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Fritz B, de Cesar Netto C, Fritz J. Multiaxial 3D MRI of the Ankle: Advanced High-Resolution Visualization of Ligaments, Tendons, and Articular Cartilage. Clin Podiatr Med Surg 2024; 41:685-706. [PMID: 39237179 DOI: 10.1016/j.cpm.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2024]
Abstract
MRI is a valuable tool for diagnosing a broad spectrum of acute and chronic ankle disorders, including ligament tears, tendinopathy, and osteochondral lesions. Traditional two-dimensional (2D) MRI provides a high image signal and contrast of anatomic structures for accurately characterizing articular cartilage, bone marrow, synovium, ligaments, tendons, and nerves. However, 2D MRI limitations are thick slices and fixed slice orientations. In clinical practice, 2D MRI is limited to 2 to 3 mm slice thickness, which can cause blurred contours of oblique structures due to volume averaging effects within the image slice. In addition, image plane orientations are fixated and cannot be changed after the scan, resulting in 2D MRI lacking multiplanar and multiaxial reformation abilities for individualized image plane orientations along oblique and curved anatomic structures, such as ankle ligaments and tendons. In contrast, three-dimensional (3D) MRI is a newer, clinically available MRI technique capable of acquiring high-resolution ankle MRI data sets with isotropic voxel size. The inherently high spatial resolution of 3D MRI permits up to five times thinner (0.5 mm) image slices. In addition, 3D MRI can be acquired image voxel with the same edge length in all three space dimensions (isotropism), permitting unrestricted multiplanar and multiaxial image reformation and postprocessing after the MRI scan. Clinical 3D MRI of the ankle with 0.5 to 0.7 mm isotropic voxel size resolves the smallest anatomic ankle structures and abnormalities of ligament and tendon fibers, osteochondral lesions, and nerves. After acquiring the images, operators can align image planes individually along any anatomic structure of interest, such as ligaments and tendons segments. In addition, curved multiplanar image reformations can unfold the entire course of multiaxially curved structures, such as perimalleolar tendons, into one image plane. We recommend adding 3D MRI pulse sequences to traditional 2D MRI protocols to visualize small and curved ankle structures to better advantage. This article provides an overview of the clinical application of 3D MRI of the ankle, compares diagnostic performances of 2D and 3D MRI for diagnosing ankle abnormalities, and illustrates clinical 3D ankle MRI applications.
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Affiliation(s)
- Benjamin Fritz
- Department of Radiology, Balgrist University Hospital, Forchstrasse 340, Zurich 8008, Switzerland; Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Cesar de Cesar Netto
- Department of Orthopaedics and Rehabilitation, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Jan Fritz
- Department of Radiology, Division of Musculoskeletal Radiology, NYU Grossman School of Medicine, 660 1st Avenue, New York, NY 10016, USA.
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Bajaj S, Chhabra A, Taneja AK. 3D isotropic MRI of ankle: review of literature with comparison to 2D MRI. Skeletal Radiol 2024; 53:825-846. [PMID: 37978990 DOI: 10.1007/s00256-023-04513-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/01/2023] [Accepted: 11/06/2023] [Indexed: 11/19/2023]
Abstract
The ankle joint has complex anatomy with different tissue structures and is commonly involved in traumatic injuries. Magnetic resonance imaging (MRI) is the primary imaging modality used to assess the soft tissue structures around the ankle joint including the ligaments, tendons, and articular cartilage. Two-dimensional (2D) fast spin echo/turbo spin echo (FSE/TSE) sequences are routinely used for ankle joint imaging. While the 2D sequences provide a good signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) with high spatial resolution, there are some limitations to their use owing to the thick slices, interslice gaps leading to partial volume effects, limited fluid contrast, and the need to acquire separate images in different orthogonal planes. The 3D MR imaging can overcome these limitations and recent advances have led to technical improvements that enable its widespread clinical use in acceptable time periods. The volume imaging renders the advantage of reconstructing into thin continuous slices with isotropic voxels enabling multiplanar reconstructions that helps in visualizing complex anatomy of the structure of interest throughout their course with improved sharpness, definition of anatomic variants, and fluid conspicuity of lesions and injuries. Recent advances have also reduced the acquisition time of the 3D datasets making it more efficient than 2D sequences. This article reviews the recent technical developments in the domain 3D MRI, compares imaging with 3D versus 2D sequences, and demonstrates the use-case scenarios with interesting cases, and benefits of 3D MRI in evaluating various ankle joint components and their lesions.
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Affiliation(s)
- Suryansh Bajaj
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Avneesh Chhabra
- Musculoskeletal Radiology Division, Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
- Department of Orthopaedic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
- Johns Hopkins University, Baltimore, MD, USA
- Walton Center of Neurosciences, Liverpool, UK
- University of Dallas, Richardson, TX, USA
| | - Atul Kumar Taneja
- Musculoskeletal Radiology Division, Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.
