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Mansur H, Durigan JLQ, Contessoto S, Maranho DA, Nogueira-Barbosa MH. EVALUATION OF THE HEALING STATUS OF LATERAL ANKLE LIGAMENTS SIX WEEKS AFTER AN ACUTE ANKLE SPRAIN. J Foot Ankle Surg 2024:S1067-2516(24)00150-9. [PMID: 39067610 DOI: 10.1053/j.jfas.2024.07.004] [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: 03/26/2024] [Revised: 07/02/2024] [Accepted: 07/13/2024] [Indexed: 07/30/2024]
Abstract
We aimed to investigate whether there is clinical and MRI evidence of healing of lateral ligaments 6 weeks after acute lateral ankle sprain (LAS). We prospectively enrolled 18 participants (age 32.7 ± 7.5 years) who sustained an acute LAS and underwent conservative treatment. An ankle MRI was acquired up to 48 hours and 6 weeks following the LAS. A partial tear of the anterior talofibular ligament (ATFL) was observed in 10/18 and a complete tear in 8/18 of the patients. The calcaneofibular ligament (CFL) was partially torn in 11/18 and completely torn in 1/18 of the patients. The healing status, intensity, and thickness of the ligaments, Anterior Drawer Test (ADT), and FAOS scale were assessed. A control group (CG) was composed by 17 participants (age 40 ± 13.9 years). Six weeks after the LAS, 89% of the participants presented MRI evidence of ATFL healing. The repaired ATFL was thicker in comparison with the CG (p<0.001). The cut-off of 2.5 mm for ATFL thickness in the 6th week maximized sensitivity (62.5%) and specificity (100%). CFL and PTFL presented 94% and 100% of healing signs, respectively. In the 6th week, 11/18 (61%) participants showed mild residual instability and a mean FAOS of 80 ± 11. The MRI revealed signs of the repair process in 89% of ATFL and 94% of CFL tears, 6 weeks after a moderate or severe LAS. The MRI findings were concomitant with enhancements in mechanical ankle stability and function. Level of Clinical Evidence: III (Case-control observational study).
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Affiliation(s)
- Henrique Mansur
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
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Ni M, Chen W, Zhao Q, Zhao Y, Yuan H. Deep Learning Approach for MRI in the Classification of Anterior Talofibular Ligament Injuries. J Magn Reson Imaging 2023; 58:1544-1556. [PMID: 36807381 DOI: 10.1002/jmri.28649] [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: 01/10/2023] [Revised: 02/05/2023] [Accepted: 02/06/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Diagnosing anterior talofibular ligament (ATFL) injuries differs among radiologists. Further assessment of ATFL tears is valuable for clinical decision-making. PURPOSE To establish a deep learning method for classifying ATFL injuries based on magnetic resonance imaging (MRI). STUDY TYPE Retrospective. POPULATION One thousand seventy-three patients from a single center with ankle MRI within 1 month of reference standard arthroscopy (in-group dataset), were divided into training, validation, and test sets in a ratio of 8:1:1. Additionally, 167 patients from another center were used as an independent out-group dataset. FIELD STRENGTH/SEQUENCE Fat-saturation proton density-weighted fast spin-echo sequence at 1.5/3.0 T. ASSESSMENT Patients were divided into normal, strain and degeneration, partial tear and complete tear groups (groups 0-3). The complete tear group was divided into five sub-groups by location and the potential avulsion fracture (groups 3.1-3.5). All images were input into AlexNet, VGG11, Small-Sample-Attention Net (SSA-Net), and SSA-Net + Weight Loss for classification. The results were compared with four radiologists with 5-30 years of experience. STATISTICAL TESTS Model performance was evaluated by the receiver operating characteristic (ROC) curve, the area under the ROC curve (AUC), and so on. McNemar's test was used to compare performance among the different models, and between the radiologists and models. The intraclass correlation coefficient (ICC) was used to assess the reliability of the radiologists. P < 0.05 was considered statistically significant. RESULTS The average AUC of AlexNet, VGG11, SAA-Net, and SSA-Net + Weight Loss was 0.95, 0.99, 0.99, 0.99 in groups 0-3 and 0.96, 0.99, 0.99, 0.99 in groups 3.1-3.5. The effect of SSA-Net + Weight Loss was similar to SSA-Net but better than AlexNet and VGG11. In the out-group test set, the AUC of SSA-Net + Weight Loss ranged from 0.89 to 0.99. The ICC of radiologists was 0.97-1.00. The effect of SSA-Net + Weight Loss was better than each radiologist in the in-group and out-group test sets. DATA CONCLUSION Deep learning has potential to be used for classifying ATFL injuries. SSA-Net + Weight Loss has a better diagnostic effect than radiologists with different experience levels. LEVEL OF EVIDENCE 4 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Ming Ni
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Wen Chen
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Qiang Zhao
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Yuqing Zhao
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Huishu Yuan
- Department of Radiology, Peking University Third Hospital, Beijing, China
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Leckie I, Thomas L, Weiler R. Rehabilitation of a lateral ankle reconstruction in a male professional football player - A narrative case report. Phys Ther Sport 2023; 62:32-38. [PMID: 37300971 DOI: 10.1016/j.ptsp.2023.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 05/15/2023] [Accepted: 05/16/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Lateral ankle sprains involving the ATFL and CFL are common injuries in football with a high recurrence rate. There is a lack of research to guide post-operative rehabilitation of football players following lateral ligament ankle reconstructive surgery. This narrative case report discusses the management of a lateral ligament reconstruction in a male professional football player. METHODS A 25-year-old professional footballer underwent a lateral ankle reconstruction following recurrent lateral ankle sprains leading to an unstable ankle. RESULTS Following 11-weeks of rehabilitation the player was cleared to return to full-contact training. The player competed in his first competitive match 13-weeks post-injury and completed a 6-month full-training block, without episodes of pain or instability. CONCLUSION This case report illustrates the rehabilitation process of a football player following a lateral ankle ligament reconstruction within a timeframe expected in elite sport.
