The use of MRI in pre-operative evaluation of anterior talofibular ligament in chronic ankle instability

Abstract

ObjectivesTo evaluate the applicability of MRI for the quantitative assessment of anterior talofibular ligaments (ATFLs) in symptomatic chronic ankle instability (CAI).MethodsBetween 1997 and 2010, 39 patients with symptomatic CAI underwent surgical treatment (22 male, 17 female, mean age 25.4 years (15 to 40)). In all patients, the maximum diameters of the ATFLs were measured on pre-operative T2-weighted MR images in planes parallel to the path of the ATFL. They were classified into three groups based on a previously published method with modifications: ‘normal’, diameter = 1.0 - 3.2 mm; ‘thickened’, diameter > 3.2 mm; ‘thin or absent’, diameter < 1.0 mm. Stress radiography was performed with the maximum manual force in inversion under general anaesthesia immediately prior to surgery. In surgery, ATFLs were macroscopically divided into two categories: ‘thickened’, an obvious thickened ligament and ‘thin or absent’. The imaging results were compared with the macroscopic results that are considered to be of a gold standard.ResultsAgreement was reached when comparison was made between groups, based on MRI and macroscopic findings. ATFLs were abnormal in all 39 cases and classified as ten ‘thickened’ and 29 ‘thin or absent’. As to talar tilt stress radiography, a clear cut-off angle, which would allow discrimination between ‘thickened’ and ‘thin or absent’ patients, was not identified.ConclusionMRI is valuable as a pre-operative assessment tool that can provide the quantitative information of ATFLs in patients with CAI.Cite this article Bone Joint Res 2014;3:241–5.

Deltoid Ligament and Tibiofibular Syndesmosis Injury in Chronic Lateral Ankle Instability: Magnetic Resonance Imaging Evaluation at 3T and Comparison with Arthroscopy

“…Even if one of the subdivided ligaments presented as injured, we assessed deltoid ligament or syndesmosis as injured when analyzing the prevalence. For the purpose of this study, chronic injury to these ligaments was defined as thickening, thinning, irregularities, discontinuity, nonvisualization, signal alteration, loosening or elongation of the ligaments on MRI ( 9 10 ). Additionally, the relationship between the LCLC injury complexity (ATFL alone, both ATFL and CFL, all ligaments) ( Table 1 ) and the prevalence of accompanying deltoid or syndesmosis ligament injury was also evaluated.…”

Evaluation of 3-Dimensional Magnetic Resonance Imaging (3D MRI) in Diagnosing Anterior Talofibular Ligament Injury

“…MRI has the ability to display soft tissues and the advantages of noninvasiveness, rapid evaluation, multiplanar display, and no radiation damage. Numerous studies have reported that MRI examination has a high diagnostic value [ 7 – 9 ]. Kumar et al reported a sensitivity of ATFL tears of 60%, accuracy of 72%, and specificity of 87% [ 10 ].…”

Stress radiography in the diagnosis and assessment of the outcomes of surgical treatment of chronic anterolateral ankle instability

“…These symptoms result from the disturbance of the biomechanics of the connection between the foot and the shin. The majority of authors agree that surgical treatment, regardless of the method used, counteracts these changes (4,5,18). According to these authors, restoration of normal function to the ATFL improves the stability of the foot and restores normal gait, thus giving the patient a chance to return to intended physical activity (1,2,5,18,20).…”