Lateral Ankle Instability: MR Imaging of Associated Injuries and Surgical Treatment Procedures

 

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ABSTRACT

Chronic ankle instability has been defined as the development of recurrent ankle sprains and persistent symptoms after initial lateral ankle sprain. The diagnosis of ankle instability is usually established on the patient's history, physical examination, and radiographic assessment. Patients have signs of both functional and mechanical instability, and the repetitive, chronic nature of the injury may lead to intra-articular and periarticular pathologies. This article discusses the incidence, etiology, and magnetic resonance (MR) imaging of these pathologies, reviews the surgical treatment procedures for lateral ankle instability, and presents the postoperative MR imaging findings.

REFERENCES

• 1 Broström L. Sprained ankle. IV. Surgical treatment of chronic ankle ligament ruptures.  Acta Chir Scand. 1966;  132 551-566
  PubMedGoogle Scholar
• 2 Karlsson J, Lansinger O. Lateral instability of the ankle joint.  Clin Orthop Relat Res. 1992;  276 253-261
  Google Scholar
• 3 DiGiovanni C W, Brodsky A. Current concepts: lateral ankle instability.  Foot Ankle Int. 2006;  27 854-866
  CrossrefPubMedGoogle Scholar
• 4 Broström L. Sprained ankles: A Pathologic, Arthrographic and Clinical Study. Stockholm, Sweden; Diss Karolinska Institutets 1966
  Google Scholar
• 5 Glasgow M, Jackson A, Jamieson A M. Instability of the ankle after injury to the lateral ligaments.  J Bone Joint Surg [Br]. 1980;  62B 196-200
  PubMedGoogle Scholar
• 6 Mangwani J, Hakmi M A, Smith T WD. Chronic lateral ankle instability: review of anatomy, biomechanics, pathology, diagnosis and treatment.  Foot. 2001;  11 76-84
  CrossrefPubMedGoogle Scholar
• 7 Freeman M AR, Dean M RE, Hanham I WF. The etiology and prevention of functional instability of the foot.  J Bone Joint Surg [Br]. 1965;  47B 678-685
  PubMedGoogle Scholar
• 8 Freeman M AR. Treatment of ruptures of the lateral ligaments of the ankle.  J Bone Joint Surg [Br]. 1965;  47B 661-668
  PubMedGoogle Scholar
• 9 Hubbard T J, Kramer L C, Denegar C R, Hertel J. Foot Ankle Int. 2007;  28 343-354
  CrossrefPubMed
• 10 Hertel J. Functional anatomy, pathomechanics and pathophysiology of lateral ankle instability.  J Athl Train. 2002;  37 129-132
  PubMedGoogle Scholar
• 11 Wilkerson G B, Nitz A J. Dynamic ankle stability: mechanical and neuromuscular interrelationships.  J Sport Rehabil. 1994;  3 43-57
  PubMedGoogle Scholar
• 12 Colville M R. Surgical treatment of the unstable ankle.  J Am Acad Orthop Surg. 1998;  6 368-377
  PubMedGoogle Scholar
• 13 Louwerens J, Ginai A, van Linge B, Snijders C J. Stress radiography of the talocrural and subtalar joints.  Foot Ankle Int. 1995;  16 148-155
  PubMedGoogle Scholar
• 14 Ahovuo J, Kaartinen E, Slätis P. Diagnostic value of stress radiography in lesions of the lateral ligaments of the ankle.  Acta Radiol. 1988;  29 711-714
  CrossrefPubMedGoogle Scholar
• 15 Taga I, Shino K, Inoue M et al.. Articular cartilage lesions in ankles with lateral ligament injury.  Am J Sports Med. 1993;  21(1) 120-126
  CrossrefPubMedGoogle Scholar
• 16 Kibler W B. Arthroscopic findings in ankle ligament reconstruction.  Clin Sports Med. 1996;  15 799-804
  PubMedGoogle Scholar
• 17 Komenda G A, Ferkel R D. Arthroscopic findings associated with unstable ankle.  Foot Ankle Int. 1999;  20 708-713
  PubMedGoogle Scholar
• 18 Ferkel R D, Chams R N. Chronic lateral instability: arthroscopic findings and long-term results.  Foot Ankle Int. 2007;  28 24-31
  CrossrefPubMedGoogle Scholar
• 19 Hintermann B, Boss A, Schafer D et al.. Arthroscopic findings in patients with chronic ankle instability.  Am J Sports Med. 2002;  30(3) 402-409
  PubMedGoogle Scholar