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Affiliation(s)
| | | | - Richard Weiler
- University Medical Centres, Netherlands; University College London, Instistute Sport, Exercise and Health, Division of Surgery and Interventional Science, United Kingdom; Fortius Clinic London, United Kingdom
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Cao M, Liu S, Zhang X, Ren M, Xiao Z, Chen J, Chen X. Imaging diagnosis for anterior talofibular ligament injury: a systemic review with meta-analysis. Acta Radiol 2023; 64:612-624. [PMID: 35343253 DOI: 10.1177/02841851221080556] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
A definite diagnosis of ankle ligament injury is crucial, and many imaging examinations can be used. This review systematically analyzed the effectiveness of various examination methods in the diagnosis of anterior talofibular ligament (ATFL) injuries. Three English databases (PubMed, Embase, and Cochrane Library) and three Chinese databases (CNKI, VIP Database, and Wanfang Database) were searched and relevant studies were summarized. A total of 25 randomized controlled trials met the selection criteria, including six, 16, and three studies recruiting patients with acute, chronic, and both acute and chronic ATFL injuries, respectively. A total of 1409 participants were included. The pooled sensitivity rates of acute ATFL injuries were 82.1% (77.1%-86.5%) by magnetic resonance imaging (MRI) and 88.6% (82.0%-93.5%) by ultrasonography (US). The pooled sensitivity rates of chronic ATFL injuries were 86.3% (82.5%-89.5%) by MRI, 98.7% (95.3%-99.8%) by US, 74.4% (63.6%-83.4%) by stress radiography, and 100% (87.7%-100.0%) for MR arthrography. The pooled specificity rates of acute ATFL injuries were 37.8% (29.1%-47.2%) by MRI and 90.3% (80.1%-96.4%) by US. The pooled specificity rates of chronic ATFL injuries were 86.8% (81.3%-91.2%) by MRI, 94.0% (85.4%-98.3%) for US, 89.4% (76.9%- 96.5%) by stress radiography and 100% (54.1%-100.0%) by MR arthrography. In conclusion, US may be a valuable imaging technique with high sensitivity for diagnosing chronic lateral ankle ligament injuries.
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Affiliation(s)
- Mingming Cao
- Department of Radiology, Zhongshan Affiliated Hospital, 47879Guangzhou University of Chinese Medicine, Zhongshan, 528400, PR China
| | - Shuxue Liu
- Department of Radiology, Zhongshan Affiliated Hospital, 47879Guangzhou University of Chinese Medicine, Zhongshan, 528400, PR China
| | - Xiongbiao Zhang
- Department of Radiology, Zhongshan Affiliated Hospital, 47879Guangzhou University of Chinese Medicine, Zhongshan, 528400, PR China
| | - Mingda Ren
- Department of Radiology, Zhongshan Affiliated Hospital, 47879Guangzhou University of Chinese Medicine, Zhongshan, 528400, PR China
| | - Zheng Xiao
- Department of Radiology, Zhongshan Affiliated Hospital, 47879Guangzhou University of Chinese Medicine, Zhongshan, 528400, PR China
| | - Jing Chen
- Department of Radiology, Zhongshan Affiliated Hospital, 47879Guangzhou University of Chinese Medicine, Zhongshan, 528400, PR China
| | - Xianteng Chen
- Department of Radiology, Zhongshan Affiliated Hospital, 47879Guangzhou University of Chinese Medicine, Zhongshan, 528400, PR China
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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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Barini M, Zagaria D, Licandro D, Pansini S, Airoldi C, Leigheb M, Carriero A. Magnetic Resonance Accuracy in the Diagnosis of Anterior Talo-Fibular Ligament Acute Injury: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2021; 11:1782. [PMID: 34679480 PMCID: PMC8534480 DOI: 10.3390/diagnostics11101782] [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] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 09/21/2021] [Accepted: 09/23/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The studies about injury to the anterior talo-fibular ligament (ATFL) are focused mainly on chronic symptoms and chronic instability, and the literature about the accuracy of magnetic resonance imaging (MRI) in acute injuries is quite lacking. METHODS This systematic review with meta-analysis analyzes the diagnostic accuracy of MRI on acute ATFL injury. Relative studies were retrieved after searching three databases (MEDLINE, SCOPUS, and Cochrane Central Register of Controlled Trails). Eligible studies were summarized. The quality of the included articles was assessed using the revised Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Data were extracted to calculate pooled sensitivity and specificity of MRI. RESULTS Seven studies met our inclusion and exclusion criteria. For MRI, the pooled sensitivities and specificity in diagnosing acute ATFL injury were respectively 1.0 (95% CI: 0.58-1) and 0.9 (95% CI: 0.79-0.96). Pooled LR+ and LR- were respectively 10.4 (95% CI: 4.6-23) and 0 (95% CI: 0-0.82). CONCLUSION This systematic review with meta-analysis investigated the accuracy of imaging for the diagnosis of acute ATFL injury. Our results demonstrated that MRI shows high diagnostic accuracy in the diagnosis of acute ATFL lesions. These results suggest that routine MRI in the case of suspected ATFL acute injury may be clinically useful, although this is not done in clinical practice due probably to high cost.
