Enhancing Precision in OLT Measurements and Improving Agreement in Surgical Decision-Making: A Comprehensive Evaluation Using WBCT and Distance Mapping for Preoperative Planning

Category: Ankle; Other Introduction/Purpose: WBCT enables the creation of a three-dimensional model that represents the ankle morphology in a standing position. Distance mapping (DM) is a complementary feature that uses color coding to represent the relative intraarticular distance and can be used to outline intraarticular defects. Consequently, DM offers a novel approach to delineating OLT, allowing for the quantification of its surface area, volume, and depth. The reliability of DM for OLT measurements has yet to be thoroughly evaluated. This study primarily aims to determine the reliability of DM in measuring the surface, depth, and volume of OLT. A secondary objective is to ascertain whether measurements obtained through DM, when integrated with a predefined treatment algorithm, can facilitate consensus among surgeons regarding the optimal surgical intervention Methods: This cohort comprised 36 patients with 40 OLTs evaluated using WBCT and DM. Two raters used DM to determine the lesion boundary (LB) and lesion fundus (LF) and calculate the lesion depth, surface, and volume. The raters were asked to choose between bone marrow stimulation, autologous matrix-induced chondrogenesis, and osteochondral transposition based on the measurement. Inter-rater and intra-rater agreement was measured. Results: Interclass correlation of the lesion's depth surface produced an excellent interrater and intrareader agreement of 0.90 -0.94 p-value < 0.001. Cohen's Kappa agreement analysis of the preferable preoperative plan produced a Kappa = 0.834 P-value< 0.001, indicating a near-perfect agreement Conclusion: WBCT-based 3D modules and DM can be used to measure the OLT surface and depth and to calculate the lesion volume with excellent interrater and interrater reliability; using the OLT measurement and a predetermined treatment algorithm, a near-perfect interrater agreement for the preoperative planning was reached. WBCT in conjunction could help determine the type of surgery needed preoperatively and assess if additional surgeries are needed.