivity was found for +15° (65.7%), +20° (61.0%), +25° (60.7%), +30° (56.3%) and +35° (54.5%). Specificity ranged from 78.0% to 94.7%. The combination of the standard lateral view in combination with exorotated views showed higher sensitivity. For detecting an os trigonum, a negative predictive value of 94.6% (+15°), 94.1% (+20°) and 96.1% (+25°) was found. Conclusion This study underlines the additional diagnostic value of exorotated views instead of, or in addition to the standard lateral view in detecting an osseous impediment. We recommend to use the 25° exorotated view in combination with the routine standard lateral ankle view in the workup of patients with posterior ankle pain. Level of evidence Level III.",

keywords = "X-ray, ankle, impingement",

author = "{On behalf of the Ankle Platform Study Group} and Dobbe, {Johannes G.G.} and Streekstra, {Geert J.} and Leendert Blankevoort and Wiegerinck, {Johannes I.} and Mario Maas and Ruben Zwiers and {Van Dijk}, {C. Niek} and Christian Plaa{\ss} and Leho Rips and Mansur, {Nacime Salom{\~a}o Barbachan} and Kandasam Sampathkumar and Ovidiu, {Muntean George} and Alessandro Russo and Alon Burg and Harish Kurup and Andrzej Boszczyk and Gerards, {Rogier M.} and Thomas Barwick and Jayaprasad, {P. S.} and David Kim and Ivan Bojanic and Nikica Darabos and Ettore Vulcano and Paulick, {Risi Michelethomas} and Mohan Kumar and Georges Laval and Theofanis Vasilakakos and {Lopez Astegiano}, Valeria and Gaston Daguerre and Grzegorz Hajduk and Paolo Ceccarini and {De Diego Guti{\'e}rrez}, V{\'i}ctor and Christopher Brown and {\"O}rs P{\'e}csi and Diederik Verbeek and Jai Thilak and Nikolaos Koukoulias and {El Hage}, Samer and Vitor Miranda and Jeffrey Seybold and Ang{\'e}lica Mill{\'a}n and {De Arimath{\'e}a Brand{\~a}o}, Jos{\'e} and Carolina Lins and Christopher Lu and Onur Bilge and Pahlplatz, {Thijs M.J.} and Ivica Medenica and Horea Benea and Vaso Kecojevic and Pasion, {Enrique Leonardo}",

note = "Publisher Copyright: {\textcopyright} International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine 2019. No commercial re-use. See rights and permissions. Published by BMJ.",

year = "2019",

month = jul,

day = "1",

doi = "10.1136/jisakos-2019-000272",

language = "English",

volume = "4",

pages = "181--187",

journal = "Journal of ISAKOS",

issn = "2059-7754",

publisher = "BMJ Publishing Group",

number = "4",

}

TY - JOUR

T1 - Exorotated radiographic views have additional diagnostic value in detecting an osseous impediment in patients with posterior ankle impingement

AU - On behalf of the Ankle Platform Study Group

AU - Dobbe, Johannes G.G.

AU - Streekstra, Geert J.

AU - Blankevoort, Leendert

AU - Wiegerinck, Johannes I.

AU - Maas, Mario

AU - Zwiers, Ruben

AU - Van Dijk, C. Niek

AU - Plaaß, Christian

AU - Rips, Leho

AU - Mansur, Nacime Salomão Barbachan

AU - Sampathkumar, Kandasam

AU - Ovidiu, Muntean George

AU - Russo, Alessandro

AU - Burg, Alon

AU - Kurup, Harish

AU - Boszczyk, Andrzej

AU - Gerards, Rogier M.

AU - Barwick, Thomas

AU - Jayaprasad, P. S.

AU - Kim, David

AU - Bojanic, Ivan

AU - Darabos, Nikica

AU - Vulcano, Ettore

AU - Paulick, Risi Michelethomas

AU - Kumar, Mohan

AU - Laval, Georges

AU - Vasilakakos, Theofanis

AU - Lopez Astegiano, Valeria

AU - Daguerre, Gaston

AU - Hajduk, Grzegorz

AU - Ceccarini, Paolo

AU - De Diego Gutiérrez, Víctor

AU - Brown, Christopher

AU - Pécsi, Örs

AU - Verbeek, Diederik

AU - Thilak, Jai

AU - Koukoulias, Nikolaos

AU - El Hage, Samer

AU - Miranda, Vitor

AU - Seybold, Jeffrey

AU - Millán, Angélica

AU - De Arimathéa Brandão, José

AU - Lins, Carolina

AU - Lu, Christopher

AU - Bilge, Onur

AU - Pahlplatz, Thijs M.J.