• 20 DiGiovanni B F, Fraga C J, Cohen B E et al.. Associated injuries found in chronic lateral instability.  Foot Ankle Int. 2000;  21 809-815
  PubMedGoogle Scholar
• 21 Cannon L B, Slater H K. The role of ankle arthroscopy and surgical approach in lateral ankle ligament repair.  Foot Ankle Surg. 2005;  11 1-4
  PubMedGoogle Scholar
• 22 Sammarco G J, DiRaimondo C V. Chronic peroneus brevis tendon lesions.  Foot Ankle. 1989;  9 163-170
  PubMedGoogle Scholar
• 23 Bonnin M, Tavernier T, Bouysset M. Split lesions of the peroneus brevis tendon in chronic ankle laxity.  Am J Sports Med. 1997;  25(5) 699-703
  PubMedGoogle Scholar
• 24 Larsen E. Tendon transfer for lateral ankle and subtalar instability.  Acta Orthop Scand. 1988;  59 168-172
  PubMedGoogle Scholar
• 25 Karlsson J, Eriksson B I, Renström P A. Subtalar ankle instability.  Sports Med. 1997;  24(5) 337-346
  CrossrefPubMedGoogle Scholar
• 26 Harper M C. The lateral ligamentous support of the subtalar joint.  Foot Ankle. 1991;  11 354-358
  PubMedGoogle Scholar
• 27 Zell B K, Shereff M J, Greenspan A et al.. Combined ankle and subtalar instability.  Bull Hosp Jt Dis Orthop Inst. 1986;  46 35-47
  PubMedGoogle Scholar
• 28 Hintermann B, Valderrabano V, Boss A, Trouillier H H, Dick W. Medial ankle instability. an exploratory, prospective study of fifty-two cases.  Am J Sports Med. 2004;  32(1) 183-190
  CrossrefPubMedGoogle Scholar
• 29 Ferkel E D. Soft tissue lesions of the ankle. In: Whipple TL Arthroscopic Surgery: The Foot and Ankle. Philadelphia, Pa; Lippincott-Raven 1996: 121-143
  Google Scholar
• 30 Larsen E, Aru A. Synovitis in chronically unstable ankles.  Acta Orthop Scand. 1989;  60(3) 340-344
  PubMedGoogle Scholar
• 31 Winalski C S, Foldes K, Gravalles E M et al.. Synovial membrane disorders. In: Stark DD, Bradley WG Magnetic Resonance Imaging. St. Louis, Mo; Mosby 1999: 1079-1095
  Google Scholar
• 32 Cerezal L, Abascal F, Garcia-Valtuille R, Canga A. Ankle MR arthrography: how, why, when.  Radiol Clin North Am. 2005;  43 693-707
  CrossrefPubMedGoogle Scholar
• 33 Bassett F H, Gates HS III, Billys J B, Morris H B, Nikolaou P K. Talar impingement by the anteroinferior tibiofibular ligament. A cause of chronic pain in the ankle after inversion sprain.  J Bone Joint Surg. 1990;  72 55-59
  PubMedGoogle Scholar
• 34 Wolin I, Glassman F, Sideman S. Internal derangement of the talofibular component of the ankle joint.  Surg Gynecol Obstet. 1950;  91 193-200
  PubMedGoogle Scholar
• 35 Liu S H, Nuccion S, Finerman G. Diagnosis of anterolateral ankle impingement. Comparison between magnetic resonance imaging and clinical examination.  Am J Sports Med. 1997;  25(3) 389-393
  CrossrefPubMedGoogle Scholar
• 36 Farooki S, Yao L, Seeger L L. Anterolateral impingement of the ankle: effectiveness of MR imaging.  Radiology. 1998;  207 357-360
  PubMedGoogle Scholar
• 37 Jordan III L K, Helms C A, Cooperman A E et al.. Magnetic resonance imaging findings in anterolateral impingement of the ankle.  Skeletal Radiol. 2000;  29 34-39
  CrossrefPubMedGoogle Scholar
• 38 Rubin D A, Tishkoff N W, Britton C A et al.. Anterolateral soft tissue impingement in the ankle: diagnosis using MR imaging.  AJR Am J Roentgenol. 1997;  169 829-835
  PubMedGoogle Scholar
• 39 Robinson P, White L M, Salonen D C et al.. Anterolateral ankle impingement: MR arthrographic assessment of the anterolateral recess.  Radiology. 2001;  221 186-190
  PubMedGoogle Scholar
• 40 Haller J, Bernt R, Seeger T, Weissenbäck A, Tüchler H, Resnick D. MR-imaging of anterior tibiotalar impingement syndrome: agreement, sensitivity and specificity of MR-imaging and indirect MR-arthrography.  Eur J Radiol. 2006;  58(3) 450-460
  CrossrefPubMedGoogle Scholar
• 41 Ferkel E D. Articular surface defects, loose bodies and osteophytes. In: Whipple TL Arthroscopic Surgery: The Foot and Ankle. Philadelphia, Pa; Lippincott-Raven 1996: 145-184