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Fritz B, de Cesar Netto C, Fritz J. Multiaxial 3D MRI of the Ankle: Advanced High-Resolution Visualization of Ligaments, Tendons, and Articular Cartilage. Foot Ankle Clin 2023; 28:529-550. [PMID: 37536817 DOI: 10.1016/j.fcl.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
MRI is a valuable tool for diagnosing a broad spectrum of acute and chronic ankle disorders, including ligament tears, tendinopathy, and osteochondral lesions. Traditional two-dimensional (2D) MRI provides a high image signal and contrast of anatomic structures for accurately characterizing articular cartilage, bone marrow, synovium, ligaments, tendons, and nerves. However, 2D MRI limitations are thick slices and fixed slice orientations. In clinical practice, 2D MRI is limited to 2 to 3 mm slice thickness, which can cause blurred contours of oblique structures due to volume averaging effects within the image slice. In addition, image plane orientations are fixated and cannot be changed after the scan, resulting in 2D MRI lacking multiplanar and multiaxial reformation abilities for individualized image plane orientations along oblique and curved anatomic structures, such as ankle ligaments and tendons. In contrast, three-dimensional (3D) MRI is a newer, clinically available MRI technique capable of acquiring high-resolution ankle MRI data sets with isotropic voxel size. The inherently high spatial resolution of 3D MRI permits up to five times thinner (0.5 mm) image slices. In addition, 3D MRI can be acquired image voxel with the same edge length in all three space dimensions (isotropism), permitting unrestricted multiplanar and multiaxial image reformation and postprocessing after the MRI scan. Clinical 3D MRI of the ankle with 0.5 to 0.7 mm isotropic voxel size resolves the smallest anatomic ankle structures and abnormalities of ligament and tendon fibers, osteochondral lesions, and nerves. After acquiring the images, operators can align image planes individually along any anatomic structure of interest, such as ligaments and tendons segments. In addition, curved multiplanar image reformations can unfold the entire course of multiaxially curved structures, such as perimalleolar tendons, into one image plane. We recommend adding 3D MRI pulse sequences to traditional 2D MRI protocols to visualize small and curved ankle structures to better advantage. This article provides an overview of the clinical application of 3D MRI of the ankle, compares diagnostic performances of 2D and 3D MRI for diagnosing ankle abnormalities, and illustrates clinical 3D ankle MRI applications.
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Affiliation(s)
- Benjamin Fritz
- Department of Radiology, Balgrist University Hospital, Forchstrasse 340, Zurich 8008, Switzerland; Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Cesar de Cesar Netto
- Department of Orthopaedics and Rehabilitation, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Jan Fritz
- Department of Radiology, Division of Musculoskeletal Radiology, NYU Grossman School of Medicine, 660 1st Avenue, New York, NY 10016, USA.
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Nagatomo M, Yoshimura I, Hagio T, Ishimatsu T, Sugino Y, Yamamoto T. Straight Form of Calcaneofibular Ligament as a Three-Dimensional Magnetic Resonance Imaging Sign in Diagnosis of Calcaneofibular Ligament and Anterior Talofibular Ligament Inferior Fascicle Injury. J Foot Ankle Surg 2022; 61:327-332. [PMID: 34610885 DOI: 10.1053/j.jfas.2021.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/14/2021] [Accepted: 09/01/2021] [Indexed: 02/03/2023]
Abstract
The present study was performed to investigate the morphological characteristics of the calcaneofibular ligament (CFL) and evaluate its relationship to the anterior talofibular ligament (ATFL) in patients with lateral ankle ligament injury using 3-dimensional magnetic resonance imaging (3D-MRI). This retrospective study involved 35 patients with lateral ankle ligament injury and 24 patients without a history of ankle trauma and a bone abnormality as controls. Reconstructed 3D-MRI was used to classify the form of the CFL as curved, wavy, or straight. The presence/absence of continuity between the fibula and CFL was evaluated in the 35 patients with injury, who were divided into 2 groups (continuity and discontinuity groups). The number of fascicles in the ATFL and the continuity between the distal end of the fibula and the proximal end of the ATFL were then evaluated. Among the patients with injury, 54.3% had the curve type of CFL, 34.3% had the wave type, and 11.4% had the straight type. In the control group, 62.5% had the curve type, 37.5% had the wave type, and none had the straight type. Continuity between the fibula and CFL was seen in 88.6%, and discontinuity was seen in 11.4%. Additionally, 85.7% had double fascicles in the ATFL. Inferior fascicle discontinuity between the ATFL and fibula was found in 13.3% with a double-fascicle ATFL; in all of these patients, the form of the CFL was straight and exhibited inferior fascicle discontinuity. The straight form of CFL could be a 3D-MRI sign in the diagnosis of CFL and ATFL inferior fascicle injury.
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Affiliation(s)
- Masaya Nagatomo
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Jonan-ku, Fukuoka, Japan
| | - Ichiro Yoshimura
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Jonan-ku, Fukuoka, Japan.
| | - Tomonobu Hagio
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Jonan-ku, Fukuoka, Japan
| | - Tetsuro Ishimatsu
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Jonan-ku, Fukuoka, Japan
| | - Yuki Sugino
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Jonan-ku, Fukuoka, Japan
| | - Takuaki Yamamoto
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Jonan-ku, Fukuoka, Japan
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Kitsukawa K, Hirano T, Niki H, Tachizawa N, Mimura H. The Diagnostic Accuracy of MRI to Evaluate Acute Lisfranc Joint Injuries: Comparison With Direct Operative Observations. FOOT & ANKLE ORTHOPAEDICS 2022; 7:24730114211069080. [PMID: 35097492 PMCID: PMC8792696 DOI: 10.1177/24730114211069080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Early diagnosis is important in patients with Lisfranc joint injury to avoid
subsequent complications. As the ligaments in the Lisfranc joint are
relatively small and course obliquely, isotropic 3-dimensional (3D) magnetic
resonance imaging (MRI) can be beneficial to evaluate ligament injury. The
purpose of this study was to investigate the diagnostic accuracy of MRI,
including isotropic 3D MRI for acute injury of the Lisfranc joint,
especially of the interosseous C1-M2 ligament (Lisfranc ligament), the
dorsal C1-M2 ligament (dorsal ligament), and the interosseous C1-C2
ligament, compared with direct operative observations. Methods: This retrospective review identified 27 patients who had undergone MR
examination for acute Lisfranc joint injury followed by surgery. We reviewed
the operative reports that described the Lisfranc, dorsal, and interosseous
C1-C2 ligaments. All patients underwent an MRI, including a 2D oblique plane
image parallel to the Lisfranc ligament and an isotropic 3D MRI. An image
analysis of the integrity of the 3 ligaments and other associated injuries
was performed. The diagnostic accuracy of MRI was analyzed using operative
findings as a reference standard. Results: Lisfranc and dorsal ligament injuries were identified on MRI in all patients.
