Relationship between stress ankle radiographs and injured ligaments on MRI

Objective

This study was performed to investigate the relationship between the injured lateral ankle ligaments on MRI and stress ankle radiographs.

Materials and methods

Two hundred and twenty-nine consecutive patients (mean age 35.5 years, SD 14.6 years; 136 males and 93 females) that underwent ankle stress radiographs and MRI for lateral ankle instability were included. Tibiotalar tilt angle and anterior translation of talus were measured on stress ankle radiographs. Degree of lateral ligaments (anterior talofibular, calcaneofibular, and posterior talofibular) and deltoid ligament injuries were evaluated and scored as intact (0), partial injury (1), and complete injury (2) on MR images. Effusion of ankle joint was also recorded. The effects of gender, age, injuries of ligaments, and ankle joint effusion on stress radiographs were statistically analyzed.

Results

Gender (p?=?0.010), age (p?=?0.020), and anterior talofibular ligament (ATFL) injury (p?<?0.001) were the factors significantly affecting tibiotalar tilt angle. Posterior talofibular ligament (PTFL) injury (p?=?0.014) was found to be the only significant factor affecting the anterior translation on the anterior drawer radiographs.

Conclusions

ATFL injury and PTFL injury on MRI significantly affected tibiotalar tilt angle and anterior drawer on stress radiographs. Other factors, such as age and gender, need to be considered in evaluating radiographic lateral ankle instability.     

Lateral ankle ligaments: MR arthrography with anatomic correlation in cadavers

Objective

The purpose of our study was to use magnetic resonance (MR) imaging and MR arthrography to demonstrate the anatomy of the lateral ankle ligaments using standard and oblique imaging planes in cadavers.

Material and methods

MR imaging of ten cadaveric ankles was performed before and after intra-articular administration of contrast solution. Proton-density MR images were acquired in standard and oblique imaging planes. MR imaging was correlated with anatomic sections. Measurements using oblique imaging planes were obtained to characterize the morphology of the lateral ligaments.

Results

The anterior talofibular ligament (ATFL) had a variable number of bands in all specimens, separated by fat signal oriented obliquely parallel to the long axis of the ligament. The fibular attachment of ATFL was located in close proximity to the fibular attachment of the distal band of the anterior tibiofibular ligament (AITFL). The angle formed by the calcaneofibular ligament (CFL) and the fibular shaft varied with different ankle positions. Special axial oblique plane best demonstrated the CFL. The posterior talofibular ligament (PTFL) was multi-fasciculated in appearance. Dorsiflexion of the ankle joint helped elongate the PTFL and best depicted this ligament in its entirety in the axial plane.

Conclusion

Oblique imaging planes parallel to the long axis of the individual ligaments may improve visualization of the anatomy of the lateral ankle ligaments. The orientation of the lateral ankle ligaments is affected by the position of the talocrural and subtalar joints. Understanding the morphology of the lateral ankle ligaments can help radiologists diagnose abnormalities of these ligaments.     

Management and rehabilitation of ligamentous injuries to the ankle

The management of ligamentous injuries to the ankle is controversial. Neither the methods for classification and diagnosis, or the procedures for treatment are clear cut. Ankle sprains are a common occurrence, with the majority involving the lateral ligament complex. Within this complex, the anterior talofibular ligament is injured most frequently, usually while the foot is in the plantar flexed position. Ankle injuries can be diagnosed through physical exam, including the anterior drawer test and/or a stress exam, or through roentgenographic evaluation. The purpose of the stress roentgenogram is to measure the degree of talar tilt. However, it does not always yield consistent, reliable results. This inconsistency has led to the use of arthrography. There is debate over its use as well, however, Ankle sprains can be classified into three groups, according to functional loss. Treatment for first and second degree sprains is usually non-operative. The best approach to Grade III sprains is debatable. The issues in the treatment of Grade III sprains are first, whether treatment should be operative or non-operative, and second, whether non-operative treatment should emphasise immobilisation or mobilisation. Brostrom's work is cited as noteworthy. He recommended adhesive strapping followed by mobilisation as the treatment of choice, and reserves surgery for cases of chronic instability. Results demonstrated that strapping yielded shorter disability periods, while surgery produced less instability. The prevention of functional instability is a major concern in the treatment of ankle injuries. There is no consensus for treating a lateral ligament rupture. The authors suggest immobilisation followed by a rehabilitative programme. Three methods of immobilisation are plaster casting, adhesive strapping, and the air-stirrup. The physiological mechanism of cryotherapy and thermotherapy are discussed briefly and recommendations for their use are provided. Aspiration is also discussed. Loss of motion is designated as a primary cause of chronic pain and reinjury, and exercises intended to restore range of motion are provided. Exercises aimed at restoring strength and proprioception are also presented. This allows for return to activity and serves to prevent reinjury.     

