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High-stress distribution in the lateral region of the subtalar joint in the patient with chronic lateral ankle instability

  • Arthroscopy and Sports Medicine
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Purpose

Chronic lateral ankle instability (CLAI) is associated with osteoarthritis (OA). However, the characteristics of patients with CLAI who progress to OA are not clear. Measurement of Hounsfield Unit (HU) value on computed tomography (CT) is reported to be useful to evaluate the stress distribution. We aimed to evaluate the stress distribution in the ankle and subtalar joints and factors enhancing it in patients with CLAI.

Materials and methods

Thirty-three ankles with CLAI (CLAI group) and 26 ankles without CLAI (control group) were included. A mean age of CLAI was 35.2 years and control was 30.3 years. Color map was created in the ankle and subtalar joint according to the HU values using three-dimensional CT to identify the region with high HU values, and HU values in those regions were measured using two-dimensional CT and compared between control and CLAI groups. In CLAI group, the relationships between HU values and ankle activity score (AAS), OA, talar tilting angle (TTA), cartilage injury were assessed.

Results

The HU values in the anteromedial region of the talus and lateral region in the subtalar joint were higher than those in the control. In CLAI, patients with an AAS of ≧ 6, over 10° of TTA, cartilage injury, and OA changes in the medial gutter had significantly higher HU values in the lateral region of the subtalar joint than those with an AAS of ≦5, less than 10° of TTA without cartilage injury and OA change.

Conclusions

CLAI patients, especially in the patients with high activity level, large TTA, cartilage injury, and OA changes at the medial gutter, have high HU values in the lateral region of the subtalar joint, which suggests that disruption of the subtalar compensation toward OA will occur. For these patients, instability should be completely eliminated to prevent ankle OA.

Level of evidence

Level III, comparative series.

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Acknowledgements

We would like to thank Editage (www.editage.com) for English language editing.

Funding

No funds were received in support of this study.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima city, Hiroshima, 734-8551, Japan

    Tomoyuki Nakasa, Yasunari Ikuta, Junichi Sumii, Akinori Nekomoto & Nobuo Adachi

  2. Medical Center for Translational and Clinical Research, Hiroshima University Hospital, 1-2-3 Kasumi, Minamiku, Hiroshima city, Hiroshima, 734-8551, Japan

    Tomoyuki Nakasa

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  1. Tomoyuki Nakasa
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Contributions

TN collected and analyzed the data and drafted the manuscript. YI, JS and AN collected and analyzed the data. NA gave final approval to the manuscript.

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Correspondence to Tomoyuki Nakasa.

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The study was approved by the local ethics committee of our university.

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Nakasa, T., Ikuta, Y., Sumii, J. et al. High-stress distribution in the lateral region of the subtalar joint in the patient with chronic lateral ankle instability. Arch Orthop Trauma Surg 142, 1579–1587 (2022). https://doi.org/10.1007/s00402-021-04078-6

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