J Korean Soc Radiol.  2019 Nov;80(6):1121-1131. 10.3348/jksr.2019.80.6.1121.

Qualitative Analysis on Magnetic Resonance Imaging for Preoperative Evaluation of Chronic Lateral Ankle Ligament Injury

• Jang H
• Kim NR
• Moon SG
• Jung HG

• KMID: 2464911
• DOI: http://doi.org/10.3348/jksr.2019.80.6.1121

Abstract

PURPOSE
To compare the MRI findings of anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) injuries in chronic lateral ankle instability (CLAI) between surgical treatment groups.
MATERIALS AND METHODS
Fifty-two patients with CLAI were divided into the modified Broström procedure (MBP) (n = 31) and lateral ankle ligament reconstruction (LAR) (n = 21) groups. T2-weighted MRI findings between the groups were compared for caliber change, slope, signal intensity, and thickness measurements of the ligaments. Additionally, the talar tilt angles were measured on stress radiographs.
RESULTS
The injured ATFL (p = 0.002 vs. p = 0.001) and CFL (p = 0.008 vs. p = 0.039) were more commonly scarce or thin and had decreased slopes in the LAR group. The mean thickness of ATFL (P = 0.002) and CFL (p = 0.002) was 1.1 ± 0.9 mm and 1.3 ± 0.8 mm, respectively, in the LAR group and 2.2 ± 1.3 mm and 2.1 ± 0.9 mm, respectively, in the MBP group. The mean talar tilt angle was greater in the LAR group (13.4 ± 3.9°) than in the MBP group (9.5 ± 3.8°) (p = 0.001).
CONCLUSION
A qualitative analysis of the ligaments on MRI is valuable in selecting the surgical method.

MeSH Terms

Ankle Injuries
Ankle*
Collateral Ligaments
Humans
Lateral Ligament, Ankle
Ligaments*
Magnetic Resonance Imaging*
Methods

Figure

• 

  Fig. 1 A 35-year-old woman with chronic ankle pain. The anterior talofibular ligament is well-visualized on axial T2-weighted image. The uninjured ligament is of uniform thickness and low T2 signal intensity (arrow).

• 

  Fig. 2 A 26-year-old woman who underwent the modified Broström procedure for the treatment of chronic lateral ankle instability. The talar tilt angle on ankle inversion stress radiography was 9°. A. Axial T2-weighted image shows diffuse thickening of the ATFL with low signal intensity and normal slope (arrow). B. Coronal T2-weighted image reveals a thickened ATFL (arrowheads). C. Axial T2-weighted image shows mild thickening of the calcaneofibular ligament with low signal intensity and normal slope (arrow). ATFL = anterior talofibular ligament

• 

  Fig. 3 A 38-year-old man who underwent lateral ankle ligament reconstruction for the treatment of chronic lateral ankle instability. The talar tilt angle on ankle inversion stress radiography was 16°. A. The injured ATFL has a thin and wavy appearance with low signal intensity (arrow) on an axial T2-weighted image. B. Coronal T2-weighted image reveals a thinned ATFL (arrowheads). C. Axial T2-weighted image shows irregular thinning of the calcaneofibular ligament with low signal intensity and decreased slope (arrow). ATFL = anterior talofibular ligament

• 

  Fig. 4 A 55-year-old man who underwent lateral ankle ligament reconstruction for the treatment of chronic lateral ankle instability. The talar tilt angle on ankle inversion stress radiography was 15°. A. Axial T2-weighted image demonstrates a markedly thin and wavy anterior talofibular ligament with focal discontinuity (arrow). B. Axial T2-weighted image shows irregular thickening of the calcaneofibular ligament with low signal intensity and decreased slope (arrows).

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