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Affiliation(s)
- Michela Barini
- Department of Radiodiagnostic and Interventional Radiology, AOU Maggiore della Carità, 28100 Novara, Italy; (M.B.); (D.L.); (S.P.); (A.C.)
| | - Domenico Zagaria
- Department of Radiodiagnostic and Interventional Radiology, AOU Maggiore della Carità, 28100 Novara, Italy; (M.B.); (D.L.); (S.P.); (A.C.)
| | - Davide Licandro
- Department of Radiodiagnostic and Interventional Radiology, AOU Maggiore della Carità, 28100 Novara, Italy; (M.B.); (D.L.); (S.P.); (A.C.)
| | - Sergio Pansini
- Department of Radiodiagnostic and Interventional Radiology, AOU Maggiore della Carità, 28100 Novara, Italy; (M.B.); (D.L.); (S.P.); (A.C.)
| | - Chiara Airoldi
- Unit of Medical Statistics and Epidemiology, Department of Translation Medicine, University of Piemonte Orientale, AOU Maggiore della Carità, 28100 Novara, Italy;
| | - Massimiliano Leigheb
- Orthopaedics and Traumatology Unit, Department of Health Sciences, University of Piemonte Orientale, AOU Maggiore della Carità, 28100 Novara, Italy;
| | - Alessandro Carriero
- Department of Radiodiagnostic and Interventional Radiology, AOU Maggiore della Carità, 28100 Novara, Italy; (M.B.); (D.L.); (S.P.); (A.C.)
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Basha MAA, Eldib DB, Zaitoun MM, Ghandour TM, Aly T, Mostafa S, Atta DS, Algazzar HY. The Added Diagnostic Value of the Bright Rim Sign to Conventional MRI Assessment of Anterior Talofibular Ligament Disruption. Acad Radiol 2021; 28:e247-e257. [PMID: 32534965 DOI: 10.1016/j.acra.2020.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 05/07/2020] [Accepted: 05/07/2020] [Indexed: 10/24/2022]
Abstract
RATIONALE AND OBJECTIVES The bright rim sign (BRS) was used as a reliable indicator of anterior talofibular ligament (ATFL) disruption beside other well-known diagnostic criteria. Although this sign can improve accuracy of conventional magnetic resonance imaging (MRI) in diagnosis of ATFL disruption, it was not adequately discussed in the literature. This study aimed to confirm the added diagnostic value of BRS to conventional MRI assessment of ATFL disruption. MATERIALS AND METHODS A prospective study included 62 patients (47 males and 15 females; mean age, 36.9 ± 12.1 years; range, 17-52 years) with clinically suspected ATFL disruption. All patients underwent MRI and arthroscopy of ankle. MRI images were evaluated for the presence of ligament disruption sign (LDS) and BRS. The patients were classified into 3 groups: group 1 included patients with acute lateral ankle ligament sprain; group 2 included patients with chronic ankle instability; and group 3 included patients with recurring ankle sprain. The diagnostic value of the BRS was evaluated using arthroscopy as reference standard. RESULTS The diagnostic value of both signs together increased overall sensitivity in detecting ATFL disruption to 86.7% compared to 60% when considering LDS alone (p < 0.0001). In group 1 and 3, the sensitivity increased when both signs were considered together compared to LDS alone (p = 0.004 and 0.025, respectively). In group 2, there was a trend toward significance in sensitivity when both signs were considered compared to LDS alone (p = 0.08). CONCLUSION BRS is a very helpful diagnostic sign in assessment of ATFL disruption when considered conjointly with the LDS.