The role of the peroneal tendons in passive stabilisation of the ankle joint: an in vitro study

Purpose

Peroneal tendons are known as active stabilizer in acute ankle sprain while an intact ankle mortise and intact lateral ligaments are required for passive stability of the ankle joint. The goal of this study is to determine the peroneal tendons as passive stabilizer in case of lateral ligament instability.

Methods

Twelve (12) human lower leg cadaver specimens underwent a torsion simulation in the testing system, 858 Mini Bionix^® (MTS^® Systems Corporation, Eden Prairie, MN, USA) and a specially designed mounting platform for the specimens. The preset torsion between tibia and calcaneus was primarily set at 30° of internal rotation during plantar flexion and hindfoot inversion. The resisting torque around mechanical tibial axis was recorded which ensures stability in ankle sprain trauma. The first series of measurements were performed on healthy specimens and the following after transecting structures in following order: ATFL (anterior talofibular ligament) in combination with CFL (calcaneofibular ligament), followed by peroneus longus tendon and finally peroneus brevis tendon.

Results

The combined lateral ATFL and CFL instability shows a decrease of the resisting torque which ensures stability in ankle sprain trauma. Only a transection of PLT with existing lateral dual-ligament instability results in a significant decrease in torque (p < 0.0001).

Conclusion

The PLT has a substantial effect on passive stability at a present lateral ligament lesion in ankle sprain trauma. A deficiency in viscoelastic properties of the peroneus longus tendon must be considered in diagnostic and treatment for ankle instability.     

Bone bruises detected by magnetic resonance imaging following lateral ankle sprains

Although bone bruises have been well described in the knee joint, little is known about their presence in the ankle joint. The present study attempted to document the association of bone bruises with lateral ankle sprains. Magnetic resonance (MR) images were obtained from 60 consecutive patients with lateral ankle sprains between April 1994 and June 1995. There were 29 men and 31 women, aged on average 25 years (range 12–68 years). All of the patients presented within 3 weeks of the sprain. MRI examinations were done within 3 weeks of the injury in 15, after 3–6 weeks in 21, and after 6–8 weeks in 24 cases. There were 28 first-time sprains, while 32 patients had suffered one or more sprains before the most recent one. Plain radiographs showed no evidence of osseous abnormality. Following the conventional MRI examination, magnetic resonance arthrography (MRA) was done by injecting 2 mM of gadolinium diethylene triamine penta-acetic acid (DTPA) into the joint under fluoroscopic control, and the same images were obtained again to search for ligamentous lesions. A total of 11 bone bruises were detected in 10 ankles. In this group of patients, there were 5 men and 5 women aged on average 27 years (range 12–50 years). Four MRI examinations were done within 3 weeks, while six were done 3–6 weeks after the injury. One ankle which had suffered one previous sprain and complete ruptures of anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) had two lesions (talus and navicula). In another recurrent case with complete ATFL and CFL ruptures, the lesion was found in the calcaneus. The remaining eight lesions were in the talus in eight ankles. The ligamentous lesions in these ankles included three complete ATFL and CFL ruptures, and four isolated ATFL ruptures; in one ankle there were no ligamentous lesions. The location of talar bruises was medial in six and lateral in three ankles. The incidence of bone bruises associated with isolated ATFL lesions was 16% (4/25). With combined ATFL and CFL lesions the incidence was 50% (5/10). The incidence of ankles with bone bruises and first-time and recurrent sprains was 7% (2/28) and 25% (8/32), respectively. The occurrence of bone bruises should be kept in mind following ankle sprains. Their clinical significance in the long term remains to be determined. Received: 11 May 1996 Accepted: 30 January 1997     

