Agreement between arthroscopic and imaging study findings in chronic anterior talo-fibular ligament injuries

Elkaïm, Marc; Thès, André; Lopes, Ronny; Andrieu, Michaël; Cordier, Guillaume; Molinier, F.; Benoist, Jonathan; Colin, Fabrice; Boniface, Olivier; Guillo, Stéphane; Bauer, Thomas

doi:10.1016/j.otsr.2018.09.008

Cited by 31 publications

(18 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…There are various types of ATFL remnants that affect the mechanical properties. 11,28 In this study, the ATFL remnant classified as excellent arthroscopically showed a low HU ratio in the medial gutter. On the other hand, an ATFL with moderate or poor appearance and subfibular ossicle showed a high HU ratio in the medial gutter.…”

Section: Discussionmentioning

confidence: 52%

Bone Mineralization Changes in the Subchondral Bone of the Medial Gutter in Chronic Lateral Ankle Instability

et al. 2020

View full text Add to dashboard Cite

Background: Chronic ankle instability (CAI) induces osteoarthritis (OA) by inflicting abnormal stresses on the medial gutter. It is important to detect early OA change and to explore factors likely to induce the OA. The purpose of this study was to evaluate subchondral bone change in the medial gutter of CAI using computed tomography (CT) scans. Methods: Thirty-five ankles with CAI (CAI group) and 35 ankles without CAI (control group) were included. The region of interest (ROI) in the subchondral bone of the medial gutter on CT axial images was set on the tibia and talus. The Hounsfield unit (HU) in ROIs was measured and corrected by the HU of the fibula in the same slice. HU ratios were compared between the CAI and control groups. In the CAI group, the relationship between the HU ratio and the talar tilt angle (TTA), OA change, and the anterior talofibular ligament (ATFL) remnant quality were analyzed. Results: The mean HU ratio in the CAI group was significantly higher than that in the control. In the CAI group, HU ratios in ≥10 degrees of TTA were significantly higher than those in <10 degrees. But there was no significant difference in the HU ratios with or without OA change in the medial gutter. A good-quality ATFL remnant showed a low HU ratio compared with that with poor quality. Conclusion: CAI patients exhibited subchondral bone change in the medial gutter, which suggests that the elimination of instability may help to prevent or decrease the development and/or progression of osteoarthritis. Level of Evidence: Level III, comparative series.

show abstract

Section: Discussionmentioning

confidence: 52%

Bone Mineralization Changes in the Subchondral Bone of the Medial Gutter in Chronic Lateral Ankle Instability

et al. 2020

View full text Add to dashboard Cite

show abstract

“…There are many studies in the literature showing that MRI has high accuracy in the determination of ATFL damage (3)(4)(5) . However, there are few studies that have evaluated the accuracy of 3-dimensional (3D) CT and CT arthrography in the evaluation of ATFL tears (6,7) . As CT arthrography is an interventional method it is not the first choice of imaging methods to be applied to trauma cases under emergency department conditions.…”

Section: Discussionmentioning

confidence: 99%

“…In all the patients, normal ATFL could be determined as intact on CT, but in patients with partial tears, residual intact fibers were detected more accurately on 3D CT than on MRI. The compatibility between radiological imaging methods and arthroscopy was investigated in chronic ATFL damage by Elkaim M et al (7) , and the compatibility between CT arthrography and arthroscopy was found to be at a rate of 82%-88%. In the same study, CT arthrography was found to have 89% sensitivity, 83% specificity, PPV 95%, and NPV 66% in the evaluation of ATFL injury.…”

Section: Discussionmentioning

confidence: 99%

The Sensitivity of Computed Tomography in the Determination of Anterior Talofibular Ligament Tears

