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Wang Y, Hao Y, Sun X, Jiang L, Pu X, Zhang Y, Kang Q. Clinical Effects of Tibial Posterior Tendon Reconstruction in the Treatment of Young Athletes With Accessory Navicular Bone Syndrome. JOURNAL OF MUSCULOSKELETAL & NEURONAL INTERACTIONS 2024; 24:159-167. [PMID: 38825998 PMCID: PMC11145317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 06/04/2024]
Abstract
OBJECTIVE To compare the effects of anchor reconstruction of posterior tibial tendon with the traditional Kidner's procedure for accessory navicular bone syndrome. METHODS A retrospective analysis was conducted on 40 young athletes diagnosed with accessory navicular bone syndrome who were admitted to our hospital from 2018 to 2021. Among them, 20 patients underwent the modified Kidner procedure for the anchor reconstruction of the posterior tibial tendon (Experimental group), while the remaining 20 patients were treated with the traditional Kidner's procedure (Control group). Regular follow-ups were conducted to evaluate the degree of relief of foot symptoms and functional recovery. RESULTS All patients were followed up for 12 to 24 months (mean duration: 18.6±3.7) after the operation. At the last follow-up, significant differences were observed in the function and symptom relief of the affected foot compared to the preoperative state. The experimental group had a mean operation time of 52.10 ± 3.41 minutes, significantly shorter than the control group's 61.25 ± 2.75 minutes. The mean time to return to normal activity was 12.65 ± 1.23 weeks for the experimental group, compared to 15.25 ± 1.16 weeks for the control group. CONCLUSION The modified Kidner procedure demonstrates a higher patient satisfaction rate compared to the traditional Kidner procedure. This is attributed to its shorter duration, reduced trauma, and quicker recovery of normal activity.
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Affiliation(s)
- Yantao Wang
- The Third Department of Orthopedics, The Bethune International Peace Hospital, Shijiazhuang, Hebei Province, China
| | - Yunfei Hao
- The Orthopedics, Gaocheng People’s Hospital, Shijiazhuang, China
| | - Xiaofei Sun
- The Third Department of Orthopedics, The Bethune International Peace Hospital, Shijiazhuang, Hebei Province, China
| | - Liangliang Jiang
- The Third Department of Orthopedics, The Bethune International Peace Hospital, Shijiazhuang, Hebei Province, China
| | - Xiaopeng Pu
- The Third Department of Orthopedics, The Bethune International Peace Hospital, Shijiazhuang, Hebei Province, China
| | - Yaxing Zhang
- The Third Department of Orthopedics, The Bethune International Peace Hospital, Shijiazhuang, Hebei Province, China
| | - Qiangjun Kang
- The Third Department of Orthopedics, The Bethune International Peace Hospital, Shijiazhuang, Hebei Province, China
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Khalifa AA, Tawfik M, Fadle AA. Reply to Letter to the Editor regarding the article: "Joint preservation surgery for correcting adolescents' spasmodic flatfoot deformity: early results from a Specialized North African Foot and ankle unit". INTERNATIONAL ORTHOPAEDICS 2024; 48:321-322. [PMID: 38054993 DOI: 10.1007/s00264-023-06056-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 11/28/2023] [Indexed: 12/07/2023]
Affiliation(s)
- Ahmed A Khalifa
- Orthopedic Department, Qena Faculty of Medicine and University Hospital, South Valley University, Kilo 6 Qena-Safaga Highway, Qena, Egypt.
| | - Mohamed Tawfik
- Orthopedic Department, Assiut University Hospital, Assiut, Egypt
| | - Amr A Fadle
- Orthopedic Department, Assiut University Hospital, Assiut, Egypt
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Zhao Z, Zhang B, Rong C, Zhang L. Letter to the Editor regarding the article: "Joint preservation surgery for correcting adolescents' spasmodic flatfoot deformity: early results from a specialized North African foot and ankle unit". INTERNATIONAL ORTHOPAEDICS 2024; 48:315. [PMID: 37989810 DOI: 10.1007/s00264-023-06035-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 11/05/2023] [Indexed: 11/23/2023]
Affiliation(s)
- Zhenguo Zhao
- Department of Hand and Foot Surgery, Affiliated Hospital of Jining Medical University, Jining, 272029, Shandong, China.
| | - Bo Zhang
- Department of Hand and Foot Surgery, Affiliated Hospital of Jining Medical University, Jining, 272029, Shandong, China
| | - Cunmin Rong
- Department of Hand and Foot Surgery, Affiliated Hospital of Jining Medical University, Jining, 272029, Shandong, China
| | - Lei Zhang
- Department of Hand and Foot Surgery, Affiliated Hospital of Jining Medical University, Jining, 272029, Shandong, China
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Xiang F, Liu ZQ, Zhang XP, Li YJ, Wen J. Accessory navicular in children. World J Clin Cases 2023; 11:8256-8262. [PMID: 38130606 PMCID: PMC10731211 DOI: 10.12998/wjcc.v11.i35.8256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/06/2023] [Accepted: 12/04/2023] [Indexed: 12/14/2023] Open
Abstract
Accessory navicular (AN) is a developmental variation of the secondary ossification center of the navicular tuberosity. Ten percent of patients with AN will have pain symptoms that affect walking and life. As the AN changes the position of the posterior tibial tendon insertion, children with AN often have posterior tibial tendon function insufficiency and flexible flat foot. Surgical treatment is often required after failure of conservative treatment. This article reviewed the etiology, clinical manifestations, complications, and treatment methods of AN.
