Deltoid Ligament and Tibiofibular Syndesmosis Injury in Chronic Lateral Ankle Instability: Magnetic Resonance Imaging Evaluation at 3T and Comparison with Arthroscopy

Abstract

ObjectiveTo evaluate the prevalence of deltoid ligament and distal tibiofibular syndesmosis injury on 3T magnetic resonance imaging (MRI) in patients with chronic lateral ankle instability (CLAI).Materials and MethodsFifty patients (mean age, 35 years) who had undergone preoperative 3T MRI and surgical treatment for CLAI were enrolled. The prevalence of deltoid ligament and syndesmosis injury were assessed. The complexity of lateral collateral ligament complex (LCLC) injury was correlated with prevalence of deltoid or syndesmosis injuries. The diagnostic accuracy of ankle ligament imaging at 3T MRI was analyzed using arthroscopy as a reference standard.ResultsOn MRI, deltoid ligament injury was identified in 18 (36%) patients as follows: superficial ligament alone, 9 (50%); deep ligament alone 2 (11%); and both ligaments 7 (39%). Syndesmosis abnormality was found in 21 (42%) patients as follows: anterior inferior tibiofibular ligament (AITFL) alone, 19 (90%); and AITFL and interosseous ligament, 2 (10%). There was no correlation between LCLC injury complexity and the prevalence of an accompanying deltoid or syndesmosis injury on both MRI and arthroscopic findings. MRI sensitivity and specificity for detection of deltoid ligament injury were 84% and 93.5%, and those for detection of syndesmosis injury were 91% and 100%, respectively.ConclusionDeltoid ligament or syndesmosis injuries were common in patients undergoing surgery for CLAI, regardless of the LCLC injury complexity. 3T MRI is helpful for the detection of all types of ankle ligament injury. Therefore, careful interpretation of pre-operative MRI is essential.

Analysis of 3-dimensional finite element after reconstruction of impaired ankle deltoid ligament

“…However, the extortion circumference ratio of calcaneus is smaller than that of huckle-bone and its displacement is also smaller than that of the huckle-bone. Moreover, shin and ligament are in vertical position against each other which implies that Deland technique performs poorly against the ankle extortion (8). Kitaoka mainly reconstructed the shin ligament of deltoid ligament instead of ligament of shin heel, front and back by means of transplanting the hallux longus tendon.…”

Diagnóstico de la lesión sindesmal

“…Por encima de la radiografía simple o la TC, la RM logra una mayor precisión diagnóstica, especialmente en la inestabilidad sindesmal crónica (1) , y mayor aún si usamos medios de contraste y/o RM 3T (1,34) . Es una técnica no invasiva que evita la exposición a ra-diaciones ionizantes y que permite una evaluación directa de la sindesmosis, logrando una sensibilidad superior al 91% y una especificidad del 100% (35) , lo que la convierte en la prueba de elección en los casos dudosos (6) . Además, permite valorar lesiones ligamentosas óseas y condrales asociadas (34) .…”

Evidenzlage zur konservativen Therapie bei akuter Syndesmosenverletzung am oberen Sprunggelenk im Sport

“…Chun et al [31] untersuchten den Zusammenhang von Instabilitäten des Sprunggelenks und Syndesmosenverletzungen und kamen zu dem Ergebnis, dass 42 % der untersuchten Patienten mit chronischer Sprunggelenksinstabilität Abnormalitäten der Syndesmosis tibiofibularis aufwiesen. Dies zeigt zusammenfassend nochmals die Wichtigkeit einer genauen Diagnostik und Therapie der akuten Syndesmosenverletzung am OSG, um präventiv gegen die Entwicklung von chronischen Instabilitäten vorzugehen.…”