Accuracy of MRI scan in the diagnosis of ligamentous and chondral pathology in the ankle

doi:10.1016/j.fas.2009.05.012

Foot and Ankle Surgery

Volume 16, Issue 2, June 2010, Pages 78-80

https://doi.org/10.1016/j.fas.2009.05.012 Get rights and content

Abstract

Background

The aim of our study is to determine the accuracy of magnetic resonance imaging (MRI) scan in relation to arthroscopic findings in patients presenting with chronic ankle pain and/or instability.

Methods

All patients who underwent arthroscopy of the ankle as well as MRI from December 2005 to July 2008 in our institution were reviewed by the Orthopaedic surgeons. Twenty-four patients were identified and the results of MRI scans were compared with arthroscopic findings. This study specifically looked at anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL) and osteochondral lesions (OCD). Arthroscopic findings were considered as a gold standard. There were 12 female and 12 male patients with an average age 39 years (11–65 years). Time interval between MRI scan and arthroscopy was 7.0 months (2–18 months).

Results

In our study MRI showed 100% specificity for the diagnosis of ATFL and CFL tears and osteochondral lesions. However sensitivity was low particularly for CFL tears. Accuracy of MRI in detecting ATFL tear was 91.7%, CFL tear was 87.5% and osteochondral lesion was 83.3%.

Coclusions

We conclude that MRI scan has very high specificity and positive predictive value in diagnosing tears of ATFL, CFL and osteochondral lesions. However sensitivity was low with MRI. In a symptomatic patient negative results on MRI must be viewed with caution and an arthroscopy may still be required for a definitive diagnosis and treatment. However high resolution scans may differ in their ability to pick up these lesions and further research is required to assess their efficiency as evidence is not currently available.

Introduction

Magnetic resonance imaging (MRI) has become the imaging the modality of choice for the diagnosis of many conditions affecting the knee and shoulder [1]. In joints such as the wrist the MRI scan is less useful as a diagnostic tool [2]. The aim of our study is to analyse the accuracy of MRI in diagnosing ligamentous/chondral lesions in the ankle and to compare it with arthroscopic findings. Arthroscopic diagnosis was considered to be the gold standard.

Section snippets

Methods

Data of all the patients who underwent arthroscopy of the ankle between December 2005 and July 2008 were collected. A total of 24 patients underwent arthroscopy as well as MRI during this period for chronic ankle pain and/or instability. The study specifically looked at accuracy of MRI in detecting tears of the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL) and osteochondral lesions (OCD).

Patients underwent imaging with 1 T MRI machine, using standard imaging sequences and

Results

Analysis of the data confirmed that specificity and positive predictive value of MRI is 100% for detection of tears of ATFL, CFL and OCD. The sensitivity is 67% for ATFL tears, 40% for CFL tears and 73% for OCD. The negative predictive value of MRI is 90% for ATFL tears, 86% for CFL tears and 69% for OCD. The overall accuracy of MRI is 91.7% for ATFL tears, 87.5% for CFL tears and 83.3% for OCD. The results are shown in Table 1.

Four patients had intra deltoid ligament tear with only one being

Discussion

Lateral ankle sprains represent a high proportion of sports related traumatic lesions [3]. The ATFL is the weakest and the most frequently torn ankle ligament followed by CFL [3]. MR imaging of the ankle has received considerably less attention in the past [1]. This could be due to the relative complexity of ankle anatomy and the smaller size of many clinically relevant structures [1].

Normal ankle ligaments are predominantly low signal intensity but may have longitudinal streaks of intermediate

Conclusions

We conclude that MRI scan has very high specificity and positive predictive value in diagnosing tears of ATFT, CFL and osteochondral lesions. However sensitivity and negative predictive value is low with MRI. In a symptomatic patient negative results on MRI must be viewed with caution and an arthroscopy is advisable for a definitive diagnosis and treatment. It could be argued that these findings may differ with higher resolution scanner but the evidence for this is not currently available.

Conflict of interest

None of the authors of the above manuscript has any conflict of interest, which may arise from being named as an author on the manuscript.

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The purposes of this study were to classify anterior talofibular ligament injuries (ATFL), to find out the feasibility of arthroscopic ATFL repair according to injury type and to investigate the diagnostic validity of magnetic resonance imaging (MRI) of ATFL injuries by comparing MRI and arthroscopic findings. The 197 ankles (93 right, 104 left, and 12 bilateral) of 185 patients (90 men and 107 women; mean age, 33.5 years, range: 15-68 years) were treated by arthroscopic modified Broström procedure after a diagnosis of chronic lateral ankle instability. ATFL injuries were classified according to their grade and location (type P: partial rupture, type C1: fibular detachment, type C2: talar detachment, type C3: midsubstance rupture, type C4: absence of ATFL, type C5: os subfibulare). Among the 197 injured ankles, according to ankle arthroscopy, 67 were type P (34%), 28 were type C1 (14%), 13 were type C2 (7%), 29 were type C3 (15%), 26 were type C4 (13%), and 34 were type C5 (17%). The kappa value for the agreement between the arthroscopic findings and MRI findings was also high (0.85; 95% confidence interval, 0.79-0.91). Our results also supported the use of MRI for diagnosing ATFL injuries and showed that it is an informative tool during the preoperative period.

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Accuracy of MRI scan in the diagnosis of ligamentous and chondral pathology in the ankle

Abstract

Background

Methods

Results

Coclusions

Introduction

Section snippets

Methods

Results

Discussion

Conclusions

Conflict of interest

Arthroscopy

MR appearance of painful conditions of the ankle

RadioGraphics

Accuracy of direct magnetic resonance arthrography in the diagnosis of triangular fibrocartilage complex tears of the wrist

Int Orthop

MR imaging of the ankle and foot

RadioGraphics

Surgical treatment of transchondral talar-dome fractures (osteochondritis dissecans). Long-term follow-up

J Bone Joint Surg Am