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Basha MAA, Eldib DB, Zaitoun MM, Ghandour TM, Aly T, Mostafa S, Atta DS, Algazzar HY. The Added Diagnostic Value of the Bright Rim Sign to Conventional MRI Assessment of Anterior Talofibular Ligament Disruption. Acad Radiol 2021; 28:e247-e257. [DOI: https:/doi.org/10.1016/j.acra.2020.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Baltes TPA, Arnaiz J, Al-Naimi MR, Al-Sayrafi O, Geertsema C, Geertsema L, Evans T, D'Hooghe P, Kerkhoffs GMMJ, Tol JL. Limited intrarater and interrater reliability of acute ligamentous ankle injuries on 3 T MRI. J ISAKOS 2020; 6:153-160. [PMID: 34006579 DOI: 10.1136/jisakos-2020-000503] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To determine the diagnostic reliability of the Schneck grading system for acute ligamentous injuries of (1) the three major ligamentous ankle complexes, (2) the individual ankle ligaments and (3) the Sikka classification for syndesmosis injury. METHODS All acute ankle injuries in adult athletes (≥18 years), presenting to the outpatient department of a specialised Orthopaedic and Sports Medicine Hospital, within 7 days postinjury were screened for inclusion. Ankle injuries were excluded if imaging demonstrated a frank ankle fracture or if the 3 T MRI study could not be acquired within 10 days postinjury. Two radiologists graded the three major ligamentous complexes (lateral ankle complex, deltoid complex and syndesmosis complex) and their comprising individual ligaments according the four-grade Schneck grading system. Syndesmotic injuries were classified according the four-grade Sikka classification for consequent injury of the individual syndesmosis ligaments and the deltoid complex. Agreement and kappa (K) statistics were calculated to determine intrarater and interrater reliability. RESULTS Between September 2016 and September 2018, a total of 92 MR scans were obtained (87 patients). Interrater and intrarater reliability of the Schneck grading system was moderate to substantial for the lateral ankle complex (K=0.47-0.76), fair to almost perfect for the syndesmosis complex (K=0.37-0.89) and fair to moderate for the deltoid complex (K=0.14-0.51). For the individual ligaments, kappa values ranged from moderate to substantial for the anterior talofibular ligament (ATFL) (K=0.55-0.73), fair to substantial for the calcaneofibular ligament (K=0.31-0.62) and fair to almost perfect for the anteroinferior tibiofibular ligament (AITFL) (K=0.36-0.89). Diagnostic reliability of the Sikka classification ranged from moderate to almost perfect (K=0.51-0.95). CONCLUSIONS Grading of the three major ligamentous complexes and of the individual ankle ligaments according the Schneck grading system resulted in limited diagnostic reliability. When dichotomised for the presence of complete discontinuity, the interrater reliability of the Schneck grading system improved to substantial and almost perfect for the ATFL and AITFL, respectively. Classification of syndesmosis injury according the Sikka classification resulted in moderate interrater reliability.
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Affiliation(s)
- Thomas P A Baltes
- Research Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar .,Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
| | - Javier Arnaiz
- Department of Radiology, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Maryam R Al-Naimi
- Department of Radiology, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Omar Al-Sayrafi
- Department of Sports Medicine, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Celeste Geertsema
- Department of Sports Medicine, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Liesel Geertsema
- Department of Sports Medicine, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Toni Evans
- Department of Radiology, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Pieter D'Hooghe
- Department of Orthopaedic Surgery, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
| | - Johannes L Tol
- Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands.,Department of Sports Medicine, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
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Abstract
The Gaelic sports of hurling and football, native to Ireland, are increasing in popularity worldwide. The injury profile of these sports requires multidisciplinary management by sports physicians, orthopaedic surgeons, and musculoskeletal (MSK) radiologists, among others. Advances in imaging modalities and interventional techniques have aided the diagnosis and treatment of sport injuries. In this article, we review the literature and our own institutional experience to describe common injury patterns identified in Gaelic games athletes, their main imaging features and relevant therapeutic interventions. We discuss the increasing prevalence of imaging services at sporting events and the central role of MSK radiologists in sports injury management.