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Affiliation(s)
- Feng Xiang
- Department of Traumatic Orthopedics, Zhuzhou Central Hospital, The Affiliated Zhuzhou Hospital of Xiangya Medical College, Central South University, Zhuzhou 412007, Hunan Province, China
| | - Zhi-Qing Liu
- Department of Traumatic Orthopedics, Zhuzhou Central Hospital, The Affiliated Zhuzhou Hospital of Xiangya Medical College, Central South University, Zhuzhou 412007, Hunan Province, China
| | - Xi-Ping Zhang
- Department of Traumatic Orthopedics, Zhuzhou Central Hospital, The Affiliated Zhuzhou Hospital of Xiangya Medical College, Central South University, Zhuzhou 412007, Hunan Province, China
| | - Yan-Jun Li
- Department of Traumatic Orthopedics, Zhuzhou Central Hospital, The Affiliated Zhuzhou Hospital of Xiangya Medical College, Central South University, Zhuzhou 412007, Hunan Province, China
| | - Jie Wen
- Department of Pediatric Orthopedics, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
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Gong H, Xie Y, Song Z, Tang Z, Wen J, Xiao S. A modified method for reconstruction of posterior tibial tendon after resection of juvenile painful type II accessory navicular. J Orthop Surg Res 2023; 18:912. [PMID: 38031163 PMCID: PMC10688484 DOI: 10.1186/s13018-023-04383-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 11/18/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND The surgical treatment of accessory navicular (AN) is divided into simple resection of AN and Kidner surgery used to reconstruct posterior tibial tendon (PTT) after AN resection. However, both of these procedures have certain disadvantages. Herein, we proposed a modified method to reconstruct PTT and compared the short-term clinical effect of our method with the modified Kidner procedure. METHODS We collected data from 23 adolescent children with painful type II AN treated in our department between January 2015 and June 2020. The American Orthopedic Foot and Ankle Society Ankle-Hind foot (AOFAS-AH) Scores, the Meary Angle, and Pitch Angle of the lateral weight-bearing plain radiographs status were recorded before and after the operation to evaluate the treatment outcomes. RESULTS In the modified Kidner surgery (MK) group, the median AOFAS-AH increased from 61 (59-68) to 87 (83-91) (P < 0.05); the Pitch angle of the lateral weight-bearing plain radiographs increased from 13.0 (8-18) to 17.4 (14-22), and the Meary angle decreased from 18.3 (14-24) to 14.2 (8-20) (P < 0.05). In the PTT preservation folded suture (FS) group, the median AOFAS-AH increased from 61 (59-68) to 87 (85-91) (P < 0.05); the Pitch angle of the lateral weight-bearing plain radiographs increased from 12.3 (7-18) to 18.4 (15-26), and the Meary angle decreased from 17.8 (13-23) to 5.7 (3-8) (P < 0.05). There was no significant difference in AOFAS-AH postoperative scores between the FS group and MK group; however, the improvement on Pitch and Meary angle of the lateral weight-bearing plain radiographs was significantly better in the FS group than in MK group (P < 0.05). CONCLUSIONS For painful type II AN in juvenile patients, the insertion-preserving folding suture procedure had similar short-term results on AOFAS-AH scores but greater improvement in the Meary angle and the Pitch Angle than the modified Kidner method. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Haoli Gong
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, 410005, China
| | - Yuyin Xie
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, 410005, China
| | - Zhenqi Song
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, 410005, China
| | - Zhongwen Tang
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, 410005, China
| | - Jie Wen
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, 410005, China.
