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Lyu P, Liu C, Li S. Diagnostic value of ultrasonography for injury of anterior talofibular ligament and anterior inferior tibiofibular ligament distal fascicle in patients with ankle fractures. Zhejiang Da Xue Xue Bao Yi Xue Ban 2024; 53:411-418. [PMID: 38803280 PMCID: PMC11375498 DOI: 10.3724/zdxbyxb-2023-0602] [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: 05/29/2024]
Abstract
OBJECTIVES To explore the diagnostic value of ultrasonography for injuries of anterior talofibular ligament (ATFL) and anterior inferior tibiofibular ligament distal fascicle (ATiFL-DF) in patients with ankle fractures. METHODS Clinical data of 51 patients with ankle fractures who were clinically suspected of ligament injuries and underwent ankle ultrasonography examination and arthroscopy in Sir Run Run Shaw Hospital, Zhejiang University School of Medicine from April 2019 to March 2023 were retrospectively analyzed. Using arthroscopic results as the gold standard, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of ultrasonography in diagnosing ATFL and ATiFL-DF injuries were evaluated, and Kappa consistency test was performed. RESULTS The sensitivity and specificity of ultrasonography in diagnosis of ATFL injury were 100.0% and 92.3%, with the PPV of 92.6% and NPV of 100.0%. Ultrasonography findings exhibited excellent concordance with arthroscopic results (kappa=0.849). The sensitivity and specificity of ultrasonography in diagnosis of ATiFL-DF injury was 86.7% and 33.3%, with the PPV of 90.7% and NPV of 25.0%. However, the consistency between ultrasonography and arthroscopic results was poor (kappa=0.168). CONCLUSIONS Ultrasonography is reliable in assessing injuries of ATFL in patients with ankle fractures, but its specificity in diagnosing ATiFL-DF is poor. Therefore, ankle arthroscopy remains necessary for ankle fracture patients with negative findings of ATiFL-DF in ultrasonography.
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Affiliation(s)
- Panpan Lyu
- Department of Ultrasound, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China.
| | - Chao Liu
- Department of Orthopedics, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
| | - Shiyan Li
- Department of Ultrasound, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China.
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Kim JS, Kim MS, Kim DK, Lee SH. Magnetic Resonance Imaging Characteristics of a Lateral Ligament Injury in Acute Ankle Sprains Among Athletes. Orthop J Sports Med 2023; 11:23259671231207688. [PMID: 37954866 PMCID: PMC10637175 DOI: 10.1177/23259671231207688] [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: 05/18/2023] [Accepted: 05/30/2023] [Indexed: 11/14/2023] Open
Abstract
Background It is important to identify the location and pattern of lateral ligament injuries that are related to the development and prognosis of chronic ankle instability in athletes with ankle sprains. Purpose To describe the location and pattern of lateral ligament injuries on magnetic resonance imaging (MRI) in elite-level or amateur athletes with acute ankle sprains and to further assess the risk of associated concomitant injuries. Study Design Cross-sectional study; Level of evidence, 3. Methods The anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) of 110 athletes with an ankle lateral ligament injury (mean age, 24.7 years) were evaluated. MRI scans were evaluated for the location and pattern of ATFL and CFL tears such as sleeve avulsions as well as concomitant deltoid ligament injuries, bone contusions, and osteochondral lesions of the talus (OLTs). Results On MRI, 52 (47.3%) athletes had an isolated ATFL tear, 56 (50.9%) athletes had both ATFL and CFL tears, and 2 (1.8%) athletes had an isolated CFL tear. ATFL injuries occurred at the fibula, midsubstance, and talus in approximately equal numbers, whereas the majority of CFL injuries occurred at the calcaneal insertion. Concomitant deltoid ligament injuries were identified in 18 (16.4%) athletes. In addition, concomitant bone contusions and OLTs were identified in 38 (34.5%) and 6 (5.5%) athletes, respectively. Using linear-by-linear analysis, CFL injuries correlated with concomitant deltoid ligament and bone injuries (P = .023 and P = .001, respectively) and a sleeve injury pattern (P = .005). Conclusion After an acute ankle ligament rupture, almost all athletes involved in this study had injured their ATFL, and approximately 50% had a concomitant injury to the CFL. The rate of sleeve-type CFL injuries at the calcaneal insertion was high, and concomitant deltoid ligament injuries and OLTs were associated with this pattern of injury.
