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Kakegawa A, Sumitomo N, Nagira A, Ichinose Y, Fukushima N. The calcaneofibular ligament groove at the inferior fibula, an ultrasonographic anatomical landmark. Surg Radiol Anat 2024; 46:739-747. [PMID: 38573504 DOI: 10.1007/s00276-024-03346-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/08/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE Calcaneofibular ligament (CFL) injuries are harder to diagnose than anterior talofibular ligament (ATFL) ones. This study aimed to clarify the fibular attachment of the CFL and verify the bony landmark for evaluating the CFL on ultrasonography. METHODS Fifty-nine ankles were used in this anatomical study. To confirm the control function of the CFL, we performed passive movement manually using cadaveric ankles and observed the ankle positions where the CFLs were tense. Histological observation of CFL attachment of the fibula was performed using Masson's trichrome stain. The ATFL and CFL were removed, and the bone morphology of the CFL attachment and inferior fibular end was imaged using a stereomicroscope and a 3D scanner. Using ultrasonography, we evaluated the bone morphology of the fibular attachment of the CFL in short-axis images of 27 healthy adult ankles. RESULTS The CFL was tensed according to ankle motions: supination, maximum dorsi flexion, maximum plantar flexion, and mild plantar flexion-external rotation. Below the CFL attachment of the fibula was a slight groove between the inferior tip and the obscure tubercle of the fibula. This groove was observed in 81.5% of cases using short-axis ultrasonography. CONCLUSION The CFL was tensed in various ankle positions to control the movements of the talocrural and subtalar joints. There was a slight groove at the inferior end of the fibula where the CFL coursed downward. We called it the CFL groove and proposed that it could serve as a landmark for the short-axis image of ultrasonography.
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Affiliation(s)
- Akira Kakegawa
- Faculty of Human Care, Teikyo Heisei University, 2-51-4 Higashi-Ikebukuro, Toshimaku, Tokyo, Japan.
- Department of Anatomy, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, Nagano, Japan.
| | - Norimi Sumitomo
- Department of Anatomy, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, Nagano, Japan
| | - Ayata Nagira
- Department of Anatomy, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, Nagano, Japan
| | - Yuko Ichinose
- Department of Anatomy, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, Nagano, Japan
| | - Nanae Fukushima
- Department of Anatomy, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, Nagano, Japan
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2
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Smith PE, Morey M, McManus LJ, Kong A. Magnetic resonance imaging of the ankle: Pathology of the lateral and posterior compartments. J Med Imaging Radiat Oncol 2023. [PMID: 36726341 DOI: 10.1111/1754-9485.13512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/17/2023] [Indexed: 02/03/2023]
Abstract
Magnetic resonance imaging (MRI) is the gold standard for imaging the tendons and the ligaments of the ankle. MRI combines excellent tissue contrast and accurate anatomic delineation of joint structures. In the first article of this series, we discussed a compartmental approach to the interpretation of ankle pathology focusing on the anterior and medial compartments. This article will complete the MR review of the ankle, with a focus on the lateral and posterior compartments of the ankle.
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Affiliation(s)
| | - Matthew Morey
- Epworth Medical Imaging (Geelong), Geelong, Victoria, Australia
| | | | - Andrew Kong
- Regional Imaging (Albury), Albury, New South Wales, Australia
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Lôbo CFT, Pires EA, Bordalo-Rodrigues M, de Cesar Netto C, Godoy-Santos AL. Imaging of progressive collapsing foot deformity with emphasis on the role of weightbearing cone beam CT. Skeletal Radiol 2022; 51:1127-1141. [PMID: 34693455 DOI: 10.1007/s00256-021-03942-1] [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: 07/14/2021] [Revised: 10/13/2021] [Accepted: 10/13/2021] [Indexed: 02/02/2023]
Abstract
The term progressive collapsing foot deformity (PCFD) is currently recommended as the replacement to adult-acquired flatfoot deformity and posterior tibial tendon dysfunction to better reflect its pathology, which consists of a complex three-dimensional deformity involving the foot and ankle. The new consensus has also provided a new classification that requires clinical and radiographic findings for patient stratification into each class. However, conventional radiographs are susceptible to errors resulting from the inadequate positioning of patients, incorrect angulation of the X-ray tube, and overlapping of bone structures. Weightbearing cone beam computed tomography (WBCBCT), which has greater diagnostic accuracy than conventional radiograph, is useful for evaluating progressive collapsing foot deformity to determine medial arch collapse, hindfoot alignment, peritalar subluxation, posterior subtalar joint valgus, intrinsic talus valgus, and lateral extra-articular bone impingement. The present review aimed to discuss the new recommendations for nomenclature, classification, and imaging evaluation of PCFD, with an illustrative and quantitative focus on the measurements used in conventional radiography and WBCBCT. The measurements presented here are important criteria for decision-making.