- Department of Anatomy, Hunan Normal University School of Medicine, Changsha, 410013, Hunan, China.
| | - Sheng Xiao
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, 410005, China
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Fang K, Bi T, Hong A, Li X, Gong H, Li B, Li F, Wen J, Xiao S. Efficacy of modified kidner procedure combined with subtalar arthroereisis treating adolescent type 2 painful accessory navicular with flexible flatfoot. Front Pediatr 2023; 11:1258032. [PMID: 37675392 PMCID: PMC10477987 DOI: 10.3389/fped.2023.1258032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 08/09/2023] [Indexed: 09/08/2023] Open
Abstract
Purpose To investigate the clinical efficacy of modified kidner procedure combined with subtalar arthroereisis in the treatment of adolescent type II painful accessory navicular with flexible flatfoot. Methods From January 2018 to January 2022, 25 adolescent patients (40 feet) with painful type II accessory navicular and flexible flatfoot admitted to our hospital were enrolled in the study, including 13 males (23 feet) and 12 females (17 feet). All patients underwent modified kidner procedure combined with subtalar joint arthrodesis. The Meary's Angle, the first metatarsal Angle of talus (APTMT), the second metatarsal Angle of talus, Pitch Angle, talus tilt Angle, talonavicular coverage Angle (TCA), talus calcaneal Angle (LTCA), and calcaneal Angle were measured on weight-bearing anteroposterior and lateral x-ray films before operation and at last follow-up. The American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score and visual analogue scale (VAS) were used to evaluate the improvement of foot function and pain. Results All patients were followed up for average 17.4 ± 2.6 months (12-24). The incisions of 25 patients healed by first intention. The weight-bearing anteroposterior and lateral x-ray films of the foot showed that the suture anchors did not pull out or break, and the foot arch did not collapse further. There was no screw withdrawal or secondary operation to remove the screw in all patients. At the last follow-up, the postoperative visual analogue scale (VAS) score of the affected foot was significantly lower than that before operation (P < 0.01), and the American Orthopaedic Foot and Ankle Society (AOFAS) foot function score was significantly higher than that before operation (P < 0.01). At the last follow-up, the weight-bearing anteroposterior and lateral foot x-ray films showed that: The Meary's Angle, the first metatarsal Angle of the talus (APTMT), the second metatarsal Angle of the talus, Pitch Angle, talar tilt Angle, talonavicular overbite Angle (TCA), talocalcaneal Angle (LTCA), and calcaneal Angle significantly improved when compared with those before operation (P < 0.01). Conclusions The modified kidner procedure combined with subtalar arthroereisis has a good clinical effect in the treatment of adolescent type II painful accessory navicular with flexible flatfoot, which can effectively improve the pain symptoms, improve the foot function and imaging manifestations, and correct the flatfoot deformity.
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Affiliation(s)
- Ke Fang
- Department of Pediatric Orthopedics, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Ting Bi
- Department of Pediatric Orthopedics, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Ao Hong
- Department of Pediatric Orthopedics, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Xin Li
- Department of Pediatric Orthopedics, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Haoli Gong
- Department of Pediatric Orthopedics, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Bo Li
- Department of Pediatric Orthopedics, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Fanling Li
- Department of Pediatric Orthopedics, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Jie Wen
- Department of Pediatric Orthopedics, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
- Department of Anatomy, Hunan Normal University School of Medicine, Changsha, China
| | - Sheng Xiao
- Department of Pediatric Orthopedics, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
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Silva BAMDA, Silva NADA, Vasconcelos JB. MODIFIED MUBARAK TECHNIQUE FOR FLEXIBLE FLATFOOT CORRECTION IN CHILDREN AND ADOLESCENTS. ACTA ORTOPEDICA BRASILEIRA 2023; 31:e265045. [PMID: 37547233 PMCID: PMC10399999 DOI: 10.1590/1413-785220233104e265045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 10/19/2022] [Indexed: 08/08/2023]
Abstract
Objective To describe the technique, analyze possible radiographic correction and evaluate the clinical result of medial and plantar calcaneal displacement osteotomy associated with opening wedge cuboid osteotomy for flexible flatfoot correction. Methods 23 patients (30 feet) diagnosed with flexible flat foot treated with plantar and medial calcaneal displacement osteotomy associated with opening wedge cuboid osteotomy were evaluated retrospectively. In the lateral radiographs calcaneal pitch and Meary's angle were the radiographic parameters evaluated; while the talonavicular coverage angle was evaluated in the anteroposterior radiographs. To assess the clinical outcome of the surgical procedure, the American Orthopedic Foot and Ankle Society Score (AOFAS) for the ankle and hindfoot was adopted. Results The mean values of the evaluated angles and AOFAS score for ankle and hindfoot significantly improved when comparing pre- and postoperative values. Conclusion Plantar and medial calcaneal displacement osteotomy associated with an opening wedge cuboid osteotomy is able to improve radiological and clinical parameters of child patients with flexible flatfoot. Level of Evidence III, Retrospective Comparative Study.
