Ankle and Tarsal Joints

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articular cartilage of the patella may be categorized as the surface type or the basal type. The former is age-dependent, and its incidence increases precipitously with age, predisposing to osteoarthritis in later years, and the latter is a disease of young adults with more or less self-limited symptoms and clinical course.

Conventional radiography is of limited value in diagnosing this condition (Lund and Nilsson 1980), but arthrography and CT and MRI play a decisive role. Occasionally, simple radiography may reveal focal osteopenia in the retropatellar facet with or without subchondral bone changes (Figs. 9.16A and 9.17B). CT may reveal the roughening, thinning, or denudati-

The ankle (talocrural joint) is uniaxial articulation between the lower tibial end together with the medial and lateral melleoli and the troch-lear surface of the talus. Beneath the talus are the anterior, middle, and posterior subtalar joints and the talonavicular joint in front. The ankle is not a common site of osteoarthritis, and when involved it is usually the consequence of a significant trauma or the cumulative effects of repeated minor physical insults. In most cases, the talocrural joint and the subtalar and talonavicular joints are involved.

Radiographic manifestations of osteoarthritis of the ankle are inconspicuous in the early stage. As in any joint. However, established osteoarthritis manifests as articular narrowing,

Ankle And Tarsus Joints

Fig. 9.20A, B Talocrural joint involvement in slightly advanced talar osteoarthritis. A Lateral pinhole scan of the left ankle in a 21-year-old male shows patchy areas of increased uptake in the anterior subtalar joint (lower arrow) and the talocrural joint (upper arrow). B Lateral radiograph demonstrates sclerosis in the anterior articular surface of the calcaneus (lower arrow) and talocrural articular narrowing and sclerosis (upper arrow)

Fig. 9.20A, B Talocrural joint involvement in slightly advanced talar osteoarthritis. A Lateral pinhole scan of the left ankle in a 21-year-old male shows patchy areas of increased uptake in the anterior subtalar joint (lower arrow) and the talocrural joint (upper arrow). B Lateral radiograph demonstrates sclerosis in the anterior articular surface of the calcaneus (lower arrow) and talocrural articular narrowing and sclerosis (upper arrow)

Fig. 9.21A, B Advanced talar osteoarthritis. A Lateral pinhole scan of the right ankle in a 36-year-old female shows diffuse tracer uptake in the subtalar and talona-vicular joints (lower arrows) as well as the talocrural joint (upper arrow). B Lateral radiograph demonstrates sclerosis with marked articular narrowing (arrows)

subchondral sclerosis, and osteophytosis. Our limited observation has indicated that the change starts in the anterior subtalar joint followed by involvement of the talocrural joint, the middle and posterior subtalar joints, and the talonavicular joint seemingly in sequence.

The earliest change of talar osteoarthritis appears to start from the anterior subtalar joint of a painful ankle as a focal, spotty "hot" area (Fig. 9.19). Not infrequently, such a "hot" area is seen in the absence of radiographic change. As the disease progresses the talocrural joint becomes involved (Fig. 9.20) and then the sub-talar and talonavicular joints (Fig. 9.21). The initial involvement of the anterior subtalar and talocrural joints is presumably related to the fact that these joints are constantly subjected to great stress and strain.

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