Aspiration and Corticosteroid Injection

Most lateral ankle sprains heal brief with conservative treatment, Pain that lasts 6 or more weeks after a sprain may come from inadequate rehabilitation, impingement, occult osteochondral or chondral lesions, peroneal tendon or syndesmosis injury, or lateral instability. Treatment for inadequate rehabilitation includes supervised rehabilitation and home exercise. Surgery is recommended for refractory cases of impingement syndrome. Occult osteochondral or chondral lesions usually require arthroscopic excision or repair. Peroneal tendon injury should be treated conservatively before surgery is considered. The severity of syndesmosis injury determines conservative or surgical measures. Remedies for lateral instability include an ankle brace, physiotherapy, and surgery.     

Clinical association of acute lateral ankle sprain with syndesmotic involvement: a stress radiography and magnetic resonance imaging study

BACKGROUND: Information concerning the clinical association between syndesmosis injury and grade of lateral ankle ligament damage would aid in the diagnosis and treatment of ankle sprains. HYPOTHESIS: Evaluation of lateral ligament injury in terms of percentage tear of both the anterior talofibular and calcaneofibular ligaments can provide information on the extent of syndesmotic involvement. STUDY DESIGN: Prospective cohort study. METHODS: Twenty-five patients volunteered to have magnetic resonance imaging examinations performed and 21 volunteered to undergo graded stress radiographs. Talar tilt angles were measured from radiographs taken with 0, 6, 9, 12, and 15 daN of force applied medially just above the ankle joint, and the percentage of ligament tear and grade of injury were determined. Scans were obtained with the foot in neutral and plantar flexion to image the anterior talofibular and calcaneofibular ligaments. RESULTS: Grades of lateral ligament injury determined by magnetic resonance imaging and graded stress radiography were the same. The extent of syndesmotic injury could be assessed for all patients. CONCLUSIONS: Intact tibiofibular ligaments were found equally frequently among patients with normal or any grade of lateral ligament damage, but the more severe injuries to the syndesmotic ligaments were associated with normal or minimally traumatized lateral ligaments. The inverse correlation can be explained on the basis of the difference between the mechanisms that precipitate these injuries.     

Management of acute lateral ankle ligament injury in the athlete

Purpose

Inversion injuries involve about 25 % of all injuries of the musculoskeletal system and about 50 % of these injuries are sport-related. This article reviews the acute lateral ankle injuries with special emphasis on a rationale for treatment of these injuries in athletes.

Methods

A narrative review was performed using Pubmed/Medline, Ovid and Embase using key words: ankle ligaments, injury, lateral ligament, ankle sprain and athlete. Articles related to the topic were included and reviewed.

Results

It is estimated that one inversion injury of the ankle occurs for every 10,000 people each day. Ankle sprains constitute 7–10 % of all admissions to hospital emergency departments. Inversion injuries involve about 25 % of all injuries of the musculoskeletal system, and about 50 % of these injuries are sport-related. The lateral ankle ligament complex consists of three ligaments: the anterior talofibular ligament, the calcaneofibular ligament and the posterior talofibular ligament. The most common trauma mechanism is supination and adduction (inversion) of the plantar-flexed foot.

Conclusion

Delayed physical examination provides a more accurate diagnosis. Ultrasound and MRI can be useful in diagnosing associated injury and are routine investigations in professional athletes. Successful treatment of grade II and III acute lateral ankle ligament injuries can be achieved with individualized aggressive, non-operative measures. RICE therapy is the treatment of choice for the first 4–5 days to reduce pain and swelling. Initially, 10–14 days of immobilization in a below the knee cast/brace is beneficial followed by a period in a lace-up brace or functional taping reduces the risk of recurrent injury. Acute repair of the lateral ankle ligaments in grade III injuries in professional athletes may give better results.

Level of evidence

IV.     

Anatomic reconstruction of the anterior talofibular and calcaneofibular ligaments using a semitendinosus tendon allograft and interference screws

Purpose

The purpose of this study was to evaluate the functional and radiographic outcomes of a novel surgical technique devised to treat chronic lateral ankle instability. The technique involves direct repair of the anterior talofibular ligament and anatomic reconstructions of the anterior talofibular ligament (ATFL) and the calcaneofibular ligament (CFL) using a free semitendinosus tendon allograft and interference screws.