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Affiliation(s)
- Bruno Air Machado DA Silva
- Hospital de Urgencias de Aparecida de Goiania, Goiania, GO, Brazil
- Instituto Ortopedico de Goiania, Goiania, GO, Brazil
| | - Nilzio Antônio DA Silva
- Universidade Federal de Goiania, Escola de Medicina, Departamento de Reumatologia, Goiania, GO, Brazil
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Gan TJ, Liu X, Li YX, Chen Y, Li J, Zhang H. Is Kidner procedure necessary during subtalar arthroereisis for pediatric flexible flatfoot that combined with symptomatic type 2 accessory navicular? A retrospective comparative study. Foot Ankle Surg 2023:S1268-7731(23)00094-2. [PMID: 37221108 DOI: 10.1016/j.fas.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 05/11/2023] [Accepted: 05/13/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND Kidner procedure is thought to be able to eliminate the medial foot pain and contribute to restoring the medial longitudinal foot arch, making it particularly suitable for surgical treatment of pes planus that combined with symptomatic type 2 accessory navicular (AN). However, controversy remains, and the clinical evidence is still lacking. The aim of the current study is to verify the necessity of Kidner procedure during subtalar arthroereisis (STA) for pediatric flexible flatfoot (PFF) that combined with symptomatic type 2 AN. METHODS Forty pediatric patients (72 feet) who had undergone STA for flexible flatfoot and were also diagnosed with symptomatic type 2 AN concomitantly were reviewed retrospectively and divided into two groups (STA + Kidner vs STA alone). The visual analog scale (VAS), the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale, the Oxford ankle foot questionnaire for children (OAFQC), and the radiographic parameters that quantifying pes planus were evaluated as primary outcomes. Secondary outcomes included the incidence of complications. RESULTS There were 35 feet in the STA + Kidner group and 37 feet in the STA alone group, with mean follow-up periods of 2.7 years and 2.1 years, respectively. The VAS, AOFAS, OAFQC scores and radiographic parameters presented no significant difference between the two groups both preoperatively and at final follow-up (P > 0.05 for each). The complications of STA surgery occurred equally in both groups, and Kidner procedure could lead to more incision problems (22.9% vs. 2.7%) and a longer time to return to activity. CONCLUSION Kidner procedure may be unnecessary during surgical treatment of PFF that combined with painful type 2 AN. Correcting the PFF while leaving the AN alone has a high possibility of relieving the pain in the AN region, and tibialis posterior tendon (TPT) rerouting hardly aids in reconstruction of the medial foot arch. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Ting-Jiang Gan
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province 610041, China
| | - Xi Liu
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province 610041, China
| | - Ya-Xing Li
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province 610041, China; Disaster Medicine Center, Sichuan University, Chengdu, Sichuan Province 610041, China
| | - Yu Chen
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province 610041, China
| | - Jia Li
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province 610041, China
| | - Hui Zhang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province 610041, China; Disaster Medicine Center, Sichuan University, Chengdu, Sichuan Province 610041, China.
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Tian F, Wang J, Liu C, Li Y, Liang X, Wang X. Medial column reinforcement for the correction of flatfoot deformity with accessory navicular bone. Am J Transl Res 2022; 14:6368-6374. [PMID: 36247284 PMCID: PMC9556485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 08/03/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES This study aimed to evaluate the clinical effects of reinforcement of the medial column in the treatment of flatfoot deformity with accessory navicular bone. METHODS A retrospective analysis of 32 patients (46 feet) of flatfoot deformity with accessory navicular bone were reviewed. All patients underwent the reinforcement of their medial column in the midfoot, mainly including spring ligament repair, posterior tibial tendon reconstruction, and cotton osteotomy. Clinical evaluation adopted American Orthopaedic Foot and Ankle Society (AOFAS) score and pain visual analogue scale (VAS) was used to evaluate foot function and pain. Radiographic evaluation was performed, and Meary's angle, calcaneal pitch angle, talonavicular coverage angle (TCA), talar 2th metatarsal angle (T2MT) and calcaneal valgus angle (CVA) were measured. RESULTS All patients were followed up for an average duration of 24.3±3.6 months. At the final follow-up, the patient's foot pain was relieved and the foot deformity was improved. The data indicated that the mean functional AOFAS score was significantly improved and the mean VAS score was significantly decreased postoperatively at final follow-up. Additionally, Meary's angle, TCA, T2MT and CVA were all significantly decreased, and calcaneal pitch angle was significantly increased after surgery. CONCLUSION We found that reinforcement of the medial column can effectively maintain medial longitudinal arch, correct flatfoot deformity with accessory navicular bone.
