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Kandil NM, Hassan MAEF, Moharram AN, Saleh OAEFH, Hashem AB. Can ultrasound replace MRI in diagnosing causes of ankle impingement in different compartments? J Ultrasound 2023; 26:829-844. [PMID: 37526836 PMCID: PMC10632229 DOI: 10.1007/s40477-023-00803-6] [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] [Received: 04/15/2023] [Accepted: 06/23/2023] [Indexed: 08/02/2023] Open
Abstract
PURPOSE This prospective study aims to determine the role of ultrasound (US) in diagnosing different types of ankle impingement due to osseous and soft tissue pathologies and to compare the results with magnetic resonance imaging (MRI), which is considered our gold standard. METHODS The study population included 90 patients with unilateral ankle pain who presented with symptoms and signs suggestive of ankle impingement. Their age ranged from 17 to 57 years, with a mean age of 33.7 years. Using US and MRI, our cases were classified into bony and soft tissue ankle impingement. They were further classified according to the anatomical compartments affected, into anteromedial, anterior, anterolateral, posteromedial, and posterior. RESULTS 90 patients were enrolled in this study: 51 males and 39 females. In our study, posterior ankle impingement was the commonest impingement type, while anteromedial ankle impingement was the rarest type, followed by posteromedial impingement. The accuracy of US in diagnosing osseous impingement was found to have the following: sensitivity 70.37%, specificity 100%, PPV 100%, NPV 75%, accuracy 84.31%, and p value < 0.001; meanwhile, the accuracy of US in diagnosing soft tissue impingement was found to have the following: sensitivity 83.33%, specificity 100%, PPV 100%, NPV 87.10%, accuracy 92.16%, and p value < 0.001. CONCLUSION US is a good diagnostic tool in bone and soft tissue impingements, with a significant p value of 0.001 for both. US cannot replace MRI as a diagnostic tool, but as a widely available imaging modality, it can save time and cost and allows dynamic imaging.
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Affiliation(s)
| | | | | | | | - Aya Bassam Hashem
- Radiology Department, Faculty of Medicine, Cairo University, Giza, Egypt
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2
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Chen X, Huang HQ, Duan XJ. Arthroscopic treatment of ankle impingement syndrome. Chin J Traumatol 2023; 26:311-316. [PMID: 37852876 PMCID: PMC10755808 DOI: 10.1016/j.cjtee.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/20/2023] [Accepted: 09/27/2023] [Indexed: 10/20/2023] Open
Abstract
Arthroscopic treatment of ankle impingement syndrome (AIS) is a minimally invasive surgical procedure used to address symptoms caused by impingement in the ankle joint. This syndrome occurs when there is abnormal contact between certain bones or soft tissues in the ankle, leading to pain, swelling, or limited range of motion. Traditionally, open surgery was the standard approach for treating AIS. However, with advancements in technology and surgical techniques, arthroscopic treatment has become a preferred method for many patients and surgeons. With improved visualization and precise treatment of the arthroscopy, patients can experience reduced pain and improved functionality, allowing them to return to their daily activities sooner. In this paper, we reviewed the application and clinical efficacy the of arthroscopic approach for treating AIS, hoping to provide a reference for its future promotion.
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Affiliation(s)
- Xin Chen
- Center for Joint Surgery, Southwest Hospital, Third Military University (Amy Medical University), Chongqing, 400038, China
| | - He-Qin Huang
- Department of Nuclear Medicine, Southwest Hospital, Third Military University (Amy Medical University), Chongqing, 400038, China
| | - Xiao-Jun Duan
- Center for Joint Surgery, Southwest Hospital, Third Military University (Amy Medical University), Chongqing, 400038, China.
