Difference between revisions of "X-ray of ankle osteoarthritis"
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| + | [[File:X-ray of ankle osteoarthritis.jpg|180px|right]] | ||
| + | |||
| + | ==Planning== | ||
| + | Weight-bearing radiography. | ||
==Evaluation== | ==Evaluation== | ||
| − | The Kellgren-Lawrence scale has been recommended | + | The Kellgren-Lawrence scale has been recommended,<ref>{{cite journal|url=http://www.bjjprocs.boneandjoint.org.uk/content/94-B/SUPP_XXXVII/64|title=How to assess ankle osteoarthritis: comparison of the Kellgren and Lawrence scale with functional outcome and digital image analysis|author=Nicolas Holzer, Davide Salvo, Anne Karien Marijnissen, Aminudin Che Ahmad, Emanuele Sera, Pierre Hoffmeyer, Anne Lübbeke Wolff, Mathieu Assal|journal=Orthopaedic Proceedings|date=2017-09-14|volume=94-B}}</ref> but in practice it is generally acceptable to give the degree as mild/moderate or severe. |
| + | |||
{| class="wikitable" | {| class="wikitable" | ||
|+ Kellgren-Lawrence system | |+ Kellgren-Lawrence system | ||
| Line 30: | Line 35: | ||
| Large osteophytes, marked joint space narrowing, severe sclerosis and definite bony deformity | | Large osteophytes, marked joint space narrowing, severe sclerosis and definite bony deformity | ||
|} | |} | ||
| + | |||
| + | Evaluate separately for the lateral versus medial side of the joint. | ||
===Varus or valgus=== | ===Varus or valgus=== | ||
| − | Varus or valgus deformity can be measured with the frontal tibiotalar surface angle (TTS) | + | [[File:X-ray of frontal tibiotalar surface angle (TTS).jpg|right|100px]] |
| − | [ | + | Varus or valgus deformity, if suspected, can be measured with the frontal tibiotalar surface angle (TTS), formed by the mid-longitudinal tibial axis (such as through a line bisecting the tibia at 8 and 13 cm above the tibial plafond) and the talar surface.<ref name=Nosewicz2012>{{cite journal|last1=Nosewicz|first1=Tomasz L.|last2=Knupp|first2=Markus|last3=Bolliger|first3=Lilianna|last4=Hintermann|first4=Beat|title=The reliability and validity of radiographic measurements for determining the three-dimensional position of the talus in varus and valgus osteoarthritic ankles|journal=Skeletal Radiology|volume=41|issue=12|year=2012|pages=1567–1573|issn=0364-2348|doi=10.1007/s00256-012-1421-6}}</ref> An angle of less than 84 degrees is regarded as talipes varus, and an angle of more than 94 degrees is regarded as talipes valgus.<ref>[https://pure.uva.nl/ws/files/28148791/Chapter_5.pdf Chapter 5 - Radiological morphology of peritalar instability in varus and valgus tilted ankles], in: {{cite book|author=T.L. Nosewicz|title=Acute and chronic aspects of hindfoot trauma|date=2018-09-25|isbn=9789463750479|publisher=University of Amsterdam, Faculty of Medicine (AMC-UvA)}}</ref> |
| + | ==Report== | ||
| + | *Severity grading: | ||
| + | :*A subjective grading of osteoarthritis is generally warranted, such as mild, moderate or severe, which may correspond to grades 1/2, 3 and 4, respectively, of the Kellgren-Lawrence scale. In Swedish practice, such subjective grading is regarded as sufficient to report for osteoarthritis, since the management of the disease depends on symptoms<ref>{{cite web|url=https://www.nice.org.uk/guidance/ipg538/resources/joint-distraction-for-ankle-osteoarthritis-1899871873045189|title=Joint distraction for ankle osteoarthritis, Interventional procedures guidance|date=2015-12-16|website=National Institute for Health and Care Excellence (NICE)}}</ref> and any varus/valgus deformity<ref name="BargPagenstert2013">{{cite journal|last1=Barg|first1=Alexej|last2=Pagenstert|first2=Geert I.|last3=Hügle|first3=Thomas|last4=Gloyer|first4=Marcel|last5=Wiewiorski|first5=Martin|last6=Henninger|first6=Heath B.|last7=Valderrabano|first7=Victor|title=Ankle Osteoarthritis|journal=Foot and Ankle Clinics|volume=18|issue=3|year=2013|pages=411–426|issn=10837515|doi=10.1016/j.fcl.2013.06.001}}</ref> rather than the exact grading of imaging findings. | ||
| + | :*The most severe feature(s) of the osteoarthritis, such as joint space narrowing. | ||
| + | *Any varus/valgus deformity, and if such, the degree thereof. | ||
| + | |||
| + | Example: | ||
| + | {|class="wikitable" | ||
| + | | | ||
| + | [[File:X-ray of ankle osteoarthritis.jpg|140px|left]] | ||
| + | Osteoarthritis which is severe medially with marked joint space narrowing. Varus deformity with frontal tibiotalar surface angle of 72°. | ||
| + | |} | ||
| + | {{Reporting}} | ||
{{Bottom}} | {{Bottom}} | ||
Latest revision as of 09:57, 30 July 2019
Author:
Mikael Häggström [notes 1]
Planning
Weight-bearing radiography.