  Google Scholar
• 42 O'Donoghue D H. Impingement exostosis of the talus and tibia.  J Bone Joint Surg [Am]. 1957;  39-A 835-898
  PubMedGoogle Scholar
• 43 Parkes II J C, Hamilton W G, Patterson A H, Rawles Jr J G. The anterior impingement syndrome of the ankle.  J Trauma. 1980;  20 895-898
  PubMedGoogle Scholar
• 44 Nicholas J A. Ankle injuries in athletes.  Orthop Clin North Am. 1974;  5 153-175
  PubMedGoogle Scholar
• 45 Stoller S M. A comparative study of the frequency of anterior impingement exostosis of the ankle in dancer and nondancer.  Foot Ankle. 1984;  4 201-203
  PubMedGoogle Scholar
• 46 Saotome K, Tamai K, Osada D et al.. Histologic classification of loose bodies in osteoarthrosis.  J Orthop Sci. 2006;  11(6) 607-613
  CrossrefPubMedGoogle Scholar
• 47 Brossmann J, Preidler K W, Daenen B et al.. Imaging of osseous and cartilaginous intraarticular bodies in the knee: Comparison of MR imaging and MR arthrography with CT and CT arthrography in cadavers.  Radiology. 1996;  200 509-517
  PubMedGoogle Scholar
• 48 Neckers A C, Polster J M, Winalski C S, Krebs V E, Sundaram M. Comparison of MR arthrography with arthroscopy of the hip for the assessment of intra-articular loose bodies.  Skeletal Radiol. 2007;  36 963-967
  CrossrefPubMedGoogle Scholar
• 49 Geppert M J, Sobel M, Bohne W H. Lateral ankle instability as a cause of superior peroneal retinacular laxity: an anatomic and biomechanical study of cadaveric feet.  Foot Ankle. 1993;  14(6) 330-334
  PubMedGoogle Scholar
• 50 Sobel M, Geppert M J, Warren R F. Chronic ankle instability as a cause of peroneal tendon injury.  Clin Orthop Relat Res. 1993;  296 187-191
  PubMedGoogle Scholar
• 51 Bassett III F H, Speer K P. Longitudinal rupture of the peroneal tendons.  Am J Sports Med. 1993;  21 354-357
  CrossrefPubMedGoogle Scholar
• 52 Sobel M, Levy M E, Bohne W H. Congenital variations of the peroneus quartus muscle: an anatomic study.  Foot Ankle. 1990;  11 81-89 , Erratum in: Foot Ankle. 1991;11:342
  PubMedGoogle Scholar
• 53 Cheung Y Y, Rosenberg Z S, Ramsinghani R, Beltran J, Jahss M H. Peroneus quartus muscle: MR imaging features.  Radiology. 1997;  202 745-750
  PubMedGoogle Scholar
• 54 Geller J, Lin S, Cordas D, Vieira P. Relationship of a low-lying muscle belly to tears of the peroneus brevis tendon.  Am J Orthop. 2003;  32 541-544
  PubMedGoogle Scholar
• 55 Zammit J, Singh D. The peroneus quartus muscle. Anatomy and clinical relevance.  J Bone Joint Surg Br. 2003;  85 1134-1137
  CrossrefPubMedGoogle Scholar
• 56 Manoli II A, Graham B. The subtle cavus foot, “the underpronator”.  Foot Ankle Int. 2005;  26 256-263
  PubMedGoogle Scholar
• 57 Heckman D S, Reddy S, Pedowitz D, Wapner K L, Parekh S G. Operative treatment for peroneal tendon disorders.  J Bone Joint Surg [Am]. 2008;  90(2) 404-418
  CrossrefPubMedGoogle Scholar
• 58 Sobel M, Geppert M J, Olson E J et al.. The dynamics of peroneus brevis tendon splits: a proposed mechanism, technique of diagnosis, and classification of injury.  Foot Ankle. 1992;  13 413-422
  PubMedGoogle Scholar
• 59 Lamm B M, Myers D T, Dombek M, Mendicino R W, Catanzariti A R, Saltrick K. Magnetic resonance imaging and surgical correlation of peroneus brevis tears.  J Foot Ankle Surg. 2004;  43 30-36
  CrossrefPubMedGoogle Scholar
• 60 Rosenberg Z S, Beltran J, Cheung Y Y et al.. MR features of longitudinal tears of the peroneus brevis tear.  AJR Am J Roentgol. 1997;  168 141-147
  CrossrefPubMedGoogle Scholar
• 61 Bencardino J T, Rosenberg Z S, Serrano L F. MR imaging features of diseases of the peroneal tendons.  Magn Reson Clin N Am. 2001;  9(3) 493-505
  PubMedGoogle Scholar