Methods

This retrospective study involved a review of the records of 27 patients (28 ankles) with chronic lateral ankle instability treated from 2007 to 2009. VAS pain scores, AOFAS scores, Karlsson–Peterson ankle scores (24 ankles), and patient satisfaction were evaluated at median of 19 (12–26)?months postoperatively. Radiographically, talar tilt angles and anterior talar translation were assessed in pre- and postoperative ankle stress views.

Results

Median patient age at surgery was 36.5 (16–57)?years. Median VAS pain score decreased from 6 (3–9) to 2 (0–4) (P?P?P?P?Conclusions The described technique, which involves anatomic reconstruction of the ATFL and CFL using the semitendinosus tendon and interference screws with direct repair of the capsule, is a viable option for treating lateral ankle instability with stable tendon fixation and provides satisfactory clinical outcomes.

Level of evidence

Case-series, Level IV.     

Anatomical reconstruction of the lateral ligaments of the ankle with a gracilis autograft: a new technique using an interference fit anchoring system

BACKGROUND: Few anatomical and minor invasive procedures have been reported for surgical reconstruction of the lateral ligaments to treat lateral instability of the ankle. Furthermore, there are no standards according to which ligaments should be reconstructed. HYPOTHESIS: A new technique for anatomically reconstructing the lateral ligaments of the ankle using an interference fit anchoring system and determining which ligaments need to be reconstructed according to the results of standard stress radiography of the talocrural and subtalar joints will be effective for treating lateral instability of the ankle. STUDY DESIGN: Case series; level of evidence, 4. METHODS: Twenty-one patients with lateral instability of the ankle underwent surgery using the proposed interference fit anchoring system. Standard stress radiographs of the subtalar joint were performed, and if the talocalcaneal angle was less than 10 degrees , only the anterior talofibular ligament was reconstructed; if there was a 10 degrees or greater opening of the talocalcaneal angle, both the anterior talofibular ligament and the calcaneofibular ligament were reconstructed. RESULTS: In the 17 patients who received only the anterior talofibular ligament reconstruction, the mean talar tilt angle on standard stress radiography of the talocrural joint was 14.5 degrees +/- 1.7 degrees before surgery and 2.6 degrees +/- 0.8 degrees 2 years after surgery (P < .0001). For the 4 patients who had both the anterior talofibular ligament and calcaneofibular ligament reconstructed, the mean talar tilt angle was 16.5 degrees +/- 1.5 degrees before surgery and 3.0 degrees +/- 0.5 degrees 2 years after surgery (P = .0015). The overall mean talocalcaneal angle on standard stress radiography of the subtalar joint was 11.3 degrees +/- 1.4 degrees before surgery and 3.5 degrees +/- 0.8 degrees 2 years after surgery (P = .0060). CONCLUSION: The proposed system has several advantages, including anatomical reconstruction with normal stability and range of motion restored, the need for only a small incision during the reconstruction, and sufficient strength at the tendon graft-bone tunnel junction, in comparison with the tension strength of the lateral ligaments of the ankle.     

Arthroscopic assessment of the chronic unstable ankle joint

The purpose of this study was to evaluate prospectively the findings during arthroscopy in patients with chronic instability of the ankle joint. One hundred and ten consecutive patients who had suffered at least two ankle sprains and were symptomatic for at least 6 months were included in this study. A complete rupture of the anterior talofibular ligament was found in 64%, of the calcancofibular ligament in 41% and of the deltoid ligament in 6%. Cartilage lesions of the talus were seen in 54% of the joints, more of them medial (56%) than lateral (15%) or ventral (20%). Other frequently observed findings were synovialitis (38%), rupture of the syndesmosis (7%), and ventral scarring (6%). While cartilage damage was found independently of the lateral ligament injuries, all complete tears of the deltoid ligament were associated with cartilage injury of the talus. Medial instability was assessed in five ankles clinically and found arthroscopically in 23 ankle joints. Our arthroscopic findings show that chronic instability of the ankle joint is associated with various pathological conditions of ligaments, capsule and cartilage. It can therefore give essential information about the status of the chronic unstable joint with regard to the choice of operative or conservative treatment.     

