The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons · 2026
The Composite Deformity Score (CDS): Development and Preliminary Assessment of a Radiographic Scoring System for Assessing Osteochondral Lesion Severity of the Talus.
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Hamoud Moaaz Ali, Swealem Ahmed, Hatata Mohamed
Аннотация
BACKGROUND: Osteochondral lesions of the talus (OLTs) vary widely in severity; lower-limb biomechanical alignment may contribute to this variation, but no composite radiographic score exists to capture it. We developed and preliminarily assessed the Composite Deformity Score (CDS), a five-parameter radiographic score designed a priori to summarize multiple alignment domains, with prospective stratification by lesion location.
METHODS: A prospective cohort of 80 patients with MRI-confirmed OLTs was enrolled (June 2024-June 2025; power analysis minimum n=74). CDS summed five prespecified weight-bearing radiographic parameters (LDTA, HAD, MAD, Meary's Angle, Calcaneal Pitch), each scored 0-2 using an equal-weight sum. A parsimonious logistic regression model assessed the CDS-large lesion (>2 cm²) association after BMI adjustment. Reliability was assessed for both radiographic CDS scoring and MRI lesion measurements; two independent fellowship-trained radiologists measured MRI lesions under blinded conditions, with interobserver ICC 0.91-0.96 and intraobserver reassessment. Patients were stratified into medial, central, and lateral Raikin-zone subgroups.
RESULTS: CDS showed excellent reliability (interobserver ICC=0.91; intraobserver ICC=0.92-0.93) and correlated with lesion size (r=+0.74, p<0.001). CDS and lesion size varied significantly by location: medial lesions had the highest CDS (6.1±0.7) and most large lesions (66.7%), while lateral lesions had the lowest CDS (3.4±1.2) and fewest large lesions (5.6%) (p<0.001 for both). CDS remained independently associated with large OLTs after BMI adjustment (OR 3.04, 95% CI 1.71-5.40, p<0.001; AUROC=0.87) and after adjusting for location (OR 2.76, p<0.001). CDS correlated inversely with AOFAS score (ρ=-0.70, p<0.001) across all locations. A CDS>6 cutoff yielded 75% sensitivity and 100% specificity.
CONCLUSION: The CDS is a reliable, reproducible score significantly associated with OLT severity, with higher scores observed in medial lesions. These findings support its biological plausibility; prospective multicentre validation against outcomes is required before any clinical adoption.
LEVEL OF EVIDENCE: III.
METHODS: A prospective cohort of 80 patients with MRI-confirmed OLTs was enrolled (June 2024-June 2025; power analysis minimum n=74). CDS summed five prespecified weight-bearing radiographic parameters (LDTA, HAD, MAD, Meary's Angle, Calcaneal Pitch), each scored 0-2 using an equal-weight sum. A parsimonious logistic regression model assessed the CDS-large lesion (>2 cm²) association after BMI adjustment. Reliability was assessed for both radiographic CDS scoring and MRI lesion measurements; two independent fellowship-trained radiologists measured MRI lesions under blinded conditions, with interobserver ICC 0.91-0.96 and intraobserver reassessment. Patients were stratified into medial, central, and lateral Raikin-zone subgroups.
RESULTS: CDS showed excellent reliability (interobserver ICC=0.91; intraobserver ICC=0.92-0.93) and correlated with lesion size (r=+0.74, p<0.001). CDS and lesion size varied significantly by location: medial lesions had the highest CDS (6.1±0.7) and most large lesions (66.7%), while lateral lesions had the lowest CDS (3.4±1.2) and fewest large lesions (5.6%) (p<0.001 for both). CDS remained independently associated with large OLTs after BMI adjustment (OR 3.04, 95% CI 1.71-5.40, p<0.001; AUROC=0.87) and after adjusting for location (OR 2.76, p<0.001). CDS correlated inversely with AOFAS score (ρ=-0.70, p<0.001) across all locations. A CDS>6 cutoff yielded 75% sensitivity and 100% specificity.
CONCLUSION: The CDS is a reliable, reproducible score significantly associated with OLT severity, with higher scores observed in medial lesions. These findings support its biological plausibility; prospective multicentre validation against outcomes is required before any clinical adoption.
LEVEL OF EVIDENCE: III.