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Affiliation(s)
- Carlos Felipe Teixeira Lôbo
- Lab. Prof. Manlio Mario Marco Napoli, Faculdade de Medicina, Universidade de São Paulo, R. Ovidio Pires de Campos, 333, São Paulo, SP, 05403-010, Brazil.
| | - Eduardo Araújo Pires
- Lab. Prof. Manlio Mario Marco Napoli, Faculdade de Medicina, Universidade de São Paulo, R. Ovidio Pires de Campos, 333, São Paulo, SP, 05403-010, Brazil
| | - Marcelo Bordalo-Rodrigues
- Lab. Prof. Manlio Mario Marco Napoli, Faculdade de Medicina, Universidade de São Paulo, R. Ovidio Pires de Campos, 333, São Paulo, SP, 05403-010, Brazil.,Hospital Sírio Libanês, São Paulo, Brazil
| | - Cesar de Cesar Netto
- Department of Orthopedic Foot and Ankle Surgery, University of Iowa School of Medicine, Iowa City, IA, USA
| | - Alexandre Leme Godoy-Santos
- Lab. Prof. Manlio Mario Marco Napoli, Faculdade de Medicina, Universidade de São Paulo, R. Ovidio Pires de Campos, 333, São Paulo, SP, 05403-010, Brazil.,Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, São Paulo, SP, 05652-900, Brazil
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Szaro P, Ghali Gataa K, Solidakis N, Pękala P. Morphometric relationships between dimensions the anterior talofibular ligament and calcaneofibular ligament in routine magnetic resonance imaging. J Exp Orthop 2021; 8:90. [PMID: 34633561 PMCID: PMC8505565 DOI: 10.1186/s40634-021-00406-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 09/17/2021] [Indexed: 08/30/2023] Open
Abstract
Purpose This study aimed to test the hypothesis that routine MRI ankle can be used to evaluate dimensions and correlations between dimensions of single and double fascicular variants of the ATFL and the CFL. Methods We reviewed ankle MRIs for 251 patients. Differences between the length, thickness, width, and length of the bony attachments were evaluated twice. P < .05 was considered as significant. Results For the ATFL, we observed a negative correlation between thickness and width, with a positive correlation between thickness and length (p < 0.001). The average values for the ATFL were thickness, 2.2 ± 0.05 mm; length, 21.5 ± 0.5 mm; and width, 7.6 ± 0.6 mm. The average values for the CFL were thickness, 2.1 ± 0.04 mm; length, 27.5 ± 0.5 mm; and width, 5.6 ± 0.3 mm. A negative correlation was found between length and width for the CFL (p < 0.001). Conclusions Routine MRI showed that most dimensions of the ATFL and CFL correlate with each other, which should be considered when planning new reconstruction techniques and developing a virtual biomechanical model of the human foot. Level of evidence III
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Affiliation(s)
- Pawel Szaro
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Göteborgsvägen 31, 431 80, Gothenburg, Sweden. .,Department of Musculoskeletal Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden. .,Department of Descriptive and Clinical Anatomy, Medical University of Warsaw, Warsaw, Poland.