Injuries of the lateral collateral ligaments of the ankle: assessment with MR imaging

The aim of this study was to evaluate the ability of MRI to display injuries of the lateral collateral ligamentous complex in patients with an acute ankle distorsion trauma. The MR examinations of 36 patients with ankle pain after ankle distorsion were evaluated retrospectively without knowledge of clinical history, outcome and/or operative findings. The examinations were performed on a 1.5-T whole-body imager using a flexible surface coil. The signs for ligamentous abnormality were as follows: complete or partial discontinuity, increased signal within, and irregularity and waviness of the ligament. The results were compared with operative findings in 18 patients with subsequent surgical repair. Eighteen patients with conservative therapy had a follow-up MR examination after 3 months. There was 1 sprain, 3 partial and 32 complete tears of the anterior talofibular ligament, and 5 sprains, 5 partial, and 7 complete tears of the calcaneofibular ligament. There were no lesions of the posterior talofibular ligament. Compared with surgery, MRI demonstrated in 18 of 18 cases the exact extent of anterior talofibular ligament injuries and underestimated the extent in 2 of 8 cases of calcaneofibular ligament injury. In patients with follow-up MRI after conservative therapy, a thickened band-like structure was found along the course of the injured ligament in 17 of 18 cases. The absence of ligament repair after conservative treatment was confirmed during operative revision in one case. The MRI technique allows for grading of the extent of injury of the lateral collateral ligamentous complex after acute ankle strain. It seems to be suitable for monitoring the healing process after conservative-functional treatment of ligament tears. Received: 29 June 1998; Revision received: 21 October 1998; Accepted: 22 October 1998     

Ligamentous posttraumatic ankle osteoarthritis

BACKGROUND: Ankle sprains are the most common injuries in sports and recreational activities. HYPOTHESIS: Ankle osteoarthritis can be caused by ankle ligament lesions. Latency time between injury and osteoarthritis is influenced by the type and side of the injured ligaments. The side of the ligamentous lesion correlates with the hindfoot alignment. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Of a cohort of 247 patients with ankle arthritis, we reviewed data from 30 patients (33 ankles; mean age, 58.6 years) with ligamentous end-stage ankle osteoarthritis. The patients were evaluated etiologically, clinically, and radiologically. RESULTS: Etiologic analysis: 55% had a ligamentous lesion from sports injuries (soccer, 33%); 85% injured the lateral ankle ligaments, and 15% injured the medial and medial-lateral ligaments. The mean latency time between injury and osteoarthritis was 34.3 years. The survivorship rate for single severe ankle sprains was worse than that for chronic recurrent ligamentous lesions (mean latency time, 25.7 vs 38.0 years; P < .05), and the rate for medial sprains was worse than for lateral sprains (mean latency time, 27.5 vs 35.0 years; P < .05). At follow-up, the American Orthopaedic Foot and Ankle Society hindfoot score was 23.0 points, 52% had varus malalignment, 52% had persistent instability, and the mean ankle arthritis grade was 2.6 points. There was a correlation between chronic lateral ankle instability and varus malalignment. CONCLUSION: Lateral ankle sprains in sports are the main cause of ligamentous posttraumatic ankle osteoarthritis and correlate with varus malalignment. At the time of end-stage ligamentous ankle osteoarthritis, persistent instability may be encountered.     

Endoscopic reconstruction of CFL and the ATFL with a gracilis graft: a cadaveric study

Purpose

The purpose of this study was to evaluate a step-by-step approach to endoscopic reconstruction of the anterior talofibular ligament (ATFL) and the calcaneofibular ligament (CFL).

Methods

Fourteen lower extremity cadaveric specimens were used. Four standard portals were defined and used. A step-by-step approach using several anatomical landmarks was used to reconstruct the ATFL and CFL. The feasibility of visualising the anatomical landmarks and both ligaments and their footprints was assessed. Both ligaments were reconstructed using a gracilis graft fixed in bone tunnels. The lateral side of the ankle was completely exposed and dissected. The specimen was assessed for clinical stability of the reconstruction and damage to the surrounding anatomical structures. The distance between the centre of the tunnel and the anatomical insertions of the ligaments was measured. The distance between the portals and the nerves was measured.