Gürsoy¹,

Mete²,

Çetinoğlu³

et al. 2019

TERH

View full text Add to dashboard Cite

Objective:The aim of this study was to determine the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of CT in the determination of anterior talofibular ligament (ATFL) tear by accepting the MRI results as the reference standard. Methods: The study included a total of 62 ankle examinations of 60 patients with both ankle CT and MR images between 2010-2018. ATFL lesions were classified on both CT and MR images, as intact or torn (partial tear or complete tear). By accepting the MRI results as the reference standard the accuracy of CT in the determination of ATFL tears was estimated. The patients were also classified as Grade 0: normal on CT and MRI, Grade 1: thick on CT compatible with force, thick and with a high signal on MRI, Grade 2: partial tear, and Grade 3: complete tear. The probability of determining the same grade in both tests was calculated. Results: CT was calculated to have 74.1% sensitivity, 100% specificity, 100% PPV, 96.4% NPV and 96.7% accuracy in the determination of ATFL tear. The probability of determining the same grade both on CT, and MRI was found to be 91.9%. Conclusion: CT has a high accuracy in the differentiation of intact ATFL from torn ATFL. Especially under emergency department conditions, the determination of whether the ATFL is intact or torn on CT, which is usually applied for the evaluation of bone pathologies, can refer the patient for MRI, and alter the form of treatment and the prognosis. ÖZ Amaç: Bu çalışmanın amacı, MRG sonuçlarını referans standart kabul ederek anterior talofibular ligament (ATFL) yırtıklarının belirlenmesinde BT'nin duyarlılık, özgüllük, pozitif prediktif değer (PPV), negatif prediktif değer (NPV) ve doğruluğunun belirlenmesidir.Yöntem Çalışmaya 2010-2018 yılları arasında ayak bileği BT ve MR görüntüleri olan 60 hastanın toplam 62 ayak bileği tetkiki dahil edildi. ATFL lezyonları hem BT hem de MR görüntülerinde sağlam veya yırtık (kısmi yırtık veya tam kat yırtık) olarak sınıflandırıldı. MRG sonuçları referans standart kabul edilerek ATFL yırtıklarının belirlenmesinde BT'nin doğruluğu hesaplandı. Hastalar aynı zamanda BT ve MRG'de evre 0: normal, evre 1: BT'de zorlama ile uyumlu kalın, MRG'de kalın ve yüksek sinyalli, evre 2: kısmi yırtık ve evre 3: tam kat yırtık olarak sınıflandırıldı. Her iki testte de aynı evreyi belirleme olasılığı hesaplandı. Bulgular: ATFL yırtıklarını saptamada BT'nin %74,1 duyarlılık, %100 özgüllük, %100 PPV, %96,4 NPV ve %96,7 doğruluk oranlarına sahip olduğu hesaplandı. BT'de sonucun MRG ile aynı evrede saptanma durumu %91,9 olarak hesaplandı. Sonuç: BT, intakt ATFL'nin yırtık ATFL'den ayrımında yüksek doğruluğa sahiptir. Özellikle acil servis koşulları altında, genellikle kemik patolojilerinin değerlendirilmesi için uygulanan BT'de ATFL'nin intakt veya yırtık olup olmadığının belirlenmesi ile hasta MRG'ye yönlendirilebilir, tedavi şekli ve prognoz değiştirilebilir.

show abstract

Section: Introductionmentioning

confidence: 99%

“…7,13 The degree of ATFL injury can be assessed with arthroscopic findings. 6 In addition, lateral instability can be determined with arthroscopic views with talar tilting by supination stress of the foot. 11 Although various dynamic and static anatomical structures around the ankle have been investigated in detail for determining the reason of injury, the anatomical factors predisposed to lateral ankle instability have not been fully clarified.…”

Section: Introductionmentioning

confidence: 99%

Radiologic Evaluation of the Effect of Distal Tibiofibular Joint Anatomy on Arthroscopically Proven Ankle Instability

et al. 2019

View full text Add to dashboard Cite

Background: Ankle sprains occur frequently in both athletes and the general population. The social and economic consequences can be significant. In an effort to understand the injury, dynamic and static structures around the ankle have been investigated in detail, but anatomical factors predisposing to lateral ankle instability have not been fully clarified. The aim of this study was to radiologically investigate the relationship between bony variations of the distal tibiofibular joint and arthroscopically proven ankle instability. Methods: Fifty patients with arthroscopically proven ankle instability and 50 patients without instability were included in this study. Measurements were obtained from a magnetic resonance imaging (MRI) section 1 cm proximal to the tibiotalar joint; distal tibiofibular joint anterior facet length ( a), posterior facet length ( b), angle between the anterior and posterior facets ( c), fibular notch depth ( d), tibia thickness ( e), and fibula thickness ( f) was measured. Results: It was found that instability was more frequent when the length of a ( P < .001) and e ( P < .001) were shorter. In addition, when value of a/ b and e/f were evaluated, it was observed that the number of individuals who had instability increased as the ratio became smaller ( P < .016-.020, respectively). Pearson correlation analysis indicated strong negative correlation between the values of a- e and instability ( r = −0.348, P < .001, and r = −0.328, P = .001; respectively). Conclusion: Lateral ankle sprains are common, and a clear understanding of the relevant structures and clinical function of the ankle complex should extend beyond the talocrural joint. This study demonstrated that the presence of narrow anterior facet ( a) and thinner tibia ( e) were strongly correlated with lateral ankle instability. Level of Evidence: Level III, retrospective case control study.

show abstract

Agreement between arthroscopic and imaging study findings in chronic anterior talo-fibular ligament injuries

Cited by 31 publications

References 18 publications

Bone Mineralization Changes in the Subchondral Bone of the Medial Gutter in Chronic Lateral Ankle Instability

Bone Mineralization Changes in the Subchondral Bone of the Medial Gutter in Chronic Lateral Ankle Instability

The Sensitivity of Computed Tomography in the Determination of Anterior Talofibular Ligament Tears

Radiologic Evaluation of the Effect of Distal Tibiofibular Joint Anatomy on Arthroscopically Proven Ankle Instability

Contact Info

Product

Resources

About