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Affiliation(s)
- Feng Tian
- Department of Foot and Ankle Surgery, Honghui Hospital, Xi'an Jiaotong University Xi'an, Shaanxi Province, P. R. China
| | - Junhu Wang
- Department of Foot and Ankle Surgery, Honghui Hospital, Xi'an Jiaotong University Xi'an, Shaanxi Province, P. R. China
| | - Cheng Liu
- Department of Foot and Ankle Surgery, Honghui Hospital, Xi'an Jiaotong University Xi'an, Shaanxi Province, P. R. China
| | - Yi Li
- Department of Foot and Ankle Surgery, Honghui Hospital, Xi'an Jiaotong University Xi'an, Shaanxi Province, P. R. China
| | - Xiaojun Liang
- Department of Foot and Ankle Surgery, Honghui Hospital, Xi'an Jiaotong University Xi'an, Shaanxi Province, P. R. China
| | - Xinwen Wang
- Department of Foot and Ankle Surgery, Honghui Hospital, Xi'an Jiaotong University Xi'an, Shaanxi Province, P. R. China
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Kim JY, Kim JY, Park SB, Kim C, Lee WW. A retrospective multicenter study of quantitative bone SPECT/CT to predict the surgical removal of the accessory navicular bone. Nucl Med Commun 2021; 42:998-1004. [PMID: 33867482 PMCID: PMC8357044 DOI: 10.1097/mnm.0000000000001433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/23/2021] [Indexed: 01/14/2023]
Abstract
OBJECTIVE The maximum standardized uptake value (SUVmax) in single-photon emission computed tomography/computed tomography (SPECT/CT) can help quantify disease activity of the accessory navicular bone (ANB). In this multicenter quantitative bone SPECT/CT study, we investigated whether SUVmax was correlated with ANB severity, thereby allowing prediction of surgical resection for ANB treatment. METHODS Two-hundred forty-six patients (men:women = 135:111, mean age = 39.3 years), who had undergone quantitative Tc-99m diphosphonate SPECT/CT of the feet, were recruited from four hospitals. SUVmax was measured using vendor-provided quantitation software. The SUVmax values were compared in relation to ANB type (type 1 = 62, type 2 = 136 and type 3 = 14), presence of pain and surgical treatment. RESULTS SUVmax (mean ± SD) was the highest in type 2 ANB (4.41 ± 5.2; P = 0.0101). The 17 resected ANBs showed greater SUVmax (8.27 ± 5.23; P < 0.0001) than the 141 asymptomatic ANBs (2.30 ± 1.68) or the 54 symptomatic ANBs without surgery (6.15 ± 4.40). Since surgery is exclusively indicated for ANB type 2, surgical resection was investigated only in these cases. In univariate analysis, young age and SUVmax were significantly associated with surgical treatment, but only SUVmax was a significant predictor of surgery in multivariate analysis (P < 0.0001). Type 2 ANBs were treated by surgery in 32.5% (13/40) of the cases when SUVmax was ≥5, and in only 1.35% (1/74) of the cases when SUVmax was <5 (P < 0.0001). CONCLUSION ANB disease activity and excision were strongly associated with the SUVmax derived from quantitative bone SPECT/CT. Our study suggests an absolute SUVmax cutoff for ultimate ANB surgical treatment, but additional prospective studies are required to validate this finding.
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Affiliation(s)
- Ji-Young Kim
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seongnam-si
| | - Ji Young Kim
- Department of Nuclear Medicine, Hanyang University Guri Hospital, Guri-si, Gyeonggi-do
| | - Soo Bin Park
- Department of Nuclear Medicine, Soonchunhyang University Seoul Hospital, Seoul
| | - Chulhan Kim
- Department of Nuclear Medicine, Korea University Ansan Hospital, Ansan
| | - Won Woo Lee
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seongnam-si
- Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Republic of Korea
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Evaluation and Management of Common Accessory Ossicles of the Foot and Ankle in Children and Adolescents. J Am Acad Orthop Surg 2021; 29:e312-e321. [PMID: 33475303 DOI: 10.5435/jaaos-d-20-00218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 11/30/2020] [Indexed: 02/01/2023] Open
Abstract
Accessory ossicles are a common radiographic finding about the foot and ankle in children and adolescents. They are often noted incidentally during evaluation of foot and ankle injuries, and most can be managed nonsurgically. Although over 20 accessory ossicles have been described around the foot and ankle, five specific structures generate the most concern in pediatric patients. An accessory navicular presents commonly with medial midfoot pain and may require surgical intervention after failure of nonsurgical treatment. Although an accessory navicular can be treated surgically with simple excision, there is some recent evidence that supports concomitant reconstruction of associated flatfoot deformities. Os trigonum, an ossicle posterior to the talus, is also commonly asymptomatic. However, os trigonum may be associated with persistent posterior ankle pain, and open and endoscopic resection techniques are successful. Os subfibulare is an uncommon ossicle that may be associated with recurrent ankle sprains. Recent literature reports successful return to activities after ossicle excision and ligament reconstruction. Os subtibiale may be confused with a medial malleolar fracture in skeletally immature patients. Os peroneum may contribute to lateral midfoot pain.
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Campbell JT, Jeng CL. Painful Accessory Navicular and Spring Ligament Injuries in Athletes. Clin Sports Med 2020; 39:859-876. [PMID: 32892972 DOI: 10.1016/j.csm.2020.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Painful accessory navicular and spring ligament injuries in athletes are different entities from more common posterior tibialis tendon problems seen in older individuals. These injuries typically affect running and jumping athletes, causing medial arch pain and in severe cases a pes planus deformity. Diagnosis requires a detailed physical examination, standing radiographs, and MRI. Initial treatment focuses on rest, immobilization, and restriction from sports. Orthotic insoles may alleviate minor pain, but many patients need surgery to expedite recovery and return to sports. The authors review their approach to these injuries and provide surgical tips along with expected rehabilitation to provide optimal outcomes.