Results

The step-by-step approach allowed a good visualisation of the entire course of the ATFL and CFL. An endoscopic reconstruction of both ligaments was performed, and good stability was obtained. The measurements revealed a good positioning of the reconstructed ligament insertions with a maximal error of 2 mm in most specimens. Anatomical dissection revealed no damage to the surrounding anatomical structures that were at risk. The average distance to the superficial peroneal nerve was 11.9 ± 5.3 mm (standard deviation), and the average distance to the sural nerve was 17.4 ± 3.2 mm (standard deviation). A safe zone was defined with regard to the surrounding nerves.

Conclusion

The described technique, which involves an anatomical endoscopic reconstruction of the ATFL and CFL, using a gracilis graft, is a viable option to treat lateral ankle instability. This technique is reproducible and safe with regard to the surrounding anatomical structures.

     

Diagnostic value of stress radiography in lesions of the lateral ligaments of the ankle

The diagnostic accuracy of inversion and anterior stress radiography in rupture of the lateral ligaments of the ankle joint was assessed in 56 patients undergoing surgery. In inversion stress radiography, 58 per cent of the patients with confirmed rupture of the lateral ligaments of the ankle had a talar tilt of 10 degrees or more, allowing a predictive value of a positive test of 94 per cent. In anterior stress radiography, 53 per cent of the patients had a posterior tibiotalar distance of 9 mm or more, allowing a predictive value of a positive test of 81 per cent. In measurements of talar tilt and anterior displacement of the talus values higher than normal in the injured ankle may be a sign of a rupture of the lateral ligament.     

Syndesmosis and deltoid ligament injuries in the athlete

Purpose

Injury to the syndesmosis and deltoid ligament is less common than lateral ligament trauma but can lead to significant time away from sport and prolonged rehabilitation. This literature review will discuss both syndesmotic and deltoid ligament injuries without fracture in the professional athlete.

Methods

A narrative review was performed using PUBMED, OVID, MEDLINE and EMBASE using the key words syndesmosis, injury, deltoid, ankle ligaments, and athlete. Articles related to the topic were included and reviewed.

Results

The incidence of syndesmotic injury ranges from 1 to 18 % of ankle sprains. This may be underreported and is an often missed injury as clinical examination is generally not specific. Both MRI and ultrasonography have high sensitivities and specificities in diagnosing injury. Arthroscopy may confirm the diagnosis, and associated intra-articular pathology can be treated at the same time as surgical stabilization. Significant deltoid ligament injury in isolation is rare, there is usually associated trauma. Major disruption of both deep and superficial parts can lead to ankle dysfunction. Repair of the ligament following ankle fracture is not necessary, but there is little literature to guide the management of deltoid ruptures in isolation or in association with syndesmotic and lateral ligament injuries in the professional athlete.

Conclusion

Management of syndesmotic injury is determined by the grade and associated injury around the ankle. Grade I injuries are treated non-surgically in a boot with a period of non-weight bearing. Treatment of Grade II and III injuries is controversial with little literature to guide management. Athletes may return to training and play sooner if the syndesmosis is surgically stabilized. For deltoid ligament injury, grade I and II sprains should be treated non-operatively. Unstable grade III injuries with associated injury to the lateral ligaments or the syndesmosis may benefit from operative repair.

Level of evidence

IV.     

MRI诊断踝关节外侧韧带损伤的Meta分析

 目的 探讨MRI技术在诊断踝关节外侧韧带损伤的有效性。方法 应用Meta分析。检索3个中文数据库(中国期刊全文数据库、万方数据库、中文科技期刊数据库)和3个英文数据库(PubMed、EMbase、The Cochrane Library)进行相关研究。检索年限均为从建库至2018-11。总结了符合条件的研究,提取数据以计算磁共振成像(MRI)在诊断踝关节外侧韧带损伤时的灵敏度和特异度。结果 16项研究符合纳入,包括660例患者。MRI诊断急性距腓前韧带损伤的合并敏感度为0.93[95%CI(0.86,0.97)],合并特异度为0.55[95%CI(0.27,0.80)]。诊断慢性距腓前韧带损伤的合并敏感度为0.86[95%CI(0.77,0.91)],合并特异度为0.80[95%CI(0.67,0.89)]。诊断急性跟腓韧带损伤的合并敏感度为0.72[95%CI(0.58,0.82)],合并特异度为0.86[95%CI(0.68,0.95)]。诊断慢性跟腓韧带损伤的合并敏感度为0.57[95%CI(0.44,0.69)],合并特异度为0.92[95%CI(0.86,0.96)]。结论 MRI检查在诊断慢性距腓前韧带损伤时的诊断效能较高。诊断急性距腓前韧带损伤时,MRI检查可以有效筛选ATFL损伤患者。在诊断急慢性跟腓韧带损伤时,其阴性结果对排除跟腓韧带损伤有一定的参考价值。     

