Dataset Information

Bilateral Symmetry, Sex Differences, and Primary Shape Factors in Ankle and Hindfoot Bone Morphology.

ABSTRACT:

Background

Ankle injuries and joint degeneration may be related to ankle bone morphology. Little data exist to characterize healthy hindfoot bone morphology. The purpose of this study was to characterize side-to-side symmetry and sex differences in ankle and hindfoot bone morphology, and to identify the primary shape factors that differentiate ankle and hindfoot bone morphology among individuals.

Methods

Computed tomography was used to create 3D surface models of the distal tibia, talus, and calcaneus for 40 ankle and hindfoot bones from 20 healthy individuals. Morphologic differences between left and right bones of the same individual and between males and females were determined. Statistical shape modeling was performed to identify primary shape variations among individuals.

Results

Side-to-side differences in bone morphology averaged 0.79 mm or less. The average distal tibia in males was larger overall than in females. No significant sex difference was noted in the tali. The average female calcaneus was longer and thinner than the average male calcaneus. Variability in ankle and hindfoot bone morphology is primarily associated with articulating surface shape, overall length and width, and tendon/ligament attachment points.

Conclusion

In general, the contralateral ankle can serve as an accurate guide for operative restoration of native ankle morphology; however, specific regions demonstrate higher asymmetry.

Clinical relevance

Knowledge of regions of high and low bilateral symmetry can improve hindfoot and ankle reconstruction. Design of ankle prostheses can be improved by accounting for differences in bone morphology associated with sex and shape differences among individuals.

SUBMITTER: Gabrielli AS

PROVIDER: S-EPMC8697112 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:OBJECTIVES:The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale is among the most used questionnaires for measuring functional recovery after a hindfoot injury. Recently, this instrument was translated and culturally adapted into a Dutch version. In this study, the measurement properties of the Dutch language version (DLV) were investigated in patients with a unilateral hindfoot fracture. DESIGN:Multicentre, prospective observational study. SETTING:This multicentre study was conducted in three Dutch hospitals. PARTICIPANTS:In total, 118 patients with a unilateral hindfoot fracture were included. Three patients were lost to follow-up. PRIMARY AND SECONDARY OUTCOME MEASURES:Patients were asked to complete the AOFAS-DLV, the Foot Function Index and the Short Form-36 on three occasions. Descriptive statistics (including floor and ceiling effects), reliability (ie, internal consistency), construct validity, reproducibility (ie, test-retest reliability, agreement and smallest detectable change (SDC)) and responsiveness were determined. RESULTS:Internal consistency was inadequate for the AOFAS-DLV total scale (?=0.585), but adequate for the function subscale (?=0.863). The questionnaire had adequate construct validity (82.4% of predefined hypotheses were confirmed), but inadequate longitudinal validity (70.6%). No floor effects were found, but ceiling effects were present in all AOFAS-DLV (sub)scales, most pronounced from 6 to 24 months after trauma onwards. Responsiveness was only adequate for the pain and alignment subscales, with a SDC of 1.7 points. CONCLUSIONS:The AOFAS Ankle-Hindfoot Scale DLV has adequate construct validity and is reliable, making it a suitable instrument for cross-sectional studies investigating functional outcome in patients with a hindfoot fracture. The inadequate longitudinal validity and responsiveness, however, hamper the use of the questionnaire in longitudinal studies and for assessing long-term functional outcome. TRIAL REGISTRATION NUMBER:NTR5613; Post-results.

Project description:ObjectivesThe American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale is among the most commonly used instruments for measuring outcome of treatment in patients who sustained a complex ankle or hindfoot injury. It consists of a patient-reported and a physician-reported part. A validated, Dutch version of this instrument is currently not available. The aim of this study was to translate the instrument into Dutch and to determine the measurement properties of the AOFAS Ankle-Hindfoot Scale Dutch language version (DLV) in patients with a unilateral ankle fracture.SettingMulticentre (two Dutch hospitals), prospective observational study.ParticipantsIn total, 142 patients with a unilateral ankle fracture were included. Ten patients were lost to follow-up.Primary and secondary outcome measuresPatients completed the subjective (patient-reported) part of the AOFAS Ankle-Hindfoot Scale-DLV. A physician or trained physician-assistant completed the physician-reported part. For comparison and evaluation of the measuring characteristics, the Foot Function Index and the Short Form-36 were completed by the patient. Descriptive statistics (including floor and ceiling effects), reliability (ie, internal consistency), construct validity, reproducibility (ie, test-retest reliability, agreement and smallest detectable change) and responsiveness were determined.ResultsThe AOFAS-DLV and its subscales showed good internal consistency (Cronbach's α >0.90). Construct validity and longitudinal validity were proven to be adequate (76.5% of predefined hypotheses were confirmed). Floor effects were not present. Ceiling effects were present from 6 months onwards, as expected. Responsiveness was adequate, with a smallest detectable change of 12.0 points.ConclusionsThe AOFAS-DLV is a reliable, valid and responsive measurement instrument for evaluating functional outcome in patients with a unilateral ankle fracture. This implies that the questionnaire is suitable to compare different treatment modalities within this population or to compare outcome across hospitals.Trial registrationThe Netherlands Trial Register (NTR5613; 05-jan-2016).