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Affiliation(s)
- Jin Su Kim
- Department of Orthopedic Surgery, Sejong Sports Medicine and Performance Center, Seoul, Republic of Korea
| | - Min Seok Kim
- Department of Orthopedic Surgery, Wonkwang University Hospital, School of Medicine, Wonkwang University, Iksan, Republic of Korea
| | - Do Kyun Kim
- Department of Orthopedic Surgery, Wonkwang University Hospital, School of Medicine, Wonkwang University, Iksan, Republic of Korea
| | - Sung Hyun Lee
- Department of Orthopedic Surgery, Wonkwang University Hospital, School of Medicine, Wonkwang University, Iksan, Republic of Korea
- Musculoskeletal and Immune Disease Research Institute, School of Medicine, Wonkwang University, Iksan, Republic of Korea
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He L, Xu Y, Duan D, Ouyang L. The anterior talofibular ligament: A thin-slice three-dimensional magnetic resonance imaging study. Foot Ankle Surg 2022; 28:1202-1209. [PMID: 34920953 DOI: 10.1016/j.fas.2021.11.011] [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: 08/09/2021] [Revised: 10/19/2021] [Accepted: 11/28/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE The aim of this study was to provide an accurate and improved understanding of anterior talofibular ligament (ATFL) anatomy, and to determine the exact positioning and diameter of the bony tunnel during ATFL repair and/or reconstruction surgery. METHOD A total of 58 healthy asymptomatic volunteers were examined, wherein 38 underwent bilateral ankle 3D MRI, and 20 underwent unilateral ankle 3D MRI (10 left and 10 right ankles). Data from a total of 96 MRI datasets were collected. The MRI data from these cases were exported into Mimics to enable reconstruction of 3D ATFL models. The resulting image quality was evaluated using a 5-point subjective scoring system. In addition, the length, width, thickness, and positioning of each ATFL and the area of the ATFL footprints were identified within the 3D model using Mimics and SolidWorks. RESULTS The image quality score was 4.48 ± 0.50. The ATFL formed one (65.6%), two (31.3%), or three (3.1%) bundles forms. The footprint area was 31.25 ± 6.29 mm2 on the fibular side, and 17.48 ± 4.49 mm2 on the talar side. CONCLUSION Thin-slice 3D MRI aids in the reconstruction of the 3D ATFL model, and it provides reference for the accurate anatomy of the area and location of the ATFL. This technology will facilitate diagnosis of ATFL injuries and choice of surgical methods. LEVEL OF EVIDENCE level IV.
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Affiliation(s)
- Lei He
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
| | - Yan Xu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
| | - Deyu Duan
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
| | - Liu Ouyang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
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Impact of the T2-weighted axial oblique MRI sequence in the assessment of peroneal tendons. Clin Radiol 2020; 75:642.e15-642.e23. [PMID: 32327227 DOI: 10.1016/j.crad.2020.02.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 02/28/2020] [Indexed: 11/21/2022]
Abstract
AIM To define the role of the T2-weighted axial oblique sequence for the magnetic resonance imaging (MRI) assessment of peroneal tendon pathologies. MATERIALS AND METHODS Two radiologists interpreted 180 ankle MRI examinations using standard sequences alone and then in combination with an axial oblique sequence. The readers indicated how likely a peroneal pathology was present using a five-level confidence scale. Diagnostic confidence, interobserver agreement, and clinical correlation were compared. Changes in diagnosis were recorded. RESULTS For both readers, the diagnostic confidence was significantly higher using the axial oblique sequence for tendinosis and inframalleolar tenosynovitis for both tendons and for peroneus brevis partial and longitudinal split tears (p<0.001). For reader 1, the diagnostic confidence was also higher using the axial oblique sequence for peroneus longus partial tears (p=0.007). Changes in diagnosis were seen for tendinosis and tenosynovitis of both tendons and for peroneus brevis partial and longitudinal split tears in 0.6-10.8% of cases. Inter-rater reliability was significantly higher with the axial oblique sequence for the diagnosis of tendinosis, inframalleolar tenosynovitis, and partial tear for both tendons, and for peroneus brevis longitudinal split tear. Amongst 105 examinations with clinical information, peroneal pathologies were most frequently diagnosed as present in cases with lateral symptoms (17% versus 14%) and absent in cases without lateral symptoms (92% versus 86%) on the axial oblique sequence. CONCLUSION The axial oblique sequence for the assessment of peroneal tendons allows for higher diagnostic confidence, inter-rater reliability, and clinical correlation and can lead to changes in diagnosis.