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3
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Koh D, Chandrakumara D, Kon Kam King C. Anteromedial Impingement in Chronic Lateral Ankle Instability: A Comparison of MRI and Arthroscopic Findings. Cureus 2023; 15:e41982. [PMID: 37593304 PMCID: PMC10427780 DOI: 10.7759/cureus.41982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2023] [Indexed: 08/19/2023] Open
Abstract
Introduction Chronic lateral ankle instability (CLAI) is a known complication of ankle sprains, most commonly involving injury to the anterior talofibular ligament (ATFL). Growing evidence has shown an association between anteromedial (AM) impingement and CLAI. The purpose of this paper is to compare magnetic resonance imaging (MRI) with arthroscopic findings for the incidence of AM impingement in CLAI. Methods A retrospective study was performed by analyzing the radiological and operative reports of all patients who underwent an arthroscopic Broström-Gould procedure for CLAI between 2021 and 2022 at Changi General Hospital, Singapore. All patients who had a pre-operative MRI ankle scan performed and mention of the presence or absence of AM impingement in the operative notes were included in this study. Patients with concomitant fractures or systemic conditions affecting the same ankle were excluded. Results Ninety-seven patients were included in this study, 65 males and 32 females; 6.2% (6 of 97) of patients had a suggestion of AM impingement based on MRI findings, and 77.3% (75 of 97) of patients were noted to have AM impingement based on arthroscopic findings. Conclusion There is a high incidence of AM impingement associated with CLAI. AM impingement is often missed based on MRI findings. Arthroscopic Broström should be considered to address both issues of AM impingement and CLAI in the same setting.
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Affiliation(s)
- Don Koh
- Orthopaedics, Changi General Hospital, Singapore, SGP
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4
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Armstrong TM, Rowbotham E, Robinson P. Update on Ankle and Foot Impingement. Semin Musculoskelet Radiol 2023; 27:256-268. [PMID: 37230126 DOI: 10.1055/s-0043-1764387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Ankle impingement syndromes are a well-recognized cause of chronic ankle symptoms in both the elite athletic and general population. They comprise several distinct clinical entities with associated radiologic findings. Originally described in the 1950s, advances in magnetic resonance imaging (MRI) and ultrasonography have allowed musculoskeletal (MSK) radiologists to further their understanding of these syndromes and the range of imaging-associated features. Many subtypes of ankle impingement syndromes have been described, and precise terminology is critical to carefully separate these conditions and thus guide treatment options. These are divided broadly into intra-articular and extra-articular types, as well as location around the ankle. Although MSK radiologists should be aware of these conditions, the diagnosis remains largely clinical, with plain film or MRI used to confirm the diagnosis or assess a surgical/treatment target. The ankle impingement syndromes are a heterogeneous group of conditions, and care must be taken not to overcall findings. The clinical context remains paramount. Treatment considerations are patient symptoms, examination, and imaging findings, in addition to the patient's desired level of physical activity.
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Affiliation(s)
- T M Armstrong
- Royal Free Hospitals NHS Foundation Trust, London, United Kingdom
| | - Emily Rowbotham
- Musculoskeletal Radiology Department, Chapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
- NIHR Leeds Biomedical Research Centre, Leeds, United Kingdom
| | - Philip Robinson
- Musculoskeletal Radiology Department, Chapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
- NIHR Leeds Biomedical Research Centre, Leeds, United Kingdom
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5
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Nery C, Baumfeld D. Anterior and Posterior Ankle Impingement Syndromes: Arthroscopic and Endoscopic Anatomy and Approaches to Treatment. Foot Ankle Clin 2021; 26:155-172. [PMID: 33487238 DOI: 10.1016/j.fcl.2020.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Ankle impingement refers to a chronic painful mechanical limitation of ankle motion caused by soft tissue or osseous abnormality affecting the anterior or posterior tibiotalar joint. Impingement can be associated with a single traumatic event or repetitive microtrauma. These syndromes are a possible etiology of persistent ankle pain. An arthroscopic approach to this pathology, when indicated, is considered as ideal treatment with its high safety and low complication rate. We describe the clinical and potential imaging features, and the arthroscopic/endoscopic management strategies, for the 4 main impingement syndromes of the ankle: anterolateral, anterior, antero-medial, and posterior.