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Affiliation(s)
- John T Campbell
- Institute for Foot and Ankle Reconstruction, Mercy Medical Center, 301 St. Paul Place, Baltimore, MD 21202, USA.
| | - Clifford L Jeng
- Institute for Foot and Ankle Reconstruction, Mercy Medical Center, 301 St. Paul Place, Baltimore, MD 21202, USA
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Ghanem I, Massaad A, Assi A, Rizkallah M, Bizdikian AJ, El Abiad R, Seringe R, Mosca V, Wicart P. Understanding the foot's functional anatomy in physiological and pathological conditions: the calcaneopedal unit concept. J Child Orthop 2019; 13:134-146. [PMID: 30996737 PMCID: PMC6442506 DOI: 10.1302/1863-2548.13.180022] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND A thorough review of the available orthopaedic literature shows significant controversies, inconsistencies and sparse data regarding the terminology used to describe foot deformities. This lack of consensus on terminology creates confusion in professional discussions of foot anatomy, pathoanatomy and treatment of deformities. The controversies apply to joint movements as well as static relationships between the bones. DESCRIPTION The calcaneopedal unit (CPU) is a specific anatomical and physiological entity, represented by the entire foot excepted the talus. The calcaneus, midfoot and forefoot are solidly bound by three strong ligaments that create a unit that articulates with the talus. The movement of the CPU is complex, as it rotates under the talus, around the axis of Henke that coincides with the talo-calcaneal ligament of Farabeuf.This calcaneopedal unit is deformable. It is compared with a twisted plate, able to adapt to many physiological situations in standing position, in order to acheive a plantigrade position.Moreover, the calcaneopedal unit and the talo-tibiofibular complex are interdependent; rotation of the latter produces morphologic modifications inside the former and vice versa. PURPOSE This paper is a review article of this concept and of its physiopathological applications.
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Affiliation(s)
- I. Ghanem
- Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon,Orthopedic Surgery Department, Hôtel-Dieu de France Hospital, University of Saint-Joseph, Beirut, Lebanon, Correspondence should be sent to I. Ghanem, MD, Hôtel-Dieu de France Hospital, A. Naccache Avenue- Achrafieh, University of Saint-Joseph, Beirut, Lebanon. E-mail:
| | - A. Massaad
- Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
| | - A. Assi
- Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
| | - M. Rizkallah
- Orthopedic Surgery Department, Hôtel-Dieu de France Hospital, University of Saint-Joseph, Beirut, Lebanon
| | - A. J. Bizdikian
- Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
| | - R. El Abiad
- Orthopedic Surgery Department, Hôtel-Dieu de France Hospital, University of Saint-Joseph, Beirut, Lebanon
| | - R. Seringe
- Orthopedic Surgery Department, Cochin University Hospital – University of Rene Descartes, Paris, France
| | - V. Mosca
- Department of Orthopedic Surgery, Seattle Children’s Hospital, Seattle, Washington, USA
| | - P. Wicart
- Orthopedic Surgery Department, Hôpital Necker-Enfants Malades, University of Paris Descartes, Paris, France
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Knapik DM, Archibald HD, Xie KK, Liu RW. A retrospective study on factors predictive of operative intervention in symptomatic accessory navicular. J Child Orthop 2019; 13:107-113. [PMID: 30838083 PMCID: PMC6376442 DOI: 10.1302/1863-2548.13.180168] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The variables causing symptomatic accessory navicular are largely unknown and may inform management of symptomatic patients. The purpose of this study was to examine patient specific factors associated with the development of accessory navicular symptoms. METHODS A total of 71 patients with clinical and radiographic evidence of accessory navicular syndrome were evaluated. Patient gender, race, date of birth, date of earliest foot complaint and laterality were recorded. Treatment was defined as conservative versus surgical. Skeletal maturity was assessed based on calcaneal ossification, accessory navicular subtype and the presence of pes planus based on talo-first metatarsal angle were assessed. RESULTS Female patients comprised 72% of the subjects and trended towards symptoms at younger ages than male patients (p = 0.06), while no significant difference in presentation age was appreciated between male and female patients. Skeletal maturity was significantly associated with earlier complaints and age at presentation but was not associated with increased need for surgical management. Patients with pes planus were significantly more likely to undergo operative management. Accessory navicular subtype was significantly correlated with skeletal maturity. CONCLUSION Female patients were more likely to report symptoms and present with symptomatic accessory navicular. The stage of skeletal maturity is not a predictor of future surgical management but patients with a higher first-metatarsal angle were more likely to require surgery. The correlation between accessory navicular subtype and skeletal maturity suggests that Type II ossicles are likely to develop into Type III over time. Radiographic evaluation of the accessory navicular may lend prognostic data on the necessity of future surgical intervention. LEVEL OF EVIDENCE IV, Case Series.