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Khil EK, Cha JG, Lee YK, Kim HJ. Evaluation of the anterior inferior tibiofibular and anterior talofibular ligaments using 2D oblique coronal imaging and 3D isotropic resolution T2-weighted fast spin-echo sequences at 3.0 T: Is there additional diagnostic value? J Med Imaging Radiat Oncol 2020; 64:338-346. [PMID: 32239668 DOI: 10.1111/1754-9485.13028] [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: 12/14/2019] [Revised: 02/23/2020] [Accepted: 03/04/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION To compare diagnostic performance of additional two-dimensional (2D) oblique coronal view and three-dimensional (3D) T2-weighted fast spin-echo(FSE) images for diagnosing injury of the anterior inferior tibiofibular (AiTFL) and anterior talofibular ligaments (ATFL). METHODS This study included 48 patients with ankle sprain who had undergone MRI using standard protocol and two additional sequences with 2D oblique coronal and 3D isotropic images, followed by arthroscopic surgery. Ligament injuries was subdivided by intact tendon, partial or complete tear. Retrospectively, two musculoskeletal radiologists respectively reviewed three image sets of MR including 2D axial image only (set 1), 2D axial and oblique coronal images (set 2), and 2D axial with 3D-isotropic images (set 3). Using arthroscopic findings as reference standard, diagnostic performances of both methods were analysed by the area under the curve (AUC). RESULTS Arthroscopy confirmed 13 AiTFL and 41 ATFL injuries. For AiTFL, when set 1 and set 3 were compared, AUC value was significantly higher for set 3 (P < 0.05). However, there was no significant difference between AUC values for set 2 and set 3 sequences by either reader for either type of tear (P > 0.05). For ATFL, both readers found there was no significant difference in AUC values between set 1 and set 3 and between set 2 and set 3. CONCLUSION Additional oblique coronal sequence demonstrated better diagnostic performance for AiTFL injury than conventional and isotropic imaging did. This sequence showed as much diagnostic accuracy as isotropic sequence for evaluation of ATFL injury.
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Affiliation(s)
- Eun Kyung Khil
- Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-si, Korea
| | - Jang Gyu Cha
- Department of Radiology, Soonchunhyang University Bucheon Hospitial, Bucheon-si, Korea
| | - Young Koo Lee
- Department of Orthopedic Surgery, Soonchunhyang University Bucheon Hospitial, Bucheon-si, Korea
| | - Hyun-Joo Kim
- Department of Radiology, Soonchunhyang University Seoul Hospitial, Bucheon-si, Korea
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Abstract
Given the prevalence of lateral ankle sprains during physical activity and the high rate of reinjury and chronic ankle instability, clinicians should be cognizant of the need to expand the evaluation of ankle instability beyond the acute time point. Physical assessments of the injured ankle should be similar, regardless of whether this is the initial lateral ankle sprain or the patient has experienced multiple sprains. To this point, a thorough injury history of the affected ankle provides important information during the clinical examination. The physical examination should assess the talocrural and subtalar joints, and clinicians should be aware of efficacious diagnostic tools that provide information about the status of injured structures. As patients progress into the subacute and return-to-activity phases after injury, comprehensive assessments of lateral ankle-complex instability will identify any disease and patient-oriented outcome deficits that resemble chronic ankle instability, which should be addressed with appropriate interventions to minimize the risk of developing long-term, recurrent ankle instability.
