Posterior tibial tendon dysfunction: Clinical and magnetic resonance imaging findings having histology as reference standard

Domenico Albano, Nicolò Martinelli, Alberto Bianchi, Giovanni Romeo, Gaetano Bulfamante, Massimo Galia, Luca Maria Sconfienza

Research output: Contribution to journalArticle

Abstract

Objective To investigate the correlation between MRI, clinical tests, histopathologic features of posterior tibial tendon (PTT) dysfunction in patients with acquired adult flatfoot deformity surgically treated with medializing calcaneal osteotomy and flexor digitorum longus tendon transposition. Materials and methods Nineteen patients (11 females; age: 46 ± 15 year, range 18–75) were pre-operatively evaluated using the single heel rise (HR) and the first metatarsal rise (FMR) sign tests. Two reviewers graded the PTT tears on a I–III scale and measured the hindfoot valgus angle on the pre-operative MRI of the ankle. The specimens of the removed portion of PTT were histologically analysed by two pathologists using the Bonar and Movin score. Linear regression, Spearman's rank-order, and intraclass correlation coefficient (ICC) statistics were used. Results ICC for MRI was excellent (0.952). Correlation between FMR and HR tests was at limit of significance (r = 0.454; P = 0.051). The HR and FMR tests were significantly correlated to the Movin score (r = 0.581; P = 0.009 and r = 0.538; P = 0.018, respectively) and were not significantly correlated to the Bonar score (both with a r = 0.424; P = 0.070). PTT tendinopathy grading at MRI was significantly correlated to the FMR test (p = 0.041) but not to the hindfoot valgus angle (p = 0.496), the HR test (p = 0.943), the Bonar score (p = 0.937), and the Movin score (p = 0.436). The hindfoot angle was not correlated to any of the other variables (p > 0.264). Conclusion For PTT dysfunction, there is high correlation between HR and FMR test and histology evaluated using the Movin score, while no correlation was seen for the Bonar score. Semiquantitative grading of PTT dysfunction at MRI only correlates to the FMR and not to histology. The hindfoot valgus angle is not correlated to any of the considered variables.

Original languageEnglish
Pages (from-to)55-61
Number of pages7
JournalEuropean Journal of Radiology
Volume99
Early online dateDec 11 2017
DOIs
Publication statusPublished - Feb 1 2018

Fingerprint

Posterior Tibial Tendon Dysfunction
Metatarsal Bones
Heel
Histology
Magnetic Resonance Imaging
Tendons
Flatfoot
Tendinopathy
Osteotomy
Tears
Ankle
Linear Models

Keywords

  • First metatarsal rise sign
  • Hindfoot valgus
  • Histology
  • Magnetic resonance imaging
  • Posterior tibial tendon dysfunction
  • Single heel rise

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Posterior tibial tendon dysfunction : Clinical and magnetic resonance imaging findings having histology as reference standard. / Albano, Domenico; Martinelli, Nicolò; Bianchi, Alberto; Romeo, Giovanni; Bulfamante, Gaetano; Galia, Massimo; Sconfienza, Luca Maria.

In: European Journal of Radiology, Vol. 99, 01.02.2018, p. 55-61.

Research output: Contribution to journalArticle

Albano, Domenico ; Martinelli, Nicolò ; Bianchi, Alberto ; Romeo, Giovanni ; Bulfamante, Gaetano ; Galia, Massimo ; Sconfienza, Luca Maria. / Posterior tibial tendon dysfunction : Clinical and magnetic resonance imaging findings having histology as reference standard. In: European Journal of Radiology. 2018 ; Vol. 99. pp. 55-61.
@article{8163a28846224200942741917f412b3f,
title = "Posterior tibial tendon dysfunction: Clinical and magnetic resonance imaging findings having histology as reference standard",
abstract = "Objective To investigate the correlation between MRI, clinical tests, histopathologic features of posterior tibial tendon (PTT) dysfunction in patients with acquired adult flatfoot deformity surgically treated with medializing calcaneal osteotomy and flexor digitorum longus tendon transposition. Materials and methods Nineteen patients (11 females; age: 46 ± 15 year, range 18–75) were pre-operatively evaluated using the single heel rise (HR) and the first metatarsal rise (FMR) sign tests. Two reviewers graded the PTT tears on a I–III scale and measured the hindfoot valgus angle on the pre-operative MRI of the ankle. The specimens of the removed portion of PTT were histologically analysed by two pathologists using the Bonar and Movin score. Linear regression, Spearman's rank-order, and intraclass correlation coefficient (ICC) statistics were used. Results ICC for MRI was excellent (0.952). Correlation between FMR and HR tests was at limit of significance (r = 0.454; P = 0.051). The HR and FMR tests were significantly correlated to the Movin score (r = 0.581; P = 0.009 and r = 0.538; P = 0.018, respectively) and were not significantly correlated to the Bonar score (both with a r = 0.424; P = 0.070). PTT tendinopathy grading at MRI was significantly correlated to the FMR test (p = 0.041) but not to the hindfoot valgus angle (p = 0.496), the HR test (p = 0.943), the Bonar score (p = 0.937), and the Movin score (p = 0.436). The hindfoot angle was not correlated to any of the other variables (p > 0.264). Conclusion For PTT dysfunction, there is high correlation between HR and FMR test and histology evaluated using the Movin score, while no correlation was seen for the Bonar score. Semiquantitative grading of PTT dysfunction at MRI only correlates to the FMR and not to histology. The hindfoot valgus angle is not correlated to any of the considered variables.",
keywords = "First metatarsal rise sign, Hindfoot valgus, Histology, Magnetic resonance imaging, Posterior tibial tendon dysfunction, Single heel rise",
author = "Domenico Albano and Nicol{\`o} Martinelli and Alberto Bianchi and Giovanni Romeo and Gaetano Bulfamante and Massimo Galia and Sconfienza, {Luca Maria}",
year = "2018",
month = "2",
day = "1",
doi = "10.1016/j.ejrad.2017.12.005",
language = "English",
volume = "99",
pages = "55--61",
journal = "European Journal of Radiology",
issn = "0720-048X",
publisher = "Elsevier Ireland Ltd",