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Affiliation(s)
- D. M. Knapik
- Rainbow and Babies Hospital at Case Western Reserve University, Cleveland, Ohio, USA,University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA,Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA, Correspondence should be sent to D. M. Knapik, M.D., University Hospitals Cleveland Medical Center, 11100 Euclid Ave., Cleveland, Ohio 44106, USA. E-mail:
| | - H. D. Archibald
- Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA
| | - K. K. Xie
- Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA
| | - R. W. Liu
- Rainbow and Babies Hospital at Case Western Reserve University, Cleveland, Ohio, USA,University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA,Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA
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15
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Bae S, Kang Y, Song YS, Lee WW. Maximum standardized uptake value of foot SPECT/CT using Tc-99m HDP in patients with accessory navicular bone as a predictor of surgical treatment. Medicine (Baltimore) 2019; 98:e14022. [PMID: 30633193 PMCID: PMC6336607 DOI: 10.1097/md.0000000000014022] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Quantitative bone SPECT/CT (single-photon emission computed tomography/computed tomography) using Tc-99m hydroxymethylene diphosphonate is emerging as a useful imaging modality for skeletal diseases. Accessory navicular bone (ANB) has been evaluated by bone scintigraphy only qualitatively and semiquantitatively. However, a truly objective quantitative assessment of ANB is lacking. Here, we measured the maximum standardized uptake value (SUVmax) of the ANB and investigated its usefulness as an imaging biomarker for ANB.Consecutive quantitative bone SPECT/CT studies that had been performed on the foot were retrospectively analyzed. One hundred five patients (male:female = 44:61; median age = 32.0 [range, 11-81] years old; 31 negative controls without ANB and 74 patients with ANB [7 unilateral and 67 bilateral]) and their 210 feet were investigated. The ANBs were classified into types I, II, III (Geist classification), and 0 (contralateral navicular of unilateral ANB). Type II ANBs were subclassified into II-1 (with bony abnormality) or II-0 (without bony abnormality). The treatment modality was observation, conservative treatment, or surgical removal. The associations between the SUVmax and clinical findings, including surgery, were investigated.Patients with type II-1 ANB had the highest SUVmax among all ANB types (P < .001). The SUVmax of symptomatic ANB was greater than that for asymptomatic ANB (P < .001), and the SUVmax for the surgically resected ANB group was also significantly higher than that for the observation only or conservative treatment group (P < .001). Subtype II-1 had a significantly higher SUVmax compared with subtype II-0 (P < .001). Logistic regression analyses in type II ANB showed that young age (P = .020) and SUVmax (P = .031) were significant predictors for surgery. Receiver operating characteristic curve and survival analyses revealed an optimal SUVmax cutoff of 5.27 g/mL for predicting final surgical treatment.SUVmax derived from quantitative bone SPECT/CT was strongly associated with symptom, surgical treatment, and a known high-risk type of ANB. Risk stratification for final surgical treatment of ANB can be achieved using the SUVmax from quantitative bone SPECT/CT.
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Affiliation(s)
- Sungwoo Bae
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine
| | - Yusuhn Kang
- Department of Radiology, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do
| | - Yoo Sung Song
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine
| | - Won Woo Lee
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine
- Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Korea
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16
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The Effect of Arch Height and Material Hardness of Personalized Insole on Correction and Tissues of Flatfoot. JOURNAL OF HEALTHCARE ENGINEERING 2017; 2017:8614341. [PMID: 29065655 PMCID: PMC5485326 DOI: 10.1155/2017/8614341] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 03/31/2017] [Accepted: 04/09/2017] [Indexed: 11/17/2022]
Abstract
Flat foot is one of the common deformities in the youth population, seriously affecting the weight supporting and daily exercising. However, there is lacking of quantitative data relative to material selection and shape design of the personalized orthopedic insole. This study was to evaluate the biomechanical effects of material hardness and support height of personalized orthopedic insole on foot tissues, by in vivo experiment and finite element modeling. The correction of arch height increased with material hardness and support height. The peak plantar pressure increased with the material hardness, and these values by wearing insoles of 40° were apparently higher than the bare feet condition. Harder insole material results in higher stress in the joint and ligament stress than softer material. In the calcaneocuboid joint, the stress increased with the arch height of insoles. The material hardness did not apparently affect the stress in the ankle joints, but the support heights of insole did. In general, insole material and support design are positively affecting the correction of orthopedic insole, but negatively resulting in unreasonable stress on the stress in the joint and ligaments. There should be an integration of improving correction and reducing stress in foot tissues.