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Affiliation(s)
- Charles J Sullivan
- Department of Radiology, National Orthopaedic Hospital Cappagh, Finglas, Dublin, Ireland
| | - Eoin C Kavanagh
- Department of Radiology, National Orthopaedic Hospital Cappagh, Finglas, Dublin, Ireland.,Department of Radiology, Mater Misericordiae University Hospital, Eccles Street, Dublin, Ireland
| | - Stephen J Eustace
- Department of Radiology, National Orthopaedic Hospital Cappagh, Finglas, Dublin, Ireland.,Department of Radiology, Mater Misericordiae University Hospital, Eccles Street, Dublin, Ireland
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Mun JU, Cho HR, Sung YJ, Kang KN, Lee J, Joo Y, Kim YU. The role of the anterior talofibular ligament area as a morphological parameter of the chronic ankle sprain. J Orthop Sci 2020; 25:297-302. [PMID: 31104886 DOI: 10.1016/j.jos.2019.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 04/16/2019] [Accepted: 04/20/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Repetitive microtrauma can result in a hypertrophied ATFL. Previous studies have found that the anterior talofibular ligament thickness (ATFLT) is correlated with lateral ankle sprains, ligament injuries and chronic stroke in patients, and thickened anterior talofibular ligament (ATFL) has been considered to be a major morphologic parameter of hypertrophied ATFL. However, hypertrophy is different from thickness. Thus, we devised the anterior talofibular ligament area (ATFLA) as a new morphological parameter to evaluate the hypertrophy of the whole ATFL. METHODS ATFL samples were collected from 53 patients with sprain group and from 50 control subjects who underwent magnetic resonance imaging (MRI) of the ankle and revealed no evidence of lateral ankle injury. Axial T1-weighted MRI images were collected at the ankle level from all subjects. We measured the ATFLA and ATFLT at the anterior margin of the fibular malleolus to the talus bone on the MRI using a picture archiving and communications system. The ATFLA was measured as the whole cross-sectional ligament area of the ATFL that was most hypertrophied in the axial MR images. The ATFLT was measured as the thickest point between the lateral malleolus and the talus of the ankle. RESULTS The average ATFLA was 25.0 ± 6.0 mm2 in the control group and 47.1 ± 10.4 mm2 in the sprain group. The average ATFLT was 2.3 ± 0.6 mm in the control group and 3.8 ± 0.6 mm in the hypertrophied group. Patients in sprain group had significantly greater ATFLA (p < 0.001) and ATFLT (p < 0.001) than the control subjects. A Receiver Operator Characteristics curve analysis showed that the best cut-off point of the ATFLA was 34.8 mm2, with 94.3% sensitivity, 94.0% specificity, and an AUC of 0.97 (95% CI, 0.94-1.00). The optimal cut-off point of the ATFLT was 3.1 mm, with 86.8% sensitivity, 86.0% specificity, and AUC of 0.95 (95% CI, 0.92-0.99). CONCLUSION ATFLA is a new morphological parameter for evaluating chronic ankle sprain, and may even be more sensitive than ATFLT.
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Affiliation(s)
- Jong-Uk Mun
- Department of Orthopaedic Surgery, Changwon Gyeongsang National University Hospital, Changwon, Republic of Korea
| | - Hyung Rae Cho
- Department of Anesthesiology and Pain Medicine, Myongji Hospital, Hanyang University College of Medicine, Republic of Korea
| | - Yoo Jun Sung
- Department of Anesthesiology and Pain Medicine, Myongji Hospital, Hanyang University College of Medicine, Republic of Korea
| | - Keum Nae Kang
- Department of Anesthesiology and Pain Medicine, National Police Hospital, Seoul, Republic of Korea
| | - Jungmin Lee
- Department of Anesthesiology and Pain Medicine, Institute for Integrative Medicine, Catholic Kwandong University, College of Medicine, International ST. Mary`s Hospital, Incheon, Republic of Korea
| | - Young Joo
- Department of Anesthesiology and Pain Medicine, Institute for Integrative Medicine, Catholic Kwandong University, College of Medicine, International ST. Mary`s Hospital, Incheon, Republic of Korea
| | - Young Uk Kim
- Department of Anesthesiology and Pain Medicine, Institute for Integrative Medicine, Catholic Kwandong University, College of Medicine, International ST. Mary`s Hospital, Incheon, Republic of Korea.