MRI depicted disruption of the interosseous C1-C2 ligament in 12 patients.
MRI diagnostic accuracy for detection of Lisfranc, dorsal, and interosseous
C1-C2 ligaments was 100% (95% CI 0.82-1.0), 74% (95% CI 0.54-0.89), and 70%
(95% CI 0.50-0.86), respectively. Conclusion: MRI with oblique planes parallel to the Lisfranc ligament and isotropic 3D
MRI was reliable for detecting Lisfranc ligament injury, whereas MRI
findings of the dorsal and interosseous C1-C2 ligaments were less consistent
with operative observations. Level of Evidence: Level IV, case series.
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Affiliation(s)
- Kaoru Kitsukawa
- Department of Radiology, St. Marianna
University School of Medicine, Kawasaki City, Kanagawa, Japan
- Kaoru Kitsukawa, MD, Chiba University
Hospital, Comprehensive Radiology Center, 1-8-1 Inohana, Chuo-Ku, Chiba-shi,
Chiba 260-8677, Japan.
| | - Takaaki Hirano
- Department of Orthopedic Surgery, St.
Marianna University School of Medicine, Kawasaki City, Kanagawa, Japan
| | - Hisateru Niki
- Department of Orthopedic Surgery, St.
Marianna University School of Medicine, Kawasaki City, Kanagawa, Japan
| | - Natsuki Tachizawa
- Department of Radiology, St. Marianna
University School of Medicine, Kawasaki City, Kanagawa, Japan
| | - Hidefumi Mimura
- Department of Radiology, St. Marianna
University School of Medicine, Kawasaki City, Kanagawa, Japan
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Won HJ, Oh CS. Classification of the interosseous tarsometatarsal ligaments of the foot. Foot Ankle Surg 2022; 28:72-78. [PMID: 33574006 DOI: 10.1016/j.fas.2021.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/20/2021] [Accepted: 01/25/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim of this study was to clarify the anatomical features of the interosseous tarsometatarsal ligaments of foot and to classify their types based on the combinations of their ligamentous components. METHODS Fifty feet from 27 adult Korean cadavers were dissected. RESULTS The interosseous tarsometatarsal ligaments were observed in the first, second, and third cuneometatarsal joint spaces. The interosseous tarsometatarsal ligament of the first cuneometatarsal space consistently connected the medial cuneiform and the second metatarsal, and was accompanied by one or two accessory ligaments above (34%) and/or below (6%) the Lisfranc ligament. The interosseous tarsometatarsal ligaments of the second and third cuneometatarsal joint spaces comprised seven and five components, and were classified into five and three types depending on the number and combination of the components, respectively. CONCLUSIONS These results are expected to advance the current knowledge on the tarsometatarsal joint and provide helpful information for more accurate and successful diagnosis and treatment of lesions at this joint.
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Affiliation(s)
- Hyung-Jin Won
- Department of Anatomy, School of Medicine, Kangwon National University, Chuncheon, Kangwon-do 24341, Republic of Korea
| | - Chang-Seok Oh
- Department of Anatomy, Sungkyunkwan University School of Medicine, Jangan-gu, Suwon, Gyeonggi-do 440-746, Republic of Korea.
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Fritz B, Fritz J, Sutter R. 3D MRI of the Ankle: A Concise State-of-the-Art Review. Semin Musculoskelet Radiol 2021; 25:514-526. [PMID: 34547816 DOI: 10.1055/s-0041-1731332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Magnetic resonance imaging (MRI) is a powerful imaging modality for visualizing a wide range of ankle disorders that affect ligaments, tendons, and articular cartilage. Standard two-dimensional (2D) fast spin-echo (FSE) and turbo spin-echo (TSE) pulse sequences offer high signal-to-noise and contrast-to-noise ratios, but slice thickness limitations create partial volume effects. Modern three-dimensional (3D) FSE/TSE pulse sequences with isotropic voxel dimensions can achieve higher spatial resolution and similar contrast resolutions in ≤ 5 minutes of acquisition time. Advanced acceleration schemes have reduced the blurring effects of 3D FSE/TSE pulse sequences by affording shorter echo train lengths. The ability for thin-slice partitions and multiplanar reformation capabilities eliminate relevant partial volume effects and render modern 3D FSE/TSE pulse sequences excellently suited for MRI visualization of several oblique and curved structures around the ankle. Clinical efficiency gains can be achieved by replacing two or three 2D FSE/TSE sequences within an ankle protocol with a single isotropic 3D FSE/TSE pulse sequence. In this article, we review technical pulse sequence properties for 3D MRI of the ankle, discuss practical considerations for clinical implementation and achieving the highest image quality, compare diagnostic performance metrics of 2D and 3D MRI for major ankle structures, and illustrate a broad spectrum of ankle abnormalities.