• 62 Hennrikus W L, Mapes R C, Lyons P M et al.. Outcomes of the Chrisman-Snook and modified-Broström procedures for chronic lateral ankle instability: a prospective, randomized comparison.  Am J Sports Med. 1996;  24 400-401
  CrossrefPubMedGoogle Scholar
• 63 Broström L. Sprained ankles. VI. Surgical treatment of “chronic” ligament ruptures.  Acta Chir Scand. 1966;  132 551-565
  PubMedGoogle Scholar
• 64 Snook G A, Chrisman O D, Wilson T. Long term results of Chrisman-Snook operation for reconstruction of the lateral ligaments of the ankle.  J Bone Joint Surg [Am]. 1985;  67A 1-7
  PubMedGoogle Scholar
• 65 Hoy G A, Henderson I J. Results of Watson-Jones ankle reconstruction for instability: the influence of articular damage.  J Bone Joint Surg [Br]. 1994;  76B 610-613
  PubMedGoogle Scholar
• 66 Karlsson J, Bergsten T, Lansinger O, Peterson L. Reconstruction of the lateral ligaments of the ankle for chronic lateral instability.  J Bone Joint Surg [Am]. 1988;  70A 581-588
  PubMedGoogle Scholar
• 67 Clanton T O, McGarvey W. Athletic injuries to the soft tissues of the foot and ankle. In: Coughlin MJ, Mann RA, Salzman CL Surgery of the Foot and Ankle. 8th ed. Philadelphia, Pa; Mosby-Elsevier 2007: 1425-1563
  Google Scholar
• 68 Bahr R, Pena F, Shine J et al.. Biomechanics of ankle ligament reconstruction: an in vitro comparison of the Broström repair, Watson-Jones reconstruction, and a new anatomic reconstruction technique.  Am J Sports Med. 1997;  25 424-432
  CrossrefPubMedGoogle Scholar
• 69 Colville M R, Marder R A, Zarins B. Reconstruction of the lateral ankle ligaments: a biomechanical analysis.  Am J Sports Med. 1992;  20 594-600
  CrossrefPubMedGoogle Scholar
• 70 Sammarco V J. Complications of lateral ankle ligament reconstruction.  Clin Orthop Relat Res. 2001;  391 123-132
  CrossrefPubMedGoogle Scholar
• 71 Gould N, Seligson D, Gassman J. Early and late repair of lateral ligaments of the ankle.  Foot Ankle. 1980;  1 84-89
  CrossrefPubMedGoogle Scholar
• 72 Coughlin M J, Schenck Jr R C, Grebing B R, Treme G. Comprehensive reconstruction of the lateral ankle for chronic instability using a free gracilis graft.  Foot Ankle Int. 2004;  25(4) 231-241
  CrossrefPubMedGoogle Scholar
• 73 Sugimoto K, Takakura Y, Kumai T et al.. Lateral ankle ligament reconstruction with patellar tendon graft.  Am J Sports Med. 2002;  30(3) 340-346
  PubMedGoogle Scholar
• 74 Anderson M E. Reconstruction of the lateral ligaments of the ankle using the plantaris tendon.  J Bone Joint Surg [Am]. 1985;  67A(6) 930-934
  PubMedGoogle Scholar
• 75 Horibe S, Shino K, Taga I, Inoue M, Ono K. Reconstruction of lateral ligaments of the ankle with allogeneic tendon grafts.  J Bone Joint Surg [Br]. 1991;  73B(5) 802-805
  PubMedGoogle Scholar
• 76 Elmslie R C. Recurrent subluxation of ankle joint.  Ann Surg. 1934;  100 364-367
  PubMedGoogle Scholar
• 77 Evans D L. Recurrent instability of the ankle—a method of surgical treatment.  Proc R Soc Med. 1953;  46 343-344
  PubMedGoogle Scholar
• 78 Watson-Jones R. Recurrent forward dislocation of the ankle joint.  J Bone Joint Surg [Br]. 1952;  34B 519-521
  PubMedGoogle Scholar
• 79 Chrisman O D, Snook G A. Reconstruction of lateral ligament tears of the ankle. An experimental study and clinical evaluation of seven patients treated by a new modification of the Elmslie procedure.  J Bone Joint Surg [Am]. 1969;  51A 904-912
  PubMedGoogle Scholar
• 80 Chien A J, Jacobsen J A, Jamadar D A et al.. Imaging appearances of lateral ankle ligament reconstruction.  Radiographics. 2004;  24 999-1008
  CrossrefPubMedGoogle Scholar
• 81 Bergin D, Morrison W B. Postoperative imaging of the ankle and foot.  Radiol Clin North Am. 2006;  44(3) 391-406
  CrossrefPubMedGoogle Scholar

Leyla AlparslanM.D. 

Department of Radiology, Akademiska Sjukhuset, Uppsala University Hospital, Uppsala University

SE-751 85 Uppsala, Sweden

Email: lalparslan@aol.com