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Affiliation(s)
- Caio Nery
- UNIFESP - Federal University of São Paulo, Brazil
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6
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Diniz P, Sousa DA, Batista JP, Abdelatif N, Pereira H. Diagnosis and treatment of anterior ankle impingement: state of the art. J ISAKOS 2020. [DOI: 10.1136/jisakos-2019-000282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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7
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Qin DA, Jin ZZ, Song JF. Combined anterior and posterior ankle impingement syndrome with nonunion of Cedell fracture in a 58-year-old female: a case report. BMC Musculoskelet Disord 2020; 21:556. [PMID: 32811509 PMCID: PMC7433144 DOI: 10.1186/s12891-020-03584-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 08/11/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Combined anterior and posterior ankle impingement has seldom been reported. Cedell fracture, fracture of posteromedial tubercle of talus, is an uncommon and easily missed injury which may elicit posteromedial ankle impingement. The injury mechanisms and management strategies of these two lesions have been reported individually. But the concurrent lesion of both of them has not been reported. CASE PRESENTATION We reported a 58-year-old female with combined anterior and posterior ankle impingement syndrome with nonunion of Cedell fracture in whom open osteophytes debridement, fracture internal fixation and posterior talotibial ligament reconstruction were performed. The AOFAS hindfoot score was 90 at 1 year follow-up. To our knowledge, this was the first reported case with anterior, posterior and posteromedial impingement which was treated operatively with an excellent short-term outcome. CONCLUSIONS To fully recognize this occult lesion and avoid missing is imperative for reducing the morbidities. We suggest CT and MRI as excellent imaging modalities that can help the timely diagnosis and appropriate treatment for this combined impingement with circumferential lesions.
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Affiliation(s)
- De-An Qin
- Department of Orthopedics, Shanxi Provincial People's Hospital Affiliated to Shanxi Medical University, NO. 29, Double Tower Street, Taiyuan, 030012, Shanxi, China.
| | - Zhi-Zhen Jin
- Department of Orthopedics, Shanxi Provincial People's Hospital Affiliated to Shanxi Medical University, NO. 29, Double Tower Street, Taiyuan, 030012, Shanxi, China
| | - Jie-Fu Song
- Department of Orthopedics, Shanxi Provincial People's Hospital Affiliated to Shanxi Medical University, NO. 29, Double Tower Street, Taiyuan, 030012, Shanxi, China
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8
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Sharabianlou Korth M, Fritz LB. [Postoperative MRI of the ankle]. Radiologe 2019; 57:891-906. [PMID: 29046932 DOI: 10.1007/s00117-017-0306-z] [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: 11/30/2022]
Abstract
CLINICAL/METHODICAL ISSUE Postoperative imaging of the ankle can be challenging, even for the experienced radiologist. Pathological and postoperative changes to the primarily complex anatomy of the ankle with its great variety of bone structures, tendons, ligaments, and soft tissue in a very limited space may cause great difficulty in differentiating underlying pathology from expected postoperative changes and artifacts, especially in magnetic resonance imaging (MRI). STANDARD RADIOLOGICAL METHODS Selecting the appropriate radiological modality is key to making the correct diagnosis. Therefore, knowledge of the initial and current symptoms is just as important as familiarity with the most frequently performed operations in the ankle. PRACTICAL RECOMMENDATIONS This article aims to give its reader a summary of the most important and frequently performed operation techniques of the ankle and discusses the expected appearance and possible complications in postoperative imaging.
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Affiliation(s)
| | - L B Fritz
- Rheinlandärzte, Bahnstraße 31, 47877, Willich, Deutschland.
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9
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LiMarzi GM, Khan O, Shah Y, Yablon CM. Imaging Manifestations of Ankle Impingement Syndromes. Radiol Clin North Am 2018; 56:893-916. [DOI: 10.1016/j.rcl.2018.06.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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10
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Abstract
Impingement syndrome of the ankle is a clinical diagnosis caused posttraumatically by overuse due to repetitive mechanical loading or the presence of predisposing anatomical variants. Ankle impingement syndrome is characterized by chronic pain and limited range of movement caused by mechanical compression of bony or soft tissues within the joint compartments. Ankle impingement syndrome is classified according to the various anatomical locations around the tibiotalar joint as anterior, anterolateral, anteromedial, posterior or posteromedial. Various imaging modalities are helpful in confirming the clinical diagnosis of ankle impingement. Radiography and computed tomography are used to identify bony abnormalities and intra-articular loose bodies. Magnetic resonance imaging is the modality of choice to demonstrate pathological soft tissue changes, bone marrow edema and osteochondral lesions. Dynamic sonography can identify the anatomical structures leading to impingement during movement.
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Affiliation(s)
- R-I Milos
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Wien, Österreich.,Abteilung für Neuroradiologie und Muskuloskelettale Radiologie, Universitätsklinik für Radiologie und Nuklearmedizin, Wien, Österreich
| | - L B Fritz
- Rheinlandärzte, Willich & Meerbusch, Willich, Deutschland
| | - C Schueller-Weidekamm
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Wien, Österreich. .,Abteilung für Neuroradiologie und Muskuloskelettale Radiologie, Universitätsklinik für Radiologie und Nuklearmedizin, Wien, Österreich.