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Affiliation(s)
- Phillip A Gribble
- Department of Athletic Training and Clinical Nutrition, College of Health Sciences, University of Kentucky, Lexington
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Cao S, Wang C, Ma X, Wang X, Huang J, Zhang C, Wang K. Reliability and validity of different ankle MRI scanning planes for the anterior talofibular ligament injury diagnosis: a cadaveric study. J Orthop Surg Res 2019; 14:69. [PMID: 30819216 PMCID: PMC6393961 DOI: 10.1186/s13018-019-1102-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 02/14/2019] [Indexed: 11/30/2022] Open
Abstract
Background The objective of the current study is to compare reliability, accuracy, sensitivity, and specificity in magnetic resonance imaging (MRI) evaluation of anterior talofibular ligament (ATFL) among the routine axial scanning plane, oblique axial-coronal scanning plane, and oblique axial-sagittal scanning plane. Methods Twenty cadaveric feet were studied. ATFL was exposed before scanning. Routine axial, oblique axial-coronal, and oblique axial-sagittal MRI scanning of 20 ATFL-intact cadaveric feet were acquired utilizing a 1.5-T MRI unit. The scans were repeated on the 20 cadaveric feet after the ATFL was artificially injured. In total, 120 sets of MR images were obtained and were randomly numbered. Three independent observers who were blinded to the experiment evaluated the images. Interobserver agreement, sensitivity, specificity, and accuracy were calculated and compared between different scanning planes utilizing the McNemar test. Results The interobserver agreement was fair to good (kappa, 0.55 to 0.65) in the routine axial plane, fair to good (kappa, 0.557 to 0.75) in the oblique axial-sagittal plane, and excellent (kappa, 0.85 to 0.95) in the oblique axial-coronal plane. The accuracy was significantly higher when utilizing oblique axial-coronal MRI scanning than routine axial MRI scanning (reader 1: p = .018; reader 2: p = .005). Conclusions The diagnostic accuracy of oblique axial-coronal plane MRI was higher than the routine axial plane concerning ATFL injury, and the interobserver agreement was excellent. The oblique axial-coronal plane could be added to the MRI scanning protocol during clinical practices to improve the diagnostic accuracy of ATFL injury.
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Affiliation(s)
- Shengxuan Cao
- Department of Orthopedics, Huashan Hospital, Fudan University, No.12, Middle Wulumuqi Road, Jingan District, Shanghai, 200040, China
| | - Chen Wang
- Department of Orthopedics, Huashan Hospital, Fudan University, No.12, Middle Wulumuqi Road, Jingan District, Shanghai, 200040, China.
| | - Xin Ma
- Department of Orthopedics, Huashan Hospital, Fudan University, No.12, Middle Wulumuqi Road, Jingan District, Shanghai, 200040, China.
| | - Xu Wang
- Department of Orthopedics, Huashan Hospital, Fudan University, No.12, Middle Wulumuqi Road, Jingan District, Shanghai, 200040, China
| | - Jiazhang Huang
- Department of Orthopedics, Huashan Hospital, Fudan University, No.12, Middle Wulumuqi Road, Jingan District, Shanghai, 200040, China
| | - Chao Zhang
- Department of Orthopedics, Huashan Hospital, Fudan University, No.12, Middle Wulumuqi Road, Jingan District, Shanghai, 200040, China
| | - Kan Wang
- Department of Radiology, Huashan Hospital, Fudan University, No.12, Middle Wulumuqi Road, Jingan District, Shanghai, 200040, China
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Kim JS, Young KW, Cho HK, Lim SM, Park YU, Lee KT. Concomitant Syndesmotic Instability and Medial Ankle Instability Are Risk Factors for Unsatisfactory Outcomes in Patients With Chronic Ankle Instability. Arthroscopy 2015; 31:1548-56. [PMID: 25882179 DOI: 10.1016/j.arthro.2015.02.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Revised: 02/05/2015] [Accepted: 02/19/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine whether concomitant chronic syndesmotic injury or chronic medial ankle instability is associated with unsatisfactory outcomes in patients with chronic lateral ankle instability (CAI). METHODS We conducted a retrospective review of prospectively collected data from 276 male military patients with CAI who had undergone a modified Broström procedure between May 2007 and March 2010 and had been followed up for a mean of 26.7 months (range, 22 to 41 months). We evaluated clinical outcomes using American Orthopaedic Foot & Ankle Society ankle-hindfoot, visual analog scale, and ankle functional satisfactory scale scores. Possible associations with concomitant