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Affiliation(s)
- Benjamin Fritz
- Department of Radiology, University Hospital Balgrist, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Jan Fritz
- New York University Grossman School of Medicine, New York University, New York, New York
| | - Reto Sutter
- Department of Radiology, University Hospital Balgrist, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
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Sripanich Y, Steadman J, Krähenbühl N, Rungprai C, Saltzman CL, Lenz AL, Barg A. Anatomy and biomechanics of the Lisfranc ligamentous complex: A systematic literature review. J Biomech 2021; 119:110287. [PMID: 33639336 DOI: 10.1016/j.jbiomech.2021.110287] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 12/21/2020] [Accepted: 01/23/2021] [Indexed: 12/15/2022]
Abstract
Lisfranc injuries are challenging to treat and can have a detrimental effect on active individuals. Over the past decade researchers have investigated methods for the reconstruction of the Lisfranc ligamentous complex (LLC) to preserve its functional stability and mobility. To aid in this innovation, this study presents the current understanding of the anatomical and biomechanical characteristics of the LLC through a systematic review. Three medical databases (PubMed, Scopus, and Embase) were searched from inception through July 2019. Original studies investigating the anatomy and/or biomechanical properties of the LLC were considered for inclusion. Data recorded from each study included: number of cadavers, number of feet, gender, laterality, age, type of specimen, measurement methods, reported ligamentous bundles, ligament origins and insertions, geometric characteristics, and biomechanical properties of the LLC. The Quality Appraisal for Cadaveric Studies (QUACS) scale was used to assess the methodologic quality of included articles. Eight cadaveric studies investigating the LLC were included out of 1204 screened articles. Most articles described the LLC as three distinct structures: the dorsal- (DLL), interosseous- (ILL), and plantar- (PLL) Lisfranc Ligaments. The ILL had the largest thickness and insertional area of osseous attachment. Biomechanically, the ILL also had the highest stiffness and resistance to load prior to failure when loaded parallel to its fiber orientation. Current knowledge of the anatomical and biomechanical properties of the LLC are presented and highlight its significant role of stabilizing the tarsometatarsal articulation. Appreciating the biomechanical characteristics of the ILL may improve clinical insight in managing LLC injuries.
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Affiliation(s)
- Yantarat Sripanich
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA; Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, 315 Rajavithi Road, Tung Phayathai, Ratchathewi, Bangkok 10400, Thailand
| | - Jesse Steadman
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Nicola Krähenbühl
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Chamnanni Rungprai
- Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, 315 Rajavithi Road, Tung Phayathai, Ratchathewi, Bangkok 10400, Thailand
| | - Charles L Saltzman
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Amy L Lenz
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA.
| | - Alexej Barg
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA; Department of Orthopaedics, Trauma and Reconstructive Surgery, University of Hamburg, Martinistrasse 52, 20246 Hamburg, Germany.
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Edama M, Takabayashi T, Hirabayashi R, Yokota H, Sekine C, Inai T, Matsuzawa K, Otsuki T, Maruyama S, Kageyama I. Morphological features of the lateral plantar ligament of the transverse metatarsal arch. Clin Anat 2020; 34:1002-1008. [PMID: 32996633 DOI: 10.1002/ca.23687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/03/2020] [Accepted: 09/19/2020] [Indexed: 02/06/2023]
Abstract
The aim of this study was to elucidate the morphological characteristics of the lateral Lisfranc ligament in a large sample. This investigation examined 100 legs from 50 cadavers. Each of the lower limbs was dissected to identify the plantar aspect of the transverse metatarsal arch, and morphological characteristics of the lateral plantar ligament were assessed, including the length, width, and thickness of the fiber bundles. The majority of plantar ligaments originated from the base of M5 and the plantar aspect of the lateral cuneiform (LC). The lateral plantar ligament could be classified into three types: Type I, a band-like fiber bundle originating from the base of M5 to the LC (41%); Type II, originating from the base of M5 and the plantar aspect of LC and mostly connected the blending the fiber bundles of the tibialis posterior (TP) and long plantar ligament (LPL) (21%); and Type III, with no ligaments originating from the base of M5 and plantar aspect of the LC (38%). The morphological characteristics of Type I lateral plantar ligament were as follows: length, 31.8 ± 3.7 mm; width, 2.3 ± 1.0 mm; and thickness, 0.2 ± 0.3 mm. The morphology of the lateral plantar ligament showed variation, originating from the base of M5 and the plantar aspect of LC most commonly, but this was not the case in 38% of limbs. The findings suggest that the lateral plantar ligament might play a role in the transverse tarsal arch, indicating a cooperative mechanism with the TP and LPL.
