Jung Hong-Geun, Kim Na-Ra, Kim Tae-Hoon, Eom Joon-Sang, Lee Dong-Oh
1 Department of Orthopedic Surgery, Konkuk University School of Medicine, Gwangjin-gu, Seoul, Republic of Korea.
2 Department of Radiology, Konkuk University School of Medicine, Gwangjin-gu, Seoul, Republic of Korea.
Foot Ankle Int. 2017 Jun;38(6):621-626. doi: 10.1177/1071100717693207. Epub 2017 Feb 1.
Studies regarding magnetic resonance imaging (MRI) findings of the lateral ankle ligaments in chronic lateral ankle instability and their clinical relevance for surgery are lacking. This study classified the lateral ankle ligament MRI findings of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) in chronic lateral ankle instability (CLAI) and correlated these findings with ankle stress radiographs.
We included 132 ankles with CLAI that underwent ligament reconstructions from 2006 to 2013. The distributions of the ATFL and CFL morphologies were evaluated using the following categories: (1) the amount of thickness: normal/thickened/attenuated/non-visualized, (2) the presence of discontinuity, (3) wavy or irregular contour, and (4) increased signal intensity on T2-weighted images. The relationships between the ligament morphologies and stress radiographs were analyzed.
The ATFL was normal in 5 (4%) ankles, thickened in 35 (27%), attenuated in 76 (58%), and non-visualized in 16 (12%), while the CFL was normal in 39 (30%) ankles, thickened in 42 (32%), attenuated in 44 (33%), and non-visualized in 7 (5%). Discontinuity of the ATFL or CFL was observed in 46 (35%) ankles. Wavy or irregular contours were observed in 55 (42%) ATFLs and 37 (28%) CFLs, and signal intensity of both ligaments was increased in 19 (14%) ankles. ATFL ( P < .001) and CFL thickness ( P = .007) correlated with the talar tilt angle.
The MRI findings of CLAI showed several morphologies and specific incidences for each morphology. Attenuated, wavy appearance was the most frequent MRI pattern. Thickness was related to the degree of instability.
Level IV, retrospective case series.
目前缺乏关于慢性外侧踝关节不稳中外侧踝关节韧带的磁共振成像（MRI）表现及其手术临床相关性的研究。本研究对慢性外侧踝关节不稳（CLAI）患者的距腓前韧带（ATFL）和跟腓韧带（CFL）的外侧踝关节韧带MRI表现进行分类，并将这些表现与踝关节应力X线片进行关联。
我们纳入了2006年至2013年间接受韧带重建的132例CLAI患者的踝关节。使用以下类别评估ATFL和CFL的形态分布：（1）厚度：正常/增厚/变薄/未显示，（2）连续性中断情况，（3）波浪状或不规则轮廓，以及（4）T2加权图像上信号强度增加。分析韧带形态与应力X线片之间的关系。
16例（12%）踝关节的ATFL正常，35例（27%）增厚，76例（58%）变薄，16例（12%）未显示；而39例（30%）踝关节的CFL正常，42例（32%）增厚，44例（33%）变薄，7例（5%）未显示。46例（35%）踝关节观察到ATFL或CFL连续性中断。55例（42%）ATFL和37例（28%）CFL观察到波浪状或不规则轮廓，19例（14%）踝关节的两条韧带信号强度均增加。ATFL（P <.001）和CFL厚度（P =.007）与距骨倾斜角相关。
CLAI的MRI表现显示出多种形态及每种形态的特定发生率。变薄、波浪状外观是最常见的MRI模式。厚度与不稳程度相关。
IV级，回顾性病例系列。