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Li HY, Li WL, Chen SY, Hua YH. Increased ATFL-PTFL angle could be an indirect MRI sign in diagnosis of chronic ATFL injury. Knee Surg Sports Traumatol Arthrosc 2020; 28:208-212. [PMID: 30413859 DOI: 10.1007/s00167-018-5252-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 10/22/2018] [Indexed: 12/20/2022]
Abstract
PURPOSE Magnetic resonance imaging (MRI) has relatively low accuracy in diagnosing chronic anterior talofibular ligament (ATFL) injury. This study's purpose was to evaluate the angle between the ATFL and posterior talofibular ligament (PTFL) as a new indirect MRI sign of chronic ATFL injury in patients with mechanical ankle instability (MAI). METHODS This study included 200 participants: 105 patients with MAI and 95 patients seen at our institution for reasons unrelated to ankle instability. MR images of all 200 participants were reviewed. The ATFL-PTFL angle in the axial plane was measured and compared between groups. Receiver operating characteristic curves (ROC) were used to analyze ATFL-PTFL angles in participants with and without ATFL injury. The sensitivity and specificity of this method for diagnosing ATFL injury were calculated. RESULTS The mean ATFL-PTFL angle was significantly larger among MAI patients than among control patients (81.5° ± 9.8° vs 75.2° ± 8.9°, respectively; P < 0.01). The area under the ROC was 0.789 (P < 0.01). The optimal cut-off point for diagnosing ATFL injury on the basis of the ATFL-PTFL angle was 79.0° (sensitivity 0.89, specificity 0.67). CONCLUSION The ATFL-PTFL angle was significantly larger among MAI patients than among those without MAI. Increased ATFL-PTFL angle offers a new indirect MRI sign for diagnosing chronic ATFL injury. The ATFL-PTFL angle can be used not only to improve the accuracy of diagnosis of chronic ATFL injury, but also to evaluate the restoration of normal ankle joint geometry after lateral ligament reconstruction. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Hong-Yun Li
- Department of Sports Medicine and Arthroscopy Surgery, Huashan Hospital, Sports Medicine Center of Fudan University, No. 12 Urumq Middle Road, Shanghai, 200040, China
| | - Wen-Long Li
- Department of Orthopaedics, Penglai Traditional Chinese Medicine Hospital, Yantai, 265600, Shandong, China
| | - Shi-Yi Chen
- Department of Sports Medicine and Arthroscopy Surgery, Huashan Hospital, Sports Medicine Center of Fudan University, No. 12 Urumq Middle Road, Shanghai, 200040, China
| | - Ying-Hui Hua
- Department of Sports Medicine and Arthroscopy Surgery, Huashan Hospital, Sports Medicine Center of Fudan University, No. 12 Urumq Middle Road, Shanghai, 200040, China.
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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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Cao S, Wang C, Ma X, Wang X, Huang J, Zhang C. Imaging diagnosis for chronic lateral ankle ligament injury: a systemic review with meta-analysis. J Orthop Surg Res 2018; 13:122. [PMID: 29788978 PMCID: PMC5964890 DOI: 10.1186/s13018-018-0811-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 04/11/2018] [Indexed: 12/23/2022] Open
Abstract
Background Various imaging techniques have been utilized for the diagnosis of chronic lateral ankle ligament injury. This systemic review will explore the effectiveness of different imaging techniques in diagnosing chronic lateral ankle ligament injury. Methods Relative studies were retrieved after searching 3 databases (MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trails). Eligible studies were summarized. Data were extracted to calculate pooled sensitivity and specificity of magnetic resonance imaging (MRI), ultrasonography (US), stress radiography, and arthrography. Results Fifteen studies met our inclusion and exclusion criteria. A total of 695 participants were included. The pooled sensitivities in diagnosing chronic ATFL injury were 0.83 [0.78, 0.87] for MRI, 0.99 [0.96, 1.00] for US, and 0.81 [0.68, 0.90] for stress radiography. The pooled specificities in diagnosing chronic ATFL injury were 0.79 [0.69, 0.87] for MRI, 0.91 [0.82, 0.97] for US, and 0.92 [0.79, 0.98] for stress radiography. The pooled sensitivities in diagnosing chronic CFL injury were 0.56 [0.46, 0.66] for MRI, 0.94 [0.85, 0.98] for US, and 0.90 [0.73, 0.98] for arthrography. The pooled specificities in diagnosing chronic CFL injury were 0.88 [0.82, 0.93] for MRI, 0.91 [0.80, 0.97] for US, and 0.90 [0.77, 0.97] for arthrography. Conclusion This systematic review with meta-analysis investigated the accuracy of imaging for the diagnosis of chronic lateral ankle ligament injury. Ultrasound manifested high diagnostic accuracy in diagnosing chronic lateral ankle ligament injury. Clinicians should be aware of the limitations of MRI in detecting chronic CFL injuries.
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Affiliation(s)
- Shengxuan Cao
- Department of Orthopedics, Huashan Hospital, Fudan University, No.12, Middle Wulumuqi Road, Jingan District, Shanghai, China
| | - Chen Wang
- Department of Orthopedics, Huashan Hospital, Fudan University, No.12, Middle Wulumuqi Road, Jingan District, Shanghai, China
| | - Xin Ma
- Department of Orthopedics, Huashan Hospital, Fudan University, No.12, Middle Wulumuqi Road, Jingan District, Shanghai, China.