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Affiliation(s)
- Mutsuaki Edama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan.,Department of Anatomy, School of Life Dentistry at Niigata, Nippon Dental University, Niigata, Japan
| | - Tomoya Takabayashi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Ryo Hirabayashi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Hirotake Yokota
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Chie Sekine
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Takuma Inai
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Kanta Matsuzawa
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Tomofumi Otsuki
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Sae Maruyama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Ikuo Kageyama
- Department of Anatomy, School of Life Dentistry at Niigata, Nippon Dental University, Niigata, Japan
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10
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Han PF, Zhang ZL, Chen CL, Han YC, Wei XC, Li PC. Comparison of primary arthrodesis versus open reduction with internal fixation for Lisfranc injuries: Systematic review and meta-analysis. J Postgrad Med 2020; 65:93-100. [PMID: 31036779 PMCID: PMC6515774 DOI: 10.4103/jpgm.jpgm_414_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Objective Multiple studies have compared primary arthrodesis versus open reduction with internal fixation (ORIF) for surgical treatment of fractures of the Lisfranc joint, but their results have been inconsistent. Therefore, the present systematic review and meta-analysis was performed to compare the clinical efficacy of arthrodesis versus ORIF for the treatment of Lisfranc injuries. Methods Through searching the Embase, PubMed, PMC, CINAHL, PQDT, and Cochrane Library databases (from July 1998 to July 2018), we identified five case-controlled trials and two randomized controlled trials that compared the clinical efficacy of primary arthrodesis and ORIF for treating Lisfranc injuries. The extracted data were analyzed using Review manager 5.3 software. Results Through comparisons of data for primary arthrodesis and ORIF groups, we found no significant differences in the anatomic reduction rate, revision surgery rate, and total rate of complications between the different treatment approaches. However, arthrodesis was associated with a significantly better American Orthopedic Foot and Ankle Society (AOFAS) score, return to duty rate, and visual analog scale score with a lower incidence of hardware removal compared with ORIF. Conclusions For the treatment for Lisfranc injuries, primary arthrodesis was superior to ORIF based on a higher AOFAS score, better return to duty rate, lower postoperative pain, and lower requirement for internal fixation removal. Further evidence from future randomized controlled trials with higher quality and larger sample sizes is needed to confirm these findings.
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Affiliation(s)
- P F Han
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, Shanxi, P.R. China
| | - Z L Zhang
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, Shanxi, P.R. China
| | - C L Chen
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, Shanxi, P.R. China
| | - Y C Han
- Department of Upper School, Subsidiary High School of Taiyuan Normal University, Taiyuan, Shanxi, P.R. China
| | - X C Wei
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, Shanxi, P.R. China
| | - P C Li
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, Shanxi, P.R. China
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11
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Gorbachova T, Chang EY, Ha AS, Amini B, Dorfman SR, Fox MG, Khurana B, Klitzke A, Lee KS, Mooar PA, Shah KH, Shah NA, Singer AD, Smith SE, Taljanovic MS, Thomas JM, Kransdorf MJ. ACR Appropriateness Criteria® Acute Trauma to the Foot. J Am Coll Radiol 2020; 17:S2-S11. [PMID: 32370964 DOI: 10.1016/j.jacr.2020.01.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 01/22/2020] [Indexed: 12/26/2022]
Abstract
Acute injuries to the foot are frequently encountered in the emergency room and in general practice settings. This publication defines best practices for imaging evaluations for several variants of patients presenting with acute foot trauma. The variants include scenarios when the Ottawa rules can be evaluated, when there are exclusionary criteria, and when suspected pathology is in anatomic areas not addressed by the Ottawa rules. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Eric Y Chang
- Panel Chair, VA San Diego Healthcare System, San Diego, California
| | - Alice S Ha
- Panel Vice-Chair, University of Washington, Seattle, Washington
| | - Behrang Amini
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | | | - Alan Klitzke
- Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Kenneth S Lee
- University of Wisconsin Hospital & Clinics, Madison, Wisconsin
| | - Pekka A Mooar
- Temple University Hospital, Philadelphia, Pennsylvania; American Academy of Orthopaedic Surgeons
| | - Kaushal H Shah
- Icahn School of Medicine at Mt Sinai, New York, New York; American College of Emergency Physicians
| | - Nehal A Shah
- Brigham & Women's Hospital, Boston, Massachusetts
| | - Adam D Singer
- Emory University School of Medicine, Atlanta, Georgia
| | - Stacy E Smith
- Brigham & Women's Hospital & Harvard Medical School, Boston, Massachusetts
| | | | - Jonelle M Thomas
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
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Sripanich Y, Weinberg MW, Krähenbühl N, Rungprai C, Mills MK, Saltzman CL, Barg A. Imaging in Lisfranc injury: a systematic literature review. Skeletal Radiol 2020; 49:31-53. [PMID: 31368007 DOI: 10.1007/s00256-019-03282-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 06/30/2019] [Accepted: 07/08/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To systematically review current diagnostic imaging options for assessment of the Lisfranc joint. MATERIALS AND METHODS PubMed and ScienceDirect were systematically searched. Thirty articles were subdivided by imaging modality: conventional radiography (17 articles), ultrasonography (six articles), computed tomography (CT) (four articles), and magnetic resonance imaging (MRI) (11 articles). Some articles discussed multiple modalities. The following data were extracted: imaging modality, measurement methods, participant number, sensitivity, specificity, and measurement technique accuracy. Methodological quality was assessed by the QUADAS-2 tool. RESULTS Conventional radiography commonly assesses Lisfranc injuries by evaluating the distance between either the first and second metatarsal base (M1-M2) or the medial cuneiform and second metatarsal base (C1-M2) and the congruence between each metatarsal base and its connecting tarsal bone. For ultrasonography, C1-M2 distance and dorsal Lisfranc ligament (DLL) length and thickness are evaluated. CT clarifies tarsometatarsal (TMT) joint alignment and occult fractures obscured on radiographs. Most MRI studies assessed Lisfranc ligament integrity. Overall, included studies show low bias for all domains except patient selection and are applicable to daily practice. CONCLUSIONS While conventional radiography can demonstrate frank diastasis at the TMT joints; applying weightbearing can improve the viewer's capacity to detect subtle Lisfranc injury by radiography. Although ultrasonography can evaluate the DLL, its accuracy for diagnosing Lisfranc instability remains unproven. CT is more beneficial than radiography for detecting non-displaced fractures and minimal osseous subluxation. MRI is clearly the best for detecting ligament abnormalities; however, its utility for detecting subtle Lisfranc instability needs further investigation. Overall, the available studies' methodological quality was satisfactory.