instability were reconstructed and investigated using the Pearson correlation coefficient and multivariate logistic regression analysis. RESULTS Of the 236 patients with satisfactory outcomes, 19 (8%) had medial ankle instability and 13 (6%) had syndesmotic instability; in contrast, of the 40 patients with unsatisfactory outcomes, 14 (35%) had medial ankle instability and 12 (30%) had syndesmotic instability. The mean American Orthopaedic Foot & Ankle Society scores for patients with satisfactory and unsatisfactory outcomes increased from 68.1 to 92.8 (P < .001) and from 65.9 to 76.8 (P < .001), respectively. The mean visual analog scale scores for the groups with satisfactory and unsatisfactory outcomes decreased from 5.8 to 2.1 (P < .001) and from 6.2 to 4.8 (P < .001), respectively. The mean ankle satisfaction score was 27.8 for patients with satisfactory outcomes and 18.7 for those with unsatisfactory outcomes (P < .001). Multivariate logistic regression analysis showed a 4-fold higher risk of dissatisfaction (95% confidence interval [CI], 0.81 to 20.07; P = .0880) with CAI and syndesmotic instability, a 3.8-fold higher risk (95% CI, 0.96 to 15.07; P = .0576) with CAI and medial ankle instability, and an 11.7-fold higher risk (95% CI, 2.60 to 52.70; P = .0014) with CAI and both syndesmotic and medial ankle instability. CONCLUSIONS Chronic syndesmotic instability and chronic medial ankle instability are significantly associated with unsatisfactory outcomes in patients with CAI. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Jin Su Kim
- Surgery of Foot and Ankle, Eulji Medical Center, College of Medicine, Eulji University, Seoul, Republic of Korea.
| | - Ki Won Young
- Surgery of Foot and Ankle, Eulji Medical Center, College of Medicine, Eulji University, Seoul, Republic of Korea
| | - Hun Ki Cho
- Surgery of Foot and Ankle, Eulji Medical Center, College of Medicine, Eulji University, Seoul, Republic of Korea
| | - Seok Min Lim
- Surgery of Foot and Ankle, Eulji Medical Center, College of Medicine, Eulji University, Seoul, Republic of Korea
| | - Young Uk Park
- Department of Orthopedic Surgery, College of Medicine, Ajou University, Suwon, Republic of Korea
| | - Kyung Tai Lee
- KT Lee's Orthopedic Hospital, Seoul, Republic of Korea
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Jeong MS, Choi YS, Kim YJ, Kim JS, Young KW, Jung YY. Deltoid ligament in acute ankle injury: MR imaging analysis. Skeletal Radiol 2014; 43:655-63. [PMID: 24599341 DOI: 10.1007/s00256-014-1842-5] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 01/23/2014] [Accepted: 02/03/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To identify the pattern of deltoid ligament injury after acute ankle injury and the relationship between ankle fracture and deltoid ligament tear by magnetic resonance imaging (MRI). MATERIALS AND METHODS Thirty-six patients (32 male, and 4 female; mean age, 29.8 years) with acute deltoid ligament injury who had undergone MRI participated in this study. The deltoid ligament was classified as having 3 superficial and 2 deep components. An image analysis included the integrity and tear site of the deltoid ligament, and other associated injuries. Association between ankle fracture and deltoid ligament tear was assessed using Fisher's exact test (P < 0.05). RESULTS Of the 36 patients, 21 (58.3 %) had tears in the superficial and deep deltoid ligaments, 6 (16.7 %) in the superficial ligaments only, and 4 (11.1 %) in the deep ligaments only. The most common tear site of the three components of the superficial deltoid and deep anterior tibiotalar ligaments was their proximal attachments (94 % and 91.7 % respectively), and that of the deep posterior tibiotalar ligament (pTTL) was its distal attachment (82.6 %). The common associated injuries were ankle fracture (63.9 %), syndesmosis tear (55.6 %), and lateral collateral ligament complex tear (44.4 %). All the components of the deltoid ligament were frequently torn in patients with ankle fractures (tibionavicular ligament, P = 0.009). CONCLUSION The observed injury pattern of the deltoid ligament was complex and frequently associated with concomitant ankle pathology. The most common tear site of the superficial deltoid ligament was the medial malleolar attachment, whereas that of the deep pTTL was near its medial talar insertion.
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Affiliation(s)
- Min Sun Jeong
- Department of Radiology, Eulji Hospital, Eulji University, 68, Hangeulbiseok-ro, Nowon-gu, Seoul, 139-711, Korea
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