Arthroscopic Assessment for Intra-articular Disorders in Residual Ankle Disability after Sprain

Takao, Masato; Uchio, Yuji; Naito, Kohei; Fukazawa, Ikuo; Ochi, Mitsuo

doi:10.1177/0363546504270566

Cited by 108 publications

(87 citation statements)

References 58 publications

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“…This method may limit detection of medial or posterior lesions, of which a relatively high number were observed in our study and previous investigations [7,10,15,18,20,24]. In another report, eight of 21 (38%) chondral lesions were missed by preoperative MRI [25], similar to the rate found for the orthopaedic surgeon in the current study.…”

Section: Discussionsupporting

confidence: 82%

“…Also, almost all lesions missed on MRI in our study were full thickness and warranted microfracture, but the lesions were not large or deep. Because MRI detects subchondral changes, more superficial lesions are less likely to be imaged [25]. Other MRI factors that may affect accuracy include the type of sequence [5,16,17,27], power of the magnet [11,12,26], and positioning [21].…”

Section: Discussionmentioning

confidence: 99%

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Is MRI Adequate to Detect Lesions in Patients with Ankle Instability?

O’Neill

Aman

Guyton

2010

Clinical Orthopaedics &Amp; Related Research

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Background Chondral lesions, peroneal tendon tears, and other disorders in patients with chronic ankle instability may not be detected by preoperative MRI. Also, MRI often is obtained and interpreted at the referring institution, leading to variability in reading. Questions/PurposesWe assessed the accuracy of the radiologists' and orthopaedic surgeon's reading of preoperative MRI for diagnosing ankle lesions in patients with ankle instability warranting surgery. Patients and Methods We retrospectively reviewed 133 patients who underwent 135 surgeries for lateral ankle ligament reconstruction with concomitant ankle arthroscopy and who had preoperative MRI. Results We found 72 associated lesions in 66 of the 135 surgeries, including 38 chondral injuries, 18 peroneus brevis tears, seven loose bodies, and nine other miscellaneous abnormalities. Eliminating eight lesions for which the decision to operate was not based on operative findings, there were 127 surgeries with 64 associated lesions that required intraoperative confirmation or were detected intraoperatively. In the original reports, the radiologists identified 39% (15) of the chondral injuries, 56% (10) of the peroneal tears, and 57% (four) of the loose bodies. Radiologists' MRI sensitivity for detecting lesions was 45%. The attending surgeon identified 47% (18) of the chondral injuries, 89% (16) of the loose bodies, 71% (five) of the peroneus brevis tears, and the posterior talus process lesion, with a sensitivity of 63%. ConclusionsOur data suggest orthopaedic surgeons should review preoperative MRIs and also suggest the sensitivity of MRI may not be adequate to detect lesions in these patients before surgery.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Is MRI Adequate to Detect Lesions in Patients with Ankle Instability?

O’Neill

Aman

Guyton

2010

Clinical Orthopaedics &Amp; Related Research

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“…Patients who developed sequelae from inversion ankle injury had an incidence of OLT between 38% and 81%. 100 Similarly, patients who underwent surgery for lateral ankle instability demonstrated a 17% to 63% incidence of OLT. 101 Plain radiographs often do not reveal the presence or extent of OLT, particularly in cases of acute ankle trauma.…”

mentioning

confidence: 98%

National Athletic Trainers' Association Position Statement: Conservative Management and Prevention of Ankle Sprains in Athletes

Kaminski

Hertel

Amendola

et al. 2013

Journal of Athletic Training

213

233

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Objective: To present recommendations for athletic trainers and other allied health care professionals in the conservative management and prevention of ankle sprains in athletes.Background: Because ankle sprains are a common and often disabling injury in athletes, athletic trainers and other sports health care professionals must be able to implement the most current and evidence-supported treatment strategies to ensure safe and rapid return to play. Equally important is initiating preventive measures to mitigate both first-time sprains and the chance of reinjury. Therefore, considerations for appropriate preventive measures (including taping and bracing), initial assessment, both short-and long-term management strategies, return-to-play guidelines, and recommendations for syndesmotic ankle sprains and chronic ankle instability are presented.Recommendations: The recommendations included in this position statement are intended to provide athletic trainers and other sports health care professionals with guidelines and criteria to deliver the best health care possible for the prevention and management of ankle sprains. An endorsement as to best practice is made whenever evidence supporting the recommendation is available.

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“…After acute ankle distortion, the incidence of OCL is estimated to be just under 7 % [25,30]. When pain is persistent after ankle distortion, the incidence is markedly higher, as osteochondral lesions could be detected in 38 % of patients with persistent pain lasting over 7 months after ankle joint trauma [31]. However, an osteochondral lesion is often described as a random finding in the MRI without concomitant symptoms and is often asymptomatic [32].…”

Section: Classification Of Osteochondral Lesionsmentioning

confidence: 99%

Modern Cartilage Imaging of the Ankle

Weber

Wünnemann

Jungmann

et al. 2017

Fortschr Röntgenstr

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ABSTR AC TBackground Talar osteochondral lesions are an important risk factor for the development of talar osteoarthritis. Furthermore, osteochondral lesions might explain persistent ankle pain. Early diagnosis of accompanying chondral defects is important to establish the optimal therapy strategy and thereby delaying or preventing the onset of osteoarthritis. The purpose of this review is to explain modern cartilage imaging with emphasis of MR imaging as well as the discussion of more sophisticated imaging studies like CT-arthrography or functional MR imaging.Methods Pubmed literature search concerning: osteochondral lesions, cartilage damage, ankle joint, talus, 2 D MR imaging, 3 D MR imaging, cartilage MR imaging, CT-arthrography, cartilage repair, microfracture, OATS, MACT.Results and Conclusion Dedicated MR imaging protocols to delineate talar cartilage and the appearance of acute and chronic osteochondral lesions were discussed. Recent developments of MR imaging, such as isotropic 3 D imaging that has a higher signal-to noise ratio when compared to 2 D imaging, and specialized imaging methods such as CT-arthrography as well as functional MR imaging were introduced. Several classifications schemes and imaging findings of osteochondral lesions that influence the conservative or surgical therapy strategy were discussed. MRI enables after surgery the noninvasive assessment of the repair tissue and the success of implantation. Key points▪ Modern MRI allows for highly resolved visualization of the articular cartilage of the ankle joint and of subchondral pathologies. ▪ Recent advances in MRI include 3 D isotropic ankle joint imaging, which deliver higher signal-to-noise ratios of the cartilage and less partial volume artifacts when compared with standard 2 D sequences. ▪ In case of osteochondral lesions MRI is beneficial for assessing the stability of the osteochondral fragment and for this discontinuity of the cartilage layer is an important factor. ▪ CT-arthrography can be used in case of contraindications of MRI and in unclear MRI findings as further diagnostic approach. Citation Format

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Arthroscopic Assessment for Intra-articular Disorders in Residual Ankle Disability after Sprain

Abstract: The present results suggest that arthroscopy can be used to diagnose the cause of residual pain after an ankle sprain in most cases that are otherwise undiagnosable by clinical examination and imaging study.

Cited by 108 publications

References 58 publications

Is MRI Adequate to Detect Lesions in Patients with Ankle Instability?

Is MRI Adequate to Detect Lesions in Patients with Ankle Instability?

National Athletic Trainers' Association Position Statement: Conservative Management and Prevention of Ankle Sprains in Athletes

Modern Cartilage Imaging of the Ankle

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