Evaluation
The Kellgren-Lawrence scale has been recommended,[1] but in practice it is generally acceptable to give the degree as mild/moderate or severe.
| Grade | Description |
|---|---|
| 0 | No radiographic features of osteoarthritis |
| 1 | Osteophyte formation and possible joint space narrowing. The normal distances between the bones in the ankle are as follows:[2]
|
| 2 | Definite osteophyte formation with possible joint space narrowing |
| 3 | Multiple osteophytes, definite joint space narrowing, sclerosis and possible bony deformity |
| 4 | Large osteophytes, marked joint space narrowing, severe sclerosis and definite bony deformity |
Evaluate separately for the lateral versus medial side of the joint.
Varus or valgus
.jpg)
Varus or valgus deformity, if suspected, can be measured with the frontal tibiotalar surface angle (TTS), formed by the mid-longitudinal tibial axis (such as through a line bisecting the tibia at 8 and 13 cm above the tibial plafond) and the talar surface.[3] An angle of less than 84 degrees is regarded as talipes varus, and an angle of more than 94 degrees is regarded as talipes valgus.[4]
Report
- Severity grading:
- A subjective grading of osteoarthritis is generally warranted, such as mild, moderate or severe, which may correspond to grades 1/2, 3 and 4, respectively, of the Kellgren-Lawrence scale. In Swedish practice, such subjective grading is regarded as sufficient to report for osteoarthritis, since the management of the disease depends on symptoms[5] and any varus/valgus deformity[6] rather than the exact grading of imaging findings.
- The most severe feature(s) of the osteoarthritis, such as joint space narrowing.
- Any varus/valgus deformity, and if such, the degree thereof.
Example:
|
Osteoarthritis which is severe medially with marked joint space narrowing. Varus deformity with frontal tibiotalar surface angle of 72°. |
- See also: General notes on reporting
Notes
- ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Radlines:Authorship for details.
References
- ↑ Nicolas Holzer, Davide Salvo, Anne Karien Marijnissen, Aminudin Che Ahmad, Emanuele Sera, Pierre Hoffmeyer, Anne Lübbeke Wolff, Mathieu Assal (2017-09-14). "How to assess ankle osteoarthritis: comparison of the Kellgren and Lawrence scale with functional outcome and digital image analysis ". Orthopaedic Proceedings 94-B. Archived from the original. .
- ↑ Imai, Kan; Ikoma, Kazuya; Kido, Masamitsu; Maki, Masahiro; Fujiwara, Hiroyoshi; Arai, Yuji; Oda, Ryo; Tokunaga, Daisaku; et al. (2015). "Joint space width of the tibiotalar joint in the healthy foot ". Journal of Foot and Ankle Research 8 (1). doi:. ISSN 1757-1146.
- ↑ Nosewicz, Tomasz L.; Knupp, Markus; Bolliger, Lilianna; Hintermann, Beat (2012). "The reliability and validity of radiographic measurements for determining the three-dimensional position of the talus in varus and valgus osteoarthritic ankles ". Skeletal Radiology 41 (12): 1567–1573. doi:. ISSN 0364-2348.
- ↑ Chapter 5 - Radiological morphology of peritalar instability in varus and valgus tilted ankles, in: T.L. Nosewicz (2018-09-25). Acute and chronic aspects of hindfoot trauma . University of Amsterdam, Faculty of Medicine (AMC-UvA). ISBN 9789463750479.
- ↑ . Joint distraction for ankle osteoarthritis, Interventional procedures guidance. National Institute for Health and Care Excellence (NICE) (2015-12-16).
- ↑ Barg, Alexej; Pagenstert, Geert I.; Hügle, Thomas; Gloyer, Marcel; Wiewiorski, Martin; Henninger, Heath B.; Valderrabano, Victor (2013). "Ankle Osteoarthritis ". Foot and Ankle Clinics 18 (3): 411–426. doi:. ISSN 10837515.