| | - Xu Wang
- Department of Orthopedics, Huashan Hospital, Fudan University, No.12, Middle Wulumuqi Road, Jingan District, Shanghai, China
| | - Jiazhang Huang
- Department of Orthopedics, Huashan Hospital, Fudan University, No.12, Middle Wulumuqi Road, Jingan District, Shanghai, China
| | - Chao Zhang
- Department of Orthopedics, Huashan Hospital, Fudan University, No.12, Middle Wulumuqi Road, Jingan District, Shanghai, China
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LiMarzi G, Scherer K, Porrino J. Visualization of the Ankle Lateral Collateral Ligament Complex. PM R 2017; 9:1051-1061. [DOI: 10.1016/j.pmrj.2017.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 06/01/2017] [Indexed: 11/25/2022]
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Shalaby MH, Sharara SM, Abdelbary MH. High resolution ultrasonography in ankle joint pain: Where does it stand? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2017. [DOI: 10.1016/j.ejrnm.2017.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Yi J, Cha JG, Lee YK, Lee BR, Jeon CH. MRI of the anterior talofibular ligament, talar cartilage and os subfibulare: Comparison of isotropic resolution 3D and conventional 2D T2-weighted fast spin-echo sequences at 3.0 T. Skeletal Radiol 2016; 45:899-908. [PMID: 26992909 DOI: 10.1007/s00256-016-2367-x] [Citation(s) in RCA: 18] [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] [Received: 10/07/2015] [Revised: 03/03/2016] [Accepted: 03/07/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the accuracy of a three-dimensional (3D) T2-weighted fast spin-echo (FSE) magnetic resonance (MR) sequence compared with two-dimensional (2D) sequence for diagnosing anterior talofibular ligament (ATFL) tears, chondral lesion of the talus (CLT) and os subfibulare/avulsion fracture of the distal fibula (OSF). MATERIALS AND METHODS Thirty-five patients were included, who had undergone ankle MRI with 3D T2-weighted FSE and 2D T2-weighted FSE sequences, as well as subsequent ankle arthroscopy, between November 2013 and July 2014. Each MR imaging sequence was independently scored by two readers retrospectively for the presence of ATFL tears, CLT and OSF. The area under the receiver operating curve (AUC) was compared to determine the discriminatory power of the two image sequences. Interobserver agreement was expressed as unweighted kappa value. RESULTS Arthroscopic findings confirmed 21 complete tears of the ATFL, 14 partial tears of the ATFL, 17 CLTs and 7 OSFs. There were no significant differences in the diagnoses of ATFL tears (p = 0.074-0.501), CLT (p = 0.090-0.450) and OSF (p = 0.317) obtained from the 2D and 3D sequences by either reader. The interobserver agreement rates between two readers using the 3D T2-weighted FSE sequence versus those obtained with the 2D sequence were substantial (κ = 0.659) versus moderate (κ = 0.553) for ATFL tears, moderate (κ = 0.499) versus substantial (κ = 0.676) for CLT and substantial (κ = 0.621) versus substantial (κ = 0.689) for OSF. CONCLUSION Three-dimensional isotropic T2-weighted FSE MRI of the ankle resulted in no statistically significant difference in diagnostic performance compared to two-dimensional T2-weighted FSE MRI in the evaluation of ATFL tears, CLTs and OSFs.
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Affiliation(s)
- Jisook Yi
- Department of Radiology, Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, Wonmi-gu, Bucheon-si, 14584, Korea
| | - Jang Gyu Cha
- Department of Radiology, Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, Wonmi-gu, Bucheon-si, 14584, Korea.
| | - Young Koo Lee
- Department of Orthopedics, Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, Wonmi-gu, Bucheon-si, 14584, Korea
| | - Bo Ra Lee
- Department of Biomedical Statistics, Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, Wonmi-gu, Bucheon-si, 14584, Korea
| | - Chan Hong Jeon
- Division of Rheumatology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, Wonmi-gu, Bucheon-si, 14584, Korea
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White WJ, McCollum GA, Calder JDF. Return to sport following acute lateral ligament repair of the ankle in professional athletes. Knee Surg Sports Traumatol Arthrosc 2016; 24:1124-9. [PMID: 26438247 DOI: 10.1007/s00167-015-3815-1] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 09/23/2015] [Indexed: 12/26/2022]
Abstract
PURPOSE Recent literature supports early reconstruction of severe acute lateral ligament injuries in professional athletes, suggesting earlier rehabilitation and reduced recurrent instability incidence. Not previously reported, predicting the time to return to training and play is important to both athlete and club. We evaluate the effectiveness and complications of lateral ligament reconstruction in professional athletes. We aim to estimate the time to return to training and sports in both isolated injuries and patients with additional injuries. METHODS A consecutive series of 42 athletes underwent modified Broström repair for clinically and radiologically confirmed acute grade III lateral ligament injury. Of 42, 30 had isolated complete rupture of ATFL and CFL. Of 42, 12 had additional injuries (osteochondral lesions, deltoid ligament injuries). All patients received minimum of 2 years post-operative assessment. RESULTS The median return to training and sports for isolated injuries was 63 days (49-110) and 77 days (56-127), respectively. However, for concomitant injury results were 86 days (63-152) and 105 days (82-178). This delay was significant (p < 0.001). Despite no difference in pre- and post-op VAS scores between the groups, those with combined injuries had significantly lower FAOS pain and symptoms sub-scores post-operatively (p = 0.027, p < 0.001). Two superficial infections responded to oral antibiotics. No patient developed recurrent instability. All returned to their pre-injury level of professional sports. CONCLUSION Lateral ligament reconstruction is a safe and effective treatment for acute severe ruptures providing a stable ankle and expected return to sports at approximately 10 weeks. Despite return to the same level of competition, club and player should be aware that associated injuries may delay return and symptoms may continue. These results may act as a guide to predict the expected time to return to training and to sport after surgical repair of acute injuries and also the influence of associated injuries in prolonging rehabilitation. LEVEL OF EVIDENCE III.