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11
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Anandkumar S. Effect of a novel mobilization with movement procedure on anterolateral ankle impingement - A case report. Physiother Theory Pract 2018; 34:569-577. [PMID: 29297724 DOI: 10.1080/09593985.2017.1422822] [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
This case report describes a 50-year-old male who presented with right anterolateral ankle pain managed unsuccessfully with rest, medications, bracing, injection, physical therapy, and massage therapy. Clinical diagnosis of anterolateral ankle impingement was based on concordant symptom reproduction with palpatory tenderness and a positive lateral synovial impingement test. This case report is a potential first time description of the successful management of anterolateral ankle impingement utilizing a novel Mulligan's mobilization with movement procedure (consisting of internal rotation of the distal tibia) and taping with immediate improvements noted in pain, range of motion, and function. The patient was seen twice a week and was discharged after four treatment sessions. A follow-up after 4 months revealed that the patient was pain free and fully functional.
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Affiliation(s)
- Sudarshan Anandkumar
- a Registered Physiotherapist , CBI Health Centre, Chilliwack , British Columbia , Canada
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12
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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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13
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Berman Z, Tafur M, Ahmed SS, Huang BK, Chang EY. Ankle impingement syndromes: an imaging review. Br J Radiol 2016; 90:20160735. [PMID: 27885856 DOI: 10.1259/bjr.20160735] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Ankle impingement syndromes encompass a broad spectrum of post-traumatic and chronic degenerative changes that present with pain on specific movements about the ankle joint. Both amateur and professional athletes are disproportionately affected by these conditions, and while conservative measures can potentially treat an impingement syndrome, definitive therapy is often alleviated surgically. Imaging (including conventional radiography, ultrasound, CT and MRI) plays an invaluable role in the diagnosis and pre-surgical work-up. An anatomically based classification system is useful in these syndromes, as the aetiology, sites of pathology and preferred treatment methods are similarly based on anatomic locations about the ankle. This review focuses on the anatomic locations, pathophysiology, imaging considerations and brief discussion of therapies for each of the major anatomic ankle impingement syndromes.
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Affiliation(s)
- Zachary Berman
- 1 Department of Radiology, University of California, San Diego, CA, USA
| | - Monica Tafur
- 2 Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Sonya S Ahmed
- 3 Department of Orthopedic Surgery, University of California, San Diego, CA, USA
| | - Brady K Huang
- 1 Department of Radiology, University of California, San Diego, CA, USA
| | - Eric Y Chang
- 1 Department of Radiology, University of California, San Diego, CA, USA.,4 Radiology Service, VA San Diego Healthcare System, San Diego, CA, USA
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14
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Abstract
Arthroscopy of the ankle is used in the treatment and diagnosis of a spectrum of intra-articular pathology including soft tissue and osseous impingement, osteochondral lesions, arthrofibrosis, and synovitis. To help identify the correct pathology, imaging techniques are often used to aid the surgeon in diagnosing pathology and determining best treatment options. This article discusses the use of imaging in various ankle pathologies.
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Affiliation(s)
- Sean T Grambart
- Carle Physician Group, Department of Orthopedics, 1802 South Mattis Avenue, Champaign, IL 61821, USA.
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15
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Abstract
Ankle impingement is a syndrome that encompasses a wide range of anterior and posterior joint pathology involving both osseous and soft tissue abnormalities. In this review, the etiology, pathoanatomy, diagnostic workup, and treatment options for both anterior and posterior ankle impingement syndromes are discussed.
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Affiliation(s)
- Kyle P Lavery
- Division of Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 175 Cambridge Street, Suite 400, Boston, MA, 02114, USA.
| | - Kevin J McHale
- Division of Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 175 Cambridge Street, Suite 400, Boston, MA, 02114, USA
| | - William H Rossy
- Division of Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 175 Cambridge Street, Suite 400, Boston, MA, 02114, USA
| | - George Theodore
- Division of Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 175 Cambridge Street, Suite 400, Boston, MA, 02114, USA
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16
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Magnetic Resonance Imaging of Ankle Ligaments. Can Assoc Radiol J 2016; 67:60-8. [DOI: 10.1016/j.carj.2015.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 09/10/2015] [Indexed: 11/23/2022] Open
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