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Lui TH. Endoscopic Fusion of the Accessory Navicular Synchondrosis That Has No Diastasis. Arthrosc Tech 2017; 6:e263-e267. [PMID: 28580240 PMCID: PMC5442306 DOI: 10.1016/j.eats.2016.09.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 09/16/2016] [Indexed: 02/03/2023] Open
Abstract
Accessory navicular bone is a common accessory ossicle of the foot and is present in 10% to 14% of normal feet. Less than 1% of the accessory navicular bones are symptomatic. Degenerative or traumatic disruption of the accessory navicular synchondrosis is one of the main causes of symptomatic accessory navicular. The disrupted synchondrosis may or may not be associated with diastasis of the synchondrosis. Fusion of the synchondrosis is indicated if the pain fails to respond to conservative measures. The purpose of this Technical Note is to describe a minimally invasive approach for fusion of the synchondrosis that has no diastasis.
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Affiliation(s)
- Tun Hing Lui
- Address correspondence to Tun Hing Lui, M.B.B.S.(HK), F.R.C.S.(Edin), F.H.K.A.M., F.H.K.C.O.S., Consultant, Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong SAR, China.ConsultantDepartment of Orthopaedics and TraumatologyNorth District Hospital9 Po Kin RoadSheung Shui, NTHong Kong SARChina
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18
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Lui TH. Endoscopic Accessory Navicular Synchondrosis Fusion. Arthrosc Tech 2016; 5:e1267-e1272. [PMID: 28149724 PMCID: PMC5263116 DOI: 10.1016/j.eats.2016.07.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 07/20/2016] [Indexed: 02/03/2023] Open
Abstract
The accessory navicular bone is one of the most common accessory ossicles of the foot. Fewer than 1% of accessory navicular bones are symptomatic, and most of these are type II accessory navicular bones. A separation of the synchondrosis is considered one of the main causes of pain. After an injury to the synchondrosis has resulted in a chondro-osseous disruption, the combined forces of tension and shear from the posterior tibial tendon and the foot aggravate the injury and prevent it from healing. Fusion of the synchondrosis is a logical surgical treatment option if the pain is recalcitrant to conservative measures. The purpose of this technical note is to report an endoscopic approach to achieve fusion. It has the advantages of better cosmesis, less scar pain, less risk of nonunion, and potential to examine the tibialis posterior tendon and the talonavicular joint.
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Affiliation(s)
- Tun Hing Lui
- Address correspondence to Tun Hing Lui, M.B.B.S.(HK), F.R.C.S.(Edin), F.H.K.A.M., F.H.K.C.O.S., Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong SAR, China.Department of Orthopaedics and TraumatologyNorth District Hospital9 Po Kin RoadSheung Shui, NTHong Kong SARChina
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Chong A, Ha JM, Lee JY. Clinical Meaning of Hot Uptake on Bone Scan in Symptomatic Accessory Navicular Bones. Nucl Med Mol Imaging 2016; 50:322-328. [PMID: 27994687 DOI: 10.1007/s13139-016-0452-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 09/06/2016] [Accepted: 09/13/2016] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION We analyzed clinical factors related to uptake on a Tc-99 m HDP bone scan of the accessory navicular (AN). MATERIALS AND METHODS We retrospectively reviewed patients who had been examined by an orthopedic surgeon and underwent bone scan due to suspected symptomatic AN. A three-point grading system was used to evaluate uptake on bone scan. Relationships between grade, symptoms, age, gender, symptom duration, and bone size were analyzed. RESULTS In total, 73 ANs (30 asymptomatic, 43 symptomatic) were enrolled. The majority of asymptomatic ANs had no uptake but some had grade 1 (n = 8) or 2 (n = 2) uptake. All asymptomatic ANs with uptake remained asymptomatic during follow-up. For the asymptomatic ANs, larger bones showed a higher grade. With a cut-off value of size ≤6.8 mm, there is no chance of uptake. All symptomatic ANs showed uptake on bone scan. For symptomatic ANs, larger size and shorter pain duration were related to a higher grade. Age, gender, and left-/right-sideness were not related to grade. Multiple regressions revealed that only uptake grade, not size or symptom duration, was the significant risk factor for a symptomatic AN. With a cut-off value of grade <1, a symptomatic AN could be ruled out with a negative predictive value of 100 %. CONCLUSION Bone scanning is useful for symptomatic ANs with a high negative predictive value. Higher grade is related to larger size and shorter pain duration. For asymptomatic ANs, grade was related to size but did not predict symptom development.
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Affiliation(s)
- Ari Chong
- Department of Nuclear Medicine, Chosun University Hospital, 588 Seoseok-dong, Dong-gu Gwangju, Republic of Korea 501-757
| | - Jung-Min Ha
- Department of Nuclear Medicine, Chosun University Hospital, 588 Seoseok-dong, Dong-gu Gwangju, Republic of Korea 501-757
| | - Jun-Young Lee
- Department of Orthopaedic Surgery, Foot and Ankle Surgery, Chosun University Hospital, Gwangju, Republic of Korea
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