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Affiliation(s)
- Yantarat Sripanich
- Department of Orthopedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Maxwell W Weinberg
- Department of Orthopedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Nicola Krähenbühl
- Department of Orthopedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Chamnanni Rungprai
- Department of Orthopedics, Phramongkutklao Hospital and College of Medicine, 315 Rajavithi Road, Tung Phayathai, Ratchathewi, Bangkok, 10400, Thailand
| | - Megan K Mills
- Department of Radiology and Imaging Sciences, University of Utah, 30 N. 1900 E. #1A071, Salt Lake City, UT, 84132, USA
| | - Charles L Saltzman
- Department of Orthopedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Alexej Barg
- Department of Orthopedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA.
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13
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Mason L, Jayatilaka MLT, Fisher A, Fisher L, Swanton E, Molloy A. Anatomy of the Lateral Plantar Ligaments of the Transverse Metatarsal Arch. Foot Ankle Int 2020; 41:109-114. [PMID: 31502882 DOI: 10.1177/1071100719873971] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND While the anatomy of the Lisfranc complex is well understood, the lateral tarsometatarsal ligamentous structures, in contrast, are less well studied. Our aim in this study was to identify an anatomical explanation as to why the second to fifth metatarsals function as a unit in homolateral and divergent midfoot injuries. METHODS Eleven cadaveric lower limbs, preserved in formaldehyde, were examined at the University of Liverpool Human Anatomy and Resource Centre. Each of the lower limbs was dissected to identify the plantar aspect of the transverse metatarsal arch. RESULTS On removal of the long plantar ligament, the peroneal longus tendon was visible, as was its insertion onto the first metatarsal base. A lateral Lisfranc ligament (which was a transverse suspensory metatarsal ligament) spanned between the bases of the second and fifth metatarsals in all specimens with an average length of 33.7 mm and width of 4.6 mm. This ligament has not previously been described. It was noted that in all specimens, the long plantar ligament blended with the lateral Lisfranc ligament. In addition to the lateral Lisfranc ligament, separate intermetatarsal ligaments were identifiable connecting each metatarsal. The long plantar ligament provided a connection through the lateral Lisfranc ligament connecting the transverse and longitudinal arches of the foot. CONCLUSION We found a plantar ligament that provided connection through the long plantar ligament of both the transverse and the longitudinal arches. It spanned from the second to the fifth metatarsal, which we believe may explain that in some cases, lateral instability can be overcome when the middle column is stabilized. CLINICAL RELEVANCE We suspect that in the majority of homolateral and divergent types of tarsometatarsal injuries that the lateral Lisfranc ligament remains intact and thus it has significant clinical ramifications.
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Affiliation(s)
- Lyndon Mason
- Aintree University Hospital, Liverpool, UK.,Human Anatomy and Resource Centre, University of Liverpool, Liverpool, UK
| | | | - Andrew Fisher
- Human Anatomy and Resource Centre, University of Liverpool, Liverpool, UK
| | - Lauren Fisher
- Human Anatomy and Resource Centre, University of Liverpool, Liverpool, UK
| | | | - Andrew Molloy
- Aintree University Hospital, Liverpool, UK.,Human Anatomy and Resource Centre, University of Liverpool, Liverpool, UK
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14
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Won H, Oh C. Variations of the plantar tarsometatarsal ligaments. Clin Anat 2019; 32:699-705. [DOI: 10.1002/ca.23376] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 03/12/2019] [Accepted: 03/13/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Hyung‐Jin Won
- Department of AnatomySchool of Medicine, Kangwon National University Chuncheon Korea
| | - Chang‐Seok Oh
- Department of AnatomySungkyunkwan University School of Medicine Suwon Gyeonggi‐do Korea
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15
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Abstract
This article reviews the imaging aspects relevant to ligamentous instabilities of the foot and ankle with a focus on MRI and ultrasound imaging. A pictorial review of the anatomy of the medial and lateral ankle ligaments, syndesmosis, spring ligament, Lisfranc complex, hallux sesamoid complex, and lesser toe plantar plate as seen on MRI is presented. Selected cases of ligamentous pathology relevant to foot and ankle instability are presented. The value of imaging in the assessment of foot and ankle instability is reviewed.
