François Lintz1, Alessio Bernasconi2,3, Louise Baschet4, Céline Fernando1, Nazim Mehdi1, Cesar de Cesar Netto5. 1. Ramsay Générale de Santé, Foot and Ankle Surgery Center, Clinique de l'Union, Saint-Jean, France. 2. Foot and Ankle Unit, Royal National Orthopaedic Hospital, Stanmore, United Kingdom. 3. Department of Public Health, Orthopaedic and Traumatology Unit, University of Napoli "Federico II," Napoli, Italy. 4. Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France. 5. Department of Orthopedic Surgery, University of Alabama, Birmingham, AL, USA.
Abstract
BACKGROUND: Varus hindfoot deformity may increase the risk of chronic lateral ankle instability (CLAI). Our aim was to analyze hindfoot alignment (HFA) in patients with CLAI using weight-bearing cone beam computed tomography (WBCT) to assess this risk. METHODS: This retrospective, comparative analysis was carried out using an existing WBCT database (Talas, CurveBeam LLC), including data sets for 370 consecutive feet (189 patients) obtained between July 2016 and October 2018 at a single institution. The software provided semiautomated measurement of HFA, given as foot ankle offset (FAO). Univariate analysis was conducted to compare feet with and without CLAI against sex, age, body mass index, and FAO. Significant variables were included in a multivariable logistic model with random effects to take into account correlation between feet of the same patient. RESULTS: Forty-three feet had CLAI (34 patients). FAO (P = .0009) was significant for CLAI by univariate analysis. Mean FAO was -2.2% ± 5.5% (varus) and + 2.6% ± 4.7% (valgus) with and without CLAI history, respectively. Multivariable logistic regression adjusted for sex and age demonstrated a 35% increased odds ratio (OR) of CLAI per 1% reduction in FAO value (varus) (adjusted OR=0.64, 95% confidence interval [CI]: 0.49-0.84; P = .001) and no significant effect of sex (adjusted OR=0.52; P = .617) or age (adjusted OR=0.94; P = .165) after adjustment for FAO. CONCLUSION: A positive relationship was found between varus HFA and the risk to have CLAI. Systematic recording of FAO measurements from WBCT images along with clinical data regarding CLAI history proved successful at quantifying the risk of CLAI. LEVEL OF EVIDENCE: Level III, retrospective cohort study.
BACKGROUND: Varus hindfoot deformity may increase the risk of chronic lateral ankle instability (CLAI). Our aim was to analyze hindfoot alignment (HFA) in patients with CLAI using weight-bearing cone beam computed tomography (WBCT) to assess this risk. METHODS: This retrospective, comparative analysis was carried out using an existing WBCT database (Talas, CurveBeam LLC), including data sets for 370 consecutive feet (189 patients) obtained between July 2016 and October 2018 at a single institution. The software provided semiautomated measurement of HFA, given as foot ankle offset (FAO). Univariate analysis was conducted to compare feet with and without CLAI against sex, age, body mass index, and FAO. Significant variables were included in a multivariable logistic model with random effects to take into account correlation between feet of the same patient. RESULTS: Forty-three feet had CLAI (34 patients). FAO (P = .0009) was significant for CLAI by univariate analysis. Mean FAO was -2.2% ± 5.5% (varus) and + 2.6% ± 4.7% (valgus) with and without CLAI history, respectively. Multivariable logistic regression adjusted for sex and age demonstrated a 35% increased odds ratio (OR) of CLAI per 1% reduction in FAO value (varus) (adjusted OR=0.64, 95% confidence interval [CI]: 0.49-0.84; P = .001) and no significant effect of sex (adjusted OR=0.52; P = .617) or age (adjusted OR=0.94; P = .165) after adjustment for FAO. CONCLUSION: A positive relationship was found between varus HFA and the risk to have CLAI. Systematic recording of FAO measurements from WBCT images along with clinical data regarding CLAI history proved successful at quantifying the risk of CLAI. LEVEL OF EVIDENCE: Level III, retrospective cohort study.
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