AU - Medenica, Ivica

AU - Benea, Horea

AU - Kecojevic, Vaso

AU - Pasion, Enrique Leonardo

PY - 2019/7/1

Y1 - 2019/7/1

N2 - Objectives A standard lateral radiograph is the first step in the diagnostic workup in patients with posterior ankle pain. Because of overprojection by other structures at suboptimal radiographic projection angle, often an os trigonum is not discovered or erroneously be mistaken for a hypertrophic posterior talar process. The aim of this study was to identify the projection angles at which a radiograph is optimal for detecting bony impediments in patients suffering from posterior ankle impingement. Methods Using ankle CT scans of patients with posterior ankle impingement, digitally reconstructed radiographs (DRRs) simulating 13 different radiographic projection angles were generated. The ankle CT scans served as a reference for the detection of an os trigonum and hypertrophic posterior talar process. Members of the Ankleplatform Study Group were invited to assess the DRRs, for presence or absence of an os trigonum or hypertrophic posterior talar process. Diagnostic accuracy and interobserver reliability were estimated for each projection angle. In addition, the diagnostic accuracy of the standard lateral view in combination with the rotated views was calculated. Results High sensitivity for detecting an os trigonum was found for +15° (90.3%), +20° (81.7%) and +25° (89.7%) degrees of exorotation. Specificity in this range of projection angles was between 89.6% and 97.8%. Regarding the presence of a hypertrophic posterior talar process, increased sensitivity was found for +15° (65.7%), +20° (61.0%), +25° (60.7%), +30° (56.3%) and +35° (54.5%). Specificity ranged from 78.0% to 94.7%. The combination of the standard lateral view in combination with exorotated views showed higher sensitivity. For detecting an os trigonum, a negative predictive value of 94.6% (+15°), 94.1% (+20°) and 96.1% (+25°) was found. Conclusion This study underlines the additional diagnostic value of exorotated views instead of, or in addition to the standard lateral view in detecting an osseous impediment. We recommend to use the 25° exorotated view in combination with the routine standard lateral ankle view in the workup of patients with posterior ankle pain. Level of evidence Level III.

AB - Objectives A standard lateral radiograph is the first step in the diagnostic workup in patients with posterior ankle pain. Because of overprojection by other structures at suboptimal radiographic projection angle, often an os trigonum is not discovered or erroneously be mistaken for a hypertrophic posterior talar process. The aim of this study was to identify the projection angles at which a radiograph is optimal for detecting bony impediments in patients suffering from posterior ankle impingement. Methods Using ankle CT scans of patients with posterior ankle impingement, digitally reconstructed radiographs (DRRs) simulating 13 different radiographic projection angles were generated. The ankle CT scans served as a reference for the detection of an os trigonum and hypertrophic posterior talar process. Members of the Ankleplatform Study Group were invited to assess the DRRs, for presence or absence of an os trigonum or hypertrophic posterior talar process. Diagnostic accuracy and interobserver reliability were estimated for each projection angle. In addition, the diagnostic accuracy of the standard lateral view in combination with the rotated views was calculated. Results High sensitivity for detecting an os trigonum was found for +15° (90.3%), +20° (81.7%) and +25° (89.7%) degrees of exorotation. Specificity in this range of projection angles was between 89.6% and 97.8%. Regarding the presence of a hypertrophic posterior talar process, increased sensitivity was found for +15° (65.7%), +20° (61.0%), +25° (60.7%), +30° (56.3%) and +35° (54.5%). Specificity ranged from 78.0% to 94.7%. The combination of the standard lateral view in combination with exorotated views showed higher sensitivity. For detecting an os trigonum, a negative predictive value of 94.6% (+15°), 94.1% (+20°) and 96.1% (+25°) was found. Conclusion This study underlines the additional diagnostic value of exorotated views instead of, or in addition to the standard lateral view in detecting an osseous impediment. We recommend to use the 25° exorotated view in combination with the routine standard lateral ankle view in the workup of patients with posterior ankle pain. Level of evidence Level III.

KW - X-ray

KW - ankle

KW - impingement

UR - http://www.scopus.com/inward/record.url?scp=85078575445&partnerID=8YFLogxK

U2 - 10.1136/jisakos-2019-000272

DO - 10.1136/jisakos-2019-000272

M3 - Article

AN - SCOPUS:85078575445

SN - 2059-7754

VL - 4

SP - 181

EP - 187

JO - Journal of ISAKOS

JF - Journal of ISAKOS

IS - 4

ER -

Exorotated radiographic views have additional diagnostic value in detecting an osseous impediment in patients with posterior ankle impingement

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