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Affiliation(s)
- Peter Salat
- Department of Radiology, University of Calgary, 2500 University Drive Northwest, Calgary, Alberta T2N 1N4, Canada; Mayfair Diagnostics, 6707 Elbow Drive Southwest 132, Calgary, Alberta T2V 0E3, Canada.
| | - Vu Le
- Department of Orthopaedics, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada
| | - Andrea Veljkovic
- Department of Orthopaedics, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada
| | - Mark E Cresswell
- Department of Radiology, St Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada
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16
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17
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Won H, Oh C, Yoon Y. Morphologic variations of the dorsal tarsometatarsal ligaments of the foot. Clin Anat 2018; 32:212-217. [DOI: 10.1002/ca.23282] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 09/12/2018] [Accepted: 09/18/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Hyung‐Jin Won
- Department of AnatomySchool of Medicine, Kangwon National University Chuncheon South Korea
| | - Chang‐Seok Oh
- Department of AnatomySungkyunkwan University School of Medicine Suwon South Korea
| | - Young‐Cheol Yoon
- Department of RadiologySamsung Medical Center, Sungkyunkwan University School of Medicine Seoul South Korea
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18
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Zghaib T, Malayeri AA, Ipek EG, Habibi M, Huang D, Balouch MA, Bluemke DA, Calkins H, Nazarian S, Zimmerman SL. Visualization of acute edema in the left atrial myocardium after radiofrequency ablation: Application of a novel high-resolution 3-dimensional magnetic resonance imaging sequence. Heart Rhythm 2018. [PMID: 29530833 DOI: 10.1016/j.hrthm.2018.03.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Ablation-induced left atrial (LA) edema may result in procedural failure due to reversible pulmonary vein isolation. Conventional T2-weighted magnetic resonance edema imaging is limited by low spatial resolution. OBJECTIVE The purpose of this pilot study was to optimize and validate a 3-dimensional (3D) sampling perfection with application-optimized contrasts using different flip-angle evolution (SPACE) sequence for quantification of T2 signal in the LA, and to apply it in recently ablated patients, comparing myocardial edema on T2-SPACE to tissue damage on late gadolinium enhancement (LGE) imaging. METHODS Phantom studies were performed to identify 3D-SPACE parameters for optimal contrast between normal and edematous myocardium. Fourteen AF patients were imaged with both 3D-SPACE and dark-blood turbo-spin echo (DB-TSE) to compare image quality and signal intensity between the 2 techniques. Eight patients underwent pre- and postablation 3D-SPACE and 3D-LGE imaging. Ablation points were co-registered with corresponding myocardial sectors, and ablation-induced changes in T2 and LGE signal intensities were measured. RESULTS Signal-to-noise ratio and contrast-to-noise ratio were higher on SPACE vs DB-TSE (65.5 ± 33.9 vs 35.7 ± 17.9; P = .01; and 59.4 ± 33.0 vs 32.9 ± 17.7; P = .04, respectively). T2-signal correlated well on 3D-SPACE and DB-TSE, such that each unit increase in TSE intensity correlated with a 0.69-unit increase in SPACE intensity (95% confidence interval 0.56-0.82; P <.001). T2 and LGE signal intensities were acutely increased at ablation sites. The extent of postablation edema was higher compared to LGE, although the spatial distribution of hyperenhancement around pulmonary veins seemed similar in both modalities. CONCLUSION T2-SPACE can be used to map the extent of acute postablation edema in the thin LA myocardium, with improved resolution and lower artifact compared to traditional DB-TSE.
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Affiliation(s)
- Tarek Zghaib
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Ashkan A Malayeri
- Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Maryland
| | - Esra G Ipek
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mohammadali Habibi
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Dong Huang
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Muhammad A Balouch
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David A Bluemke
- Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Maryland
| | - Hugh Calkins
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Saman Nazarian
- Division of Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Stefan L Zimmerman
- Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
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19
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[When is cartilage repair successful?]. Radiologe 2017; 57:907-914. [PMID: 28929186 DOI: 10.1007/s00117-017-0305-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Focal cartilage lesions are a cause of long-term disability and morbidity. After cartilage repair, it is crucial to evaluate long-term progression or failure in a reproducible, standardized manner. This article provides an overview of the different cartilage repair procedures and important characteristics to look for in cartilage repair imaging. Specifics and pitfalls are pointed out alongside general aspects. After successful cartilage repair, a complete, but not hypertrophic filling of the defect is the primary criterion of treatment success. The repair tissue should also be completely integrated to the surrounding native cartilage. After some months, the transplants signal should be isointense compared to native cartilage. Complications like osteophytes, subchondral defects, cysts, adhesion and chronic bone marrow edema or joint effusion are common and have to be observed via follow-up. Radiological evaluation and interpretation of postoperative changes should always take the repair method into account.
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20
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Linklater JM, Hayter CL, Vu D. Imaging of Acute Capsuloligamentous Sports Injuries in the Ankle and Foot: Sports Imaging Series. Radiology 2017; 283:644-662. [DOI: 10.1148/radiol.2017152442] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- James M. Linklater
- From Castlereagh Imaging, 60 Pacific Hwy, St Leonards, Sydney, NSW, Australia 2065 (J.M.L., C.L.H.); and Department of Anatomy, School of Medical Science, University of Notre-Dame Australia, Sydney, Australia (D.V.)
| | - Catherine L. Hayter
- From Castlereagh Imaging, 60 Pacific Hwy, St Leonards, Sydney, NSW, Australia 2065 (J.M.L., C.L.H.); and Department of Anatomy, School of Medical Science, University of Notre-Dame Australia, Sydney, Australia (D.V.)
| | - Dzung Vu
- From Castlereagh Imaging, 60 Pacific Hwy, St Leonards, Sydney, NSW, Australia 2065 (J.M.L., C.L.H.); and Department of Anatomy, School of Medical Science, University of Notre-Dame Australia, Sydney, Australia (D.V.)
