Hong Choon Chiet, Hallinan James Thomas Patrick Decourcy, Lau Eugene Tze Chun, Dalmau-Pastor Miki, Calder James, Kerkhoffs Gino M M J, Ge Shuliang
Department of Orthopaedic Surgery, National University Hospital, Singapore.
Department of Orthopaedic Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Knee Surg Sports Traumatol Arthrosc. 2025 May;33(5):1884-1891. doi: 10.1002/ksa.12642. Epub 2025 Mar 3.
The anterior talofibular ligament (ATFL) consists of two fascicles, with the intra-articular superior fascicle and extra-articular inferior fascicle connected to the calcaneofibular ligament (CFL) via the arciform fibres, forming the lateral fibulotalocalcaneal ligament (LFTCL) complex. Accurate identification of which fascicles have been injured is useful for determining the optimal treatment of patients with lateral ligament injuries. There is a lack of imaging studies demonstrating the distinctive anatomy of these important structures on magnetic resonance imaging (MRI). Hence, the aim of this pilot study is to investigate interobserver reliability in identifying the fascicles of the ATFL and LFTCL complex on routine two-dimensional (2D) MRI scans.
This is a single-centre review of 100 consecutive routine 2D MRI ankles performed in our institution for reasons other than ankle sprain. The ATFL fascicles and LFTCL complex were independently reviewed by three clinicians, and interobserver reliability was analysed using Fleiss kappa.
There were 46 males, and the average age was 47.7 years. In terms of the interobserver reliability, there was a substantial level of agreement in determining the number of fascicles for the ATFL (k = 0.688, p < 0.001, 95% confidence interval [CI]: 0.575-0.801) which was similar to the CFL (k = 0.747, p < 0.001, 95% CI: 0.633-0.860) while the arciform fibres had a moderate level of agreement (k = 0.489, p < 0.001, 95% CI: 0.377-0.603). There were 54 MRI scans with bifascicular ATFL, while the rest had a single inferior ATFL fascicle. The LFTCL complex was identified in 99 scans. No differences were noted in age, gender or MRI strength in the ability to visualize these structures on routine 2D MRI scans.
Routine 2D MRI can reliably identify the fascicles of the ATFL and LFTCL complex with moderate to substantial levels of agreement. This can help clinicians enhance their diagnostic accuracy and refine treatment strategies without relying on complex or costly imaging techniques.
Level III.
距腓前韧带（ATFL）由两个束组成，关节内上束和关节外下束通过弓形纤维与跟腓韧带（CFL）相连，形成外侧腓距跟韧带（LFTCL）复合体。准确识别哪些束受损对于确定外侧韧带损伤患者的最佳治疗方法很有用。缺乏影像学研究来证明这些重要结构在磁共振成像（MRI）上的独特解剖结构。因此，本初步研究的目的是调查在常规二维（2D）MRI扫描中识别ATFL和LFTCL复合体各束的观察者间可靠性。
这是一项对在我们机构进行的100例连续常规2D踝关节MRI的单中心回顾性研究，这些MRI检查的原因不是踝关节扭伤。三位临床医生独立评估ATFL束和LFTCL复合体，并使用Fleiss κ分析观察者间可靠性。
有46名男性，平均年龄为47.7岁。在观察者间可靠性方面，在确定ATFL束的数量上有较高程度的一致性（κ = 0.688，p < 0.001，95%置信区间[CI]：0.575 - 0.801），这与CFL的情况相似（κ = 0.747，p < 0.001，95% CI：0.633 - 0.860），而弓形纤维的一致性程度为中等（κ = 0.489，p < 0.001，95% CI：0.377 - 0.603）。有54例MRI扫描显示ATFL为双束，其余显示为单一的下ATFL束。在99例扫描中识别出了LFTCL复合体。在常规2D MRI扫描中观察这些结构的能力在年龄、性别或MRI强度方面未发现差异。
常规2D MRI能够可靠地识别ATFL和LFTCL复合体的束，一致性程度为中等至较高。这有助于临床医生提高诊断准确性并优化治疗策略，而无需依赖复杂或昂贵的成像技术。
III级。