}

TY - JOUR

T1 - Posterior tibial tendon dysfunction

T2 - Clinical and magnetic resonance imaging findings having histology as reference standard

AU - Albano, Domenico

AU - Martinelli, Nicolò

AU - Bianchi, Alberto

AU - Romeo, Giovanni

AU - Bulfamante, Gaetano

AU - Galia, Massimo

AU - Sconfienza, Luca Maria

PY - 2018/2/1

Y1 - 2018/2/1

N2 - Objective To investigate the correlation between MRI, clinical tests, histopathologic features of posterior tibial tendon (PTT) dysfunction in patients with acquired adult flatfoot deformity surgically treated with medializing calcaneal osteotomy and flexor digitorum longus tendon transposition. Materials and methods Nineteen patients (11 females; age: 46 ± 15 year, range 18–75) were pre-operatively evaluated using the single heel rise (HR) and the first metatarsal rise (FMR) sign tests. Two reviewers graded the PTT tears on a I–III scale and measured the hindfoot valgus angle on the pre-operative MRI of the ankle. The specimens of the removed portion of PTT were histologically analysed by two pathologists using the Bonar and Movin score. Linear regression, Spearman's rank-order, and intraclass correlation coefficient (ICC) statistics were used. Results ICC for MRI was excellent (0.952). Correlation between FMR and HR tests was at limit of significance (r = 0.454; P = 0.051). The HR and FMR tests were significantly correlated to the Movin score (r = 0.581; P = 0.009 and r = 0.538; P = 0.018, respectively) and were not significantly correlated to the Bonar score (both with a r = 0.424; P = 0.070). PTT tendinopathy grading at MRI was significantly correlated to the FMR test (p = 0.041) but not to the hindfoot valgus angle (p = 0.496), the HR test (p = 0.943), the Bonar score (p = 0.937), and the Movin score (p = 0.436). The hindfoot angle was not correlated to any of the other variables (p > 0.264). Conclusion For PTT dysfunction, there is high correlation between HR and FMR test and histology evaluated using the Movin score, while no correlation was seen for the Bonar score. Semiquantitative grading of PTT dysfunction at MRI only correlates to the FMR and not to histology. The hindfoot valgus angle is not correlated to any of the considered variables.

AB - Objective To investigate the correlation between MRI, clinical tests, histopathologic features of posterior tibial tendon (PTT) dysfunction in patients with acquired adult flatfoot deformity surgically treated with medializing calcaneal osteotomy and flexor digitorum longus tendon transposition. Materials and methods Nineteen patients (11 females; age: 46 ± 15 year, range 18–75) were pre-operatively evaluated using the single heel rise (HR) and the first metatarsal rise (FMR) sign tests. Two reviewers graded the PTT tears on a I–III scale and measured the hindfoot valgus angle on the pre-operative MRI of the ankle. The specimens of the removed portion of PTT were histologically analysed by two pathologists using the Bonar and Movin score. Linear regression, Spearman's rank-order, and intraclass correlation coefficient (ICC) statistics were used. Results ICC for MRI was excellent (0.952). Correlation between FMR and HR tests was at limit of significance (r = 0.454; P = 0.051). The HR and FMR tests were significantly correlated to the Movin score (r = 0.581; P = 0.009 and r = 0.538; P = 0.018, respectively) and were not significantly correlated to the Bonar score (both with a r = 0.424; P = 0.070). PTT tendinopathy grading at MRI was significantly correlated to the FMR test (p = 0.041) but not to the hindfoot valgus angle (p = 0.496), the HR test (p = 0.943), the Bonar score (p = 0.937), and the Movin score (p = 0.436). The hindfoot angle was not correlated to any of the other variables (p > 0.264). Conclusion For PTT dysfunction, there is high correlation between HR and FMR test and histology evaluated using the Movin score, while no correlation was seen for the Bonar score. Semiquantitative grading of PTT dysfunction at MRI only correlates to the FMR and not to histology. The hindfoot valgus angle is not correlated to any of the considered variables.

KW - First metatarsal rise sign

KW - Hindfoot valgus

KW - Histology

KW - Magnetic resonance imaging

KW - Posterior tibial tendon dysfunction

KW - Single heel rise

UR - http://www.scopus.com/inward/record.url?scp=85038226032&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85038226032&partnerID=8YFLogxK

U2 - 10.1016/j.ejrad.2017.12.005

DO - 10.1016/j.ejrad.2017.12.005

M3 - Article

AN - SCOPUS:85038226032

VL - 99

SP - 55

EP - 61

JO - European Journal of Radiology

JF - European Journal of Radiology

SN - 0720-048X

ER -