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Affiliation(s)
- W James White
- Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH, UK.
| | - Graham A McCollum
- Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH, UK
| | - James D F Calder
- Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH, UK.,Fortius Clinic, 17 Fitzhardinge St, London, W1H 6EQ, UK
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Return to sport following acute lateral ligament repair of the ankle in professional athletes. KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY : OFFICIAL JOURNAL OF THE ESSKA 2015. [PMID: 26438247 DOI: 10.1007/s00167-015-3815-1.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Recent literature supports early reconstruction of severe acute lateral ligament injuries in professional athletes, suggesting earlier rehabilitation and reduced recurrent instability incidence. Not previously reported, predicting the time to return to training and play is important to both athlete and club. We evaluate the effectiveness and complications of lateral ligament reconstruction in professional athletes. We aim to estimate the time to return to training and sports in both isolated injuries and patients with additional injuries. METHODS A consecutive series of 42 athletes underwent modified Broström repair for clinically and radiologically confirmed acute grade III lateral ligament injury. Of 42, 30 had isolated complete rupture of ATFL and CFL. Of 42, 12 had additional injuries (osteochondral lesions, deltoid ligament injuries). All patients received minimum of 2 years post-operative assessment. RESULTS The median return to training and sports for isolated injuries was 63 days (49-110) and 77 days (56-127), respectively. However, for concomitant injury results were 86 days (63-152) and 105 days (82-178). This delay was significant (p < 0.001). Despite no difference in pre- and post-op VAS scores between the groups, those with combined injuries had significantly lower FAOS pain and symptoms sub-scores post-operatively (p = 0.027, p < 0.001). Two superficial infections responded to oral antibiotics. No patient developed recurrent instability. All returned to their pre-injury level of professional sports. CONCLUSION Lateral ligament reconstruction is a safe and effective treatment for acute severe ruptures providing a stable ankle and expected return to sports at approximately 10 weeks. Despite return to the same level of competition, club and player should be aware that associated injuries may delay return and symptoms may continue. These results may act as a guide to predict the expected time to return to training and to sport after surgical repair of acute injuries and also the influence of associated injuries in prolonging rehabilitation. LEVEL OF EVIDENCE III.
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Reliability and Validity of Magnetic Resonance Imaging for the Evaluation of the Anterior Talofibular Ligament in Patients Undergoing Ankle Arthroscopy. Arthroscopy 2015; 31:1540-7. [PMID: 25882180 DOI: 10.1016/j.arthro.2015.02.024] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Revised: 02/03/2015] [Accepted: 02/17/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To analyze the reliability and validity of magnetic resonance imaging (MRI) for the detection of anterior talofibular ligament (ATFL) injuries in chronic lateral ankle instability by comparing its findings with arthroscopic findings. METHODS This diagnostic study enrolled patients who underwent MRI followed by subsequent arthroscopy for their various ankle disorders between April 2012 and February 2013. Two radiologists independently assessed the ATFL on MRI, and the results of their MRI assessments were then compared with the arthroscopic findings, which were used as the standard of reference. RESULTS On arthroscopy, 55 ATFL injuries were identified in 79 patients. The interobserver reliability of detecting ATFL injuries with MRI was excellent (intraclass correlation coefficient, 0.915). MRI, as interpreted by readers A and B, showed a sensitivity of 83.6% and 76.4%, respectively; specificity of 91.7% and 83.3%, respectively; negative predictive value of 71.0% and 60.6%, respectively; positive predictive value of 95.8% and 91.3%, respectively; and accuracy of 86.1% and 78.5%, respectively. According to the location of the ATFL injury, the sensitivity of MRI for readers A and B was 72.7% and 63.6%, respectively, at the fibular attachment site; 80.0% and 66.7%, respectively, at the talar attachment site; and 100% at the midsubstance and multiple sites. All false-negative diagnoses of ATFL injuries were observed at the fibular or talar attachment site (9 cases for reader A and 13 cases for reader B). CONCLUSIONS This study showed that MRI has excellent interobserver reliability (intraclass correlation coefficient, 0.915) for detecting ATFL injuries in patients in whom there is a clinical suspicion of chronic lateral ankle instability. The sensitivity and positive predictive value of MRI in the diagnosis of ATFL injuries were very high, whereas the sensitivity and negative predictive value of MRI were relatively low. According to the location of the ATFL injury, the sensitivities of MRI for the detection of ATFL injuries at the fibular or talar attachment site were lower than those at the midsubstance or multiple sites. In addition, all false-negative diagnoses of ATFL injuries were observed at the fibular or talar attachment site. LEVEL OF EVIDENCE Level III, diagnostic study of nonconsecutive patients (without consistently applied reference gold standard).
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