Diagnosis and Management of Deltoid Ligament Insufficiency

Sridharan, Sarup S; Dodd, Andrew

doi:10.1177/2473011419860073

Cited by 4 publications

(2 citation statements)

References 27 publications

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“…The incidence of injury of the medial ankle deltoid ligament (DL) is often underestimated in the clinic (1)(2)(3)(4). Magnetic resonance imaging (MRI) offers a useful tool for diagnosing DL rupture (5,6).…”

Section: Introductionmentioning

confidence: 99%

Bone marrow edema at ligament insertion is an accurate MRI sign of deltoid ligament injury

Tong,

Li,

et al. 2023

Acta Radiol

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Background Magnetic resonance imaging (MRI) is effective in diagnosing deltoid ligament (DL) injury but its sensitivity in chronic cases is low. Additional diagnostic signs are required to reduce the risk of a false negative diagnosis. Purpose To evaluate the added diagnostic value of bone marrow edema at the ligament insertion (BMELI) of DL to the MRI assessment of chronic DL injury. Material and Methods One hundred patients who consecutively came to our institution between November 2018 and December 2021 and underwent arthroscopic surgery for chronic ankle instability (CAI) were enrolled in the present study. Preoperative MR images were retrospectively reviewed by two orthopedic surgeons to evaluate the sensitivity, specificity and interobserver reliability of three MRI signs in diagnosing chronic DL injury, namely, abnormal ligamentous morphological characteristics (ALMC), BMELI and medial clear space (MCS). Results Taking arthroscopy as the reference standard, there were 34 patients with and 66 without DL injury. ALMC had 64.71% (22/34; 46.47–79.70) sensitivity and 83.33% (55/66; 71.71–91.00) specificity, BMELI had 70.59% (24/34; 52.33–84.29) sensitivity and 95.45% (63/66; 86.44–98.82) specificity and MCS had 26.47% (9/34; 13.51–44.65) sensitivity and 92.42% (61/66; 82.50–97.18) specificity. Compared with ALMC, BMELI had similar efficacy in superficial cases ( P = 0.06) and greater efficacy in deep cases ( P = 0.04). All three signs showed good interobserver agreement (kappa values all above 0.7). Conclusion BMELI can reliably indicate concomitant injury to the DL in CAI patients. Using BMELI as a sign of chronic DL injury when ALMC is unclear may reduce the risk of a false negative diagnosis.

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Section: Introductionmentioning

confidence: 99%

Bone marrow edema at ligament insertion is an accurate MRI sign of deltoid ligament injury

Tong,

Li,

et al. 2023

Acta Radiol

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“…In patients with chronic ankle instability (CAI), damage to the lateral ligament has been widely described in the literature. In recent cases of CAI, there is evidence suggesting an injury to the deltoid ligament (DL) (1)(2)(3)(4)(5). The DL provides support to the ankle, subtalar, and talonavicular joints by spanning the medial malleolus, talus, calcaneus, and navicular bones (6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

Prediction of anterior tibiotalar ligament injury: measurement of the angle between the deep posterior tibiotalar ligament and talus on MRI

2022

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Background Identification of anterior tibiotalar ligament (aTTL) injury is essential because it influences the surgeon's treatment option and patient prognosis. Purpose To assess the diagnostic accuracy of the angle measurement between the talus and posterior tibiotalar ligament (talus-pTTL) on magnetic resonance imaging (MRI) in patients with arthroscopically proven aTTL injuries. Material and Methods Ankle MRI scans of 67 patients who underwent arthroscopic examination were retrospectively reviewed. The talus-pTTL angle on axial T2-weighted MRI and the medial clear space (MCS) on mortise ankle radiograph were measured. Inter-observer agreement of the measurements was calculated. Also, sensitivity, specificity, and area under the receiver operating characteristic (ROC) curve (AUC) were the metrics of diagnostic accuracy. Results AUC was 0.90 for observer 1 with 78.6% sensitivity, 97.4% specificity, 88% accuracy, and 54.7° cutoff value for the talus-pTTL angle. AUC was 0.87 for observer 2 with 85.7% sensitivity, 84.6% specificity, 85.2% accuracy, and 53.7° cutoff value for the talus-pTTL angle. AUC was 0.86 with 82.1% sensitivity, 79.5% specificity, and 80.8% accuracy for observer 1 and 0.79 with 57.1% sensitivity, 92.3% specificity, and 74.7% accuracy for observer 2 for the MCS. Different MCS values and additional capabilities when complemented with the angle measurement showed an increase in diagnostic performances. Intra-observer reliability of MCS and talus-pTTL angle of the two radiologists was excellent. Inter-observer reliability of the two radiologists was excellent for both the talus-pTTL angle (0.95) and the MCS (0.85). Conclusion Measurement of the talus-pTTL angle showed good sensitivity, specificity, and accuracy for the evaluation of aTTL injury with excellent inter-observer reliability.

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A clinical guide to the medial ligaments of the ankle: Anatomy, function, diagnosis of injuries and treatment of instability-a narrative review

Obionu,

Palm,

Astrup

et al. 2024

Foot and Ankle Surgery

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Diagnosis and Management of Deltoid Ligament Insufficiency

Cited by 4 publications

References 27 publications

Bone marrow edema at ligament insertion is an accurate MRI sign of deltoid ligament injury

Bone marrow edema at ligament insertion is an accurate MRI sign of deltoid ligament injury

Prediction of anterior tibiotalar ligament injury: measurement of the angle between the deep posterior tibiotalar ligament and talus on MRI

A clinical guide to the medial ligaments of the ankle: Anatomy, function, diagnosis of injuries and treatment of instability-a narrative review

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