Impact of Chronic Lateral Ankle Instability with Lateral Collateral Ligament Injuries on Biochemical Alterations in the Cartilage of the Subtalar and Midtarsal Joints Based on MRI T2 Mapping

ObjectiveTo quantitatively assess biochemical alterations in the cartilage of the subtalar and midtarsal joints in chronic lateral ankle instability (CLAI) patients with isolated anterior talofibular ligament (ATFL) injuries and combined calcaneofibular ligament (CFL) injuries using MRI T2 mapping.Materials and MethodsThis study was performed according to regulations of the Committee for Human Research at our institution, and written informed consent was obtained from all participants. Forty CLAI patients (26 with isolated ATFL injuries and 14 with combined ATFL and CFL injuries) and 25 healthy subjects were recruited for this study. All participants underwent MRI scans with T2 mapping. Patients were assessed with the American Orthopedic Foot and Ankle Society (AOFAS) rating system. The subtalar and midtarsal joints were segmented into 14 cartilage subregions. The T2 value of each subregion was measured from T2 mapping images. Data were analyzed with ANOVA, the Student''s t test, and Pearson''s correlation coefficient.ResultsT2 values of most subregions of the subtalar joint and the calcaneal facet of the calcaneocuboid joint in CLAI patients with combined CFL injuries were higher than those in healthy controls (all p < 0.05). However, there were no significant differences in T2 values in subtalar and midtarsal joints between patients with isolated ATFL injuries and healthy controls (all p > 0.05). Moreover, T2 values of the medial talar subregions of the posterior subtalar joint in patients with combined CFL injuries showed negative correlations with the AOFAS scores (r = −0.687, p = 0.007; r = −0.609, p = 0.021, respectively).ConclusionCLAI with combined CFL injuries can lead to cartilage degeneration in subtalar and calcaneocuboid joints, while an isolated ATFL injury might not have a significant impact on the cartilage in these joints.     

急性外踝韧带和关节囊撕裂

报告了９０例（９１个踝关节）外踝韧带断裂和关节囊撕裂的病例，指出：外踝韧带断裂和踝前外侧关节囊的撕裂是踝足旋后伤所致；外踝韧带断裂易发生在篮球、足球等运动项目；外踝韧带断裂分为４型，对于运动员的Ⅲ度外踝韧带断裂应给予手术治疗，术后效果令人满意；外踝韧带损伤可导致腓骨长短肌的瞬时反应时延长；术后应加强踝关节跖屈、背伸、内翻和外翻肌力的练习，恢复关节的平衡性和灵活性。     

The radiological functional testing in fibular ligament lesions--a critical analysis and clinical study

Injuries to the lateral ligaments of the ankle require an accurate diagnosis, especially because most injuries to one ligament are not treated surgically any more. Different stress devices are in use for an objective and standardised assessment of the instability of the ankle joint. In a group of 76 patients with injuries to their lateral ligaments of the ankle we compared posttraumatic instability by radiological stress test as done by hand or by a Telos stress device. In 25 patients treated by surgery an additional intraoperative stress X-ray (talar tilt) was performed. The results of the instability tests done by hand versus those obtained with a Telos stress device showed a poor correlation (r = 0.786). An analogous result was obtained by comparing the Telos device stress views to the intraoperative stress controls done by hand (r = 0.771). Only the pre- and intraoperative measurements by hand showed a good correlation (r = 0.958). The results are discussed with reference to a biomechanical model and recommendations for routine diagnosis are proposed.