| | - Khaldun Ghali Gataa
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Göteborgsvägen 31, 431 80, Gothenburg, Sweden.,Department of Musculoskeletal Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Nektarios Solidakis
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Göteborgsvägen 31, 431 80, Gothenburg, Sweden.,Department of Musculoskeletal Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Przemysław Pękala
- Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland.,Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Kraków University, Kraków, Poland
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The awareness of hindfoot malalignment on non-weight-bearing ankle MRI. Skeletal Radiol 2021; 50:1317-1323. [PMID: 33230727 DOI: 10.1007/s00256-020-03674-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 11/06/2020] [Accepted: 11/15/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Hindfoot malalignment is a relatively common clinical finding and several studies have suggested that hindfoot valgus can be identified on non-weight-bearing ankle MRI. The aim of this study was to determine the awareness of hindfoot malalignment on ankle MRI amongst consultant musculoskeletal radiologists. MATERIALS AND METHODS All MRI studies referred by Foot and Ankle Unit Consultants reported by one of 14 consultant musculoskeletal radiologists between March 2016 and August 2019 were retrieved from the Hospital Radiology Information System. These were reviewed independently by a radiology fellow and a consultant radiologist. Tibiocalcaneal angle (TCA) was measured, and extra-articular talocalcaneal (EA-TCI) and calcaneofibular impingement (EA-CFI) were recorded. Radiology reports were then analysed for mention of hindfoot malalignment and the presence of EA-TCI and EA-CFI. RESULTS The study group comprised 129 patients, 46 males and 83 females with a mean age of 46.8 years (range 8-84 years). Based on review, hindfoot valgus was present in 78-80 cases (60.5-62%), EA-TCI in 30-36 cases (23.2-27.9%) and EA-CFI in 18-21 cases (14-16.3%). By comparison, MRI reports mentioned hindfoot valgus in 18 cases (2 incorrectly), EA-TCI in 8 cases (1 incorrectly) and EA-CFI in 10 cases (1 incorrectly). CONCLUSION Hindfoot valgus, EA-TCI and EA-CFI were present relatively commonly on review of ankle MRI studies in patients referred from a specialist Foot and Ankle Unit but were commonly under-reported highlighting a relative lack of awareness of hindfoot malalignment on ankle MRI amongst musculoskeletal radiologists, which could impact negatively on patient management.
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Toyooka S, Shimazaki N, Yasui Y, Ando S, Saho Y, Nakagawa T, Kawano H, Miyamoto W. Validity of a simple footprint assessment board for diagnosing the severity of flatfoot: a prospective cohort study. BMC Musculoskelet Disord 2021; 22:285. [PMID: 33736625 PMCID: PMC7977274 DOI: 10.1186/s12891-021-04154-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 03/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A simple, non-quantitative, and cost-effective diagnostic tool would enable the diagnosis of flatfoot without need for specialized training. A simple footprint assessment board that investigates which toe the cord passes through from the centre point of the heel to the most lateral point of the medial contour of the footprint has been developed to assess flatfoot. The purpose of this study was to verify the validity of a simple footprint assessment board for flatfoot. METHODS Thirty-five consecutive patients with foot pain, foot injury, or any associated symptoms who underwent computed tomography (CT) were analysed prospectively. At the time of the CT scan, a footprint analysis using a simple footprint assessment board was performed. The navicular index, tibiocalcaneal angle, and calcaneal inclination angle were evaluated by CT to assess flat feet. These three criteria were compared to those evaluated with the simple footprint assessment board by regression analysis. In addition, the same analysis was conducted separately for young, middle-aged, and older patients in order to investigate each age group. RESULTS The navicular index and tibiocalcaneal angle generally decreased as the score of the simple footprint assessment board increased. Calcaneal inclination angle generally increased as the score of the simple footprint assessment board increased. As the scores of the simple footprint assessment board decreased by approaching the great toe, the navicular index and tibiocalcaneal angle were higher and calcaneal inclination angle was lower, which is indicative of a higher likelihood of flatfoot. The scores derived from the simple footprint assessment board was correlated with these three criteria measured by CT, not only when the result of simple footprint assessment board was set as a non-continuous variable but also when the result was set as a continuous variable. The results of the age-stratified survey were similar for all groups. CONCLUSIONS The findings of this study suggest that a simple footprint assessment board can be potentially useful to detect flatfoot. TRIAL REGISTRATION Retrospectively registered.
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Affiliation(s)
- Seikai Toyooka
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Naoya Shimazaki
- Department of Orthopaedic Surgery, Shimazaki Hospital, Ibaraki, Japan
| | - Youichi Yasui
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Shuji Ando
- Department of Information Engineering, Tokyo University of Science, Tokyo, Japan
| | - Yasuaki Saho
- Faculty of Medical Technology, Teikyo University Institute of Sports Science and Medicine, Tokyo, Japan
| | - Takumi Nakagawa
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Hirotaka Kawano
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Wataru Miyamoto
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan.
