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

Abstract

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.

Operative treatment of lateral ligament instability

“…We routinely use it to identify talar osteochondral lesions (OCLs) and then we can counsel patients as the treatment of these lesions often changes the post-operative protocol in addition to the surgical plan. MRI sensitivity for concomitant lesions is high, especially when evaluating for osteochondral lesions [41][42][43][44]. However, the utility in diagnosing symptomatic lateral ankle instability is limited because it is a static study.…”

Return to Play Following Ankle Sprain and Lateral Ligament Reconstruction

“…Although MRI may identify associated pathology, such as osteochondral lesions, peroneal tendon tears, and loose bodies, the sensitivity of identifying such is still lower than with arthroscopy. 36,37 Clinicians should be systematic in evaluating the ankle joint during arthroscopy so as not to overlook these subtle concomitant injuries.…”

Treatment of longitudinal mid-substance tears of the peroneal tendons

“…Dynamic ultrasound also can be helpful. 5,6,7,11,16 TREATMENT Without any evidence of acute rupture, most agree on conservative management, although the duration varies among authors ranging from 2--6 months. 1--5,6,7,14,15,22 Conservative management consists of anti-inflammatory medication, bracing, orthotics, and physical therapy.…”

“…16 Recent studies have shown that MRI remains the most reliable objective measure of tears, although inaccuracies still remain. 6,7,13 Dynamic ultrasound also has proven to be a useful tool. 16 Initial conservative treatment is recommended unless an acute tear or rupture is evident.…”

“…Preoperative and intraoperative diagnostics can assist in the execution of a surgical plan. 6,7,13,14 …”