Enhancing precision in osteochondral lesions of the talus measurements and improving agreement in surgical decision‐making using weight‐bearing computed tomography and distance mapping

• Published in: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA sports traumatology, arthroscopy : official journal of the ESSKA, 2024-07, Vol.32 (7), p.1871-1879
• Main Authors: Efrima, Ben, Dahmen, Jari, Barbero, Agustin, Benady, Amit, Maccario, Camilla, Indino, Cristian, Kerkhoffs, Gino, Usuelli, Federico Giuseppe
• Format: Article
• Language: English
• Subjects: distance mapping; foot and ankle surgery; osteochondral lesions of the talus; weight‐bearing computer tomography
• ISSN: 0942-2056; 1433-7347; 1433-7347
• DOI: 10.1002/ksa.12172

Purpose Weight‐bearing computed tomography (WBCT) enables the creation of a three‐dimensional (3D) model that represents the ankle morphology in a standing position. Distance mapping (DM) is a complementary feature that uses color coding to represent the relative intraarticular distance and can be used to outline intraarticular defects. Consequently, DM offers a novel approach to delineating osteochondral lesions of the talus (OLT), allowing for the quantification of its surface, volume and depth. The reliability of DM for OLT measurements has yet to be thoroughly evaluated. This study primarily aims to determine the reliability of DM in measuring the surface, depth and volume of OLT. A secondary objective is to ascertain whether measurements obtained through DM, when integrated with a predefined treatment algorithm, can facilitate consensus among surgeons regarding the optimal surgical intervention. Methods This cohort comprised 36 patients with 40 OLTs evaluated using WBCT and DM. Two raters used DM to determine the lesion boundary (LB) and lesion fundus (LF) and calculate the lesion depth, surface and volume. The raters were asked to choose between bone marrow stimulation, autologous matrix‐induced chondrogenesis and osteochondral transposition based on the measurement. Inter‐rater and intra‐rater agreement was measured. Results Interclass correlation of the lesion's depth surface produced an excellent inter‐rater and intra‐rater agreement of 0.90–0.94 p