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Haldar A, Bernasconi A, Junaid SE, Lee KHB, Welck M, Saifuddin A. 3D imaging for hindfoot alignment assessment: a comparative study between non-weight-bearing MRI and weight-bearing CT. Skeletal Radiol 2021; 50:179-188. [PMID: 32699951 DOI: 10.1007/s00256-020-03532-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/19/2020] [Accepted: 06/29/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE The authors compared measurements of hindfoot alignment on MR imaging with weight-bearing CT (WB-CT) to establish the degree of correlation. Forty-seven feet in 44 patients had weight-bearing CT and MRI studies performed on the same day. MATERIALS AND METHODS Hindfoot alignment on MRI was assessed by two radiologists who calculated tibiocalcaneal angle (TCA) and calcaneofibular ligament angle (CFLA). On WB-CT, foot ankle offset (FAO), calcaneal offset (CO) and hindfoot angle (HA) were assessed by a senior Foot and Ankle Surgeon using dedicated software. Pearson correlation coefficient was used to evaluate the correlation between these measurements. RESULTS The study group comprised 27 males and 17 females with a mean age of 45 years (range 13-79 years). A statistically significant positive correlation was identified between TCA on MRI and all measurements of hindfoot alignment on WB-CT (p = 0.001-0.005). The CFLA on MRI only had significant correlation with CO on WB-CT (p = 0.03). A significant negative correlation was observed between both MRI parameters (p < 0.001). CONCLUSION A highly significant correlation between tibiocalcaneal angle on non-weight-bearing ankle MR imaging and hindfoot alignment measurements on weight-bearing CT was identified.
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Affiliation(s)
- Anil Haldar
- Foot and Ankle Unit, Royal National Orthopaedic Hospital, Stanmore, HA7 4LP, UK.
| | - Alessio Bernasconi
- Foot and Ankle Unit, Royal National Orthopaedic Hospital, Stanmore, HA7 4LP, UK
| | - Syed Ehtesham Junaid
- Department of Imaging, Royal National Orthopaedic Hospital, Stanmore, HA7 4LP, UK
| | - Kar Ho Brian Lee
- Department of Diagnostic and Interventional Radiology, Kwong Wah Hospital, 25 Waterloo Road, Yau Ma Tei, Kowloon, Hong Kong
| | - Matthew Welck
- Foot and Ankle Unit, Royal National Orthopaedic Hospital, Stanmore, HA7 4LP, UK
| | - Asif Saifuddin
- Department of Imaging, Royal National Orthopaedic Hospital, Stanmore, HA7 4LP, UK
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The double fascicular variations of the anterior talofibular ligament and the calcaneofibular ligament correlate with interconnections between lateral ankle structures revealed on magnetic resonance imaging. Sci Rep 2020; 10:20801. [PMID: 33247207 PMCID: PMC7695848 DOI: 10.1038/s41598-020-77856-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/18/2020] [Indexed: 12/21/2022] Open
Abstract
The anterior talofibular ligament and the calcaneofibular ligament are the most commonly injured ankle ligaments. This study aimed to investigate if the double fascicular anterior talofibular ligament and the calcaneofibular ligament are associated with the presence of interconnections between those two ligaments and connections with non-ligamentous structures. A retrospective re-evaluation of 198 magnetic resonance imaging examinations of the ankle joint was conducted. The correlation between the double fascicular anterior talofibular ligament and calcaneofibular ligament and connections with the superior peroneal retinaculum, the peroneal tendon sheath, the tibiofibular ligaments, and the inferior extensor retinaculum was studied. The relationships between the anterior talofibular ligament's and the calcaneofibular ligament's diameters with the presence of connections were investigated. Most of the connections were visible in a group of double fascicular ligaments. Most often, one was between the anterior talofibular ligament and calcaneofibular ligament (74.7%). Statistically significant differences between groups of single and double fascicular ligaments were visible in groups of connections between the anterior talofibular ligament and the peroneal tendon sheath (p < 0.001) as well as the calcaneofibular ligament and the posterior tibiofibular ligament (p < 0.05), superior peroneal retinaculum (p < 0.001), and peroneal tendon sheath (p < 0.001). Differences between the thickness of the anterior talofibular ligament and the calcaneofibular ligament (p < 0.001), the diameter of the fibular insertion of the anterior talofibular ligament (p < 0.001), the diameter of calcaneal attachment of the calcaneofibular ligament (p < 0.05), and tibiocalcaneal angle (p < 0.01) were statistically significant. The presence of the double fascicular anterior talofibular ligament and the calcaneofibular ligament fascicles correlate with connections to adjacent structures.
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