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21
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Morphological and Quantitative 7 T MRI of Hip Cartilage Transplants in Comparison to 3 T—Initial Experiences. Invest Radiol 2016; 51:552-9. [DOI: 10.1097/rli.0000000000000264] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Kitsukawa K, Hirano T, Niki H, Tachizawa N, Nakajima Y, Hirata K. MR Imaging Evaluation of the Lisfranc Ligament in Cadaveric Feet and Patients With Acute to Chronic Lisfranc Injury. Foot Ankle Int 2015; 36:1483-92. [PMID: 26253292 DOI: 10.1177/1071100715596746] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Magnetic resonance (MR) imaging is known to be useful to demonstrate Lisfranc ligament injury. There are few studies that report differences in MR imaging findings of acute or chronic Lisfranc ligament injuries. We applied oblique MR imaging planes parallel to the Lisfranc ligament for better visualization of the entire course of the ligament and assessed the detailed MR imaging appearances of the Lisfranc ligament in cadavers and patients with presumed Lisfranc injuries. METHODS Twelve preserved cadaveric feet were examined using a small-diameter surface coil. Long axis, oblique sagittal, and oblique short axis cross sections parallel to the Lisfranc ligament, dorsal ligament, and plantar ligament were obtained. Twenty-six MR examinations from 23 patients with suspected Lisfranc joint injuries were evaluated. RESULTS In the cadaveric study, the Lisfranc ligament was satisfactorily visible along its entire course in a single slice on long axis and oblique sagittal MR images. The dorsal ligament and the plantar ligament were visible separately from the Lisfranc ligament in oblique sagittal and oblique short axis planes. In the patient study, 11 MR examinations led to diagnoses of complete tears of the Lisfranc ligament that were acute injuries (3-21 days after trauma) mostly associated with disruption of the dorsal and plantar ligaments. Nine studies led to diagnoses of incomplete tears of the Lisfranc ligament that were chronic injuries (2-14 months after trauma). Recovery of the continuity of the disrupted ligament was observed in 3 patients. CONCLUSION MR imaging demonstrated the integrity of the ligaments and was useful for diagnosing an acute Lisfranc injury. Fibrous healing of the torn ligament was observed in a chronic injury.
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Affiliation(s)
- Kaoru Kitsukawa
- Department of Radiology, St. Marianna University School of Medicine, Kawasaki City, Japan
| | - Takaaki Hirano
- Department of Orthopedic Surgery, St. Marianna University School of Medicine, Kawasaki City, Japan
| | - Hisateru Niki
- Department of Orthopedic Surgery, St. Marianna University School of Medicine, Kawasaki City, Japan
| | - Natsuki Tachizawa
- Department of Radiology, St. Marianna University School of Medicine, Kawasaki City, Japan
| | - Yasuo Nakajima
- Department of Radiology, St. Marianna University School of Medicine, Kawasaki City, Japan
| | - Kazuaki Hirata
- Department of Anatomy, St. Marianna University School of Medicine, Kawasaki City, Japan
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Bancroft LW, Kransdorf MJ, Adler R, Appel M, Beaman FD, Bernard SA, Bruno MA, Dempsey ME, Fries IB, Khoury V, Khurana B, Mosher TJ, Roberts CC, Tuite MJ, Ward RJ, Zoga AC, Weissman BN. ACR Appropriateness Criteria Acute Trauma to the Foot. J Am Coll Radiol 2015; 12:575-81. [DOI: 10.1016/j.jacr.2015.02.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 02/18/2015] [Indexed: 12/23/2022]
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Kalraiya AJ, Vanhegan I, Cheung A, Rudge B. A rare Lisfranc-type injury involving dorsal dislocation of the intermediate cuneiform. BMJ Case Rep 2014; 2014:bcr-2013-203364. [PMID: 25073524 DOI: 10.1136/bcr-2013-203364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Lisfranc injuries occur at the tarsometatarsal joint resulting from direct or indirect force to the midfoot. They account for only 0.2% of all fractures, with diagnoses easily missed on presentation. The resultant instability is often associated with significant morbidity to the patient. This report describes a Lisfranc injury sustained by a healthy gentleman who suffered indirect trauma to the foot when he fell from a standing height. Plain film radiographs and CT revealed dorsal dislocation of the intermediate cuneiform associated with fractures at the base of the third and fourth metatarsals. He underwent open reduction and internal fixation the following day. His Foot and Ankle Disability Index (FADI) score improved from 16.3 1 week postoperatively to 58.7 6 months postoperatively. This report describes a rare injury pattern resulting from indirect, low-energy trauma. We provide a guide to appropriate radiological imaging and evaluation in the assessment of these complex injuries.
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Affiliation(s)
| | | | | | - Ben Rudge
- Watford General Hospital, London, UK
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25
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Siddiqui NA, Galizia MS, Almusa E, Omar IM. Evaluation of the Tarsometatarsal Joint Using Conventional Radiography, CT, and MR Imaging. Radiographics 2014; 34:514-31. [DOI: 10.1148/rg.342125215] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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26
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Multibanded Anterior Talofibular Ligaments in Normal Ankles and Sprained Ankles Using 3D Isotropic Proton Density–Weighted Fast Spin-Echo MRI Sequence. AJR Am J Roentgenol 2014; 202:W87-94. [DOI: 10.2214/ajr.13.10727] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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27
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Campbell R. Highlights of the scientific meeting of the 18th Annual Congress of the European Society of Skeletal Radiology (ESSR) 2011. Skeletal Radiol 2012; 41:121-4. [PMID: 22080361 DOI: 10.1007/s00256-011-1312-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Rob Campbell
- Department of Radiology, Royal Liverpool University Hospital, Liverpool, L7 8XP, UK.
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