Using Dynamic Portable Ultrasonography for the Diagnosis of Lateral Ankle Instability

Category: Sports; Ankle Introduction/Purpose: Destabilizing injuries to the lateral ligament have relied on physical examination and radiographic stress test for diagnosis, with a focus on anterior translation and tilting of the talus relative to the tibial bone. Portable ultrasonography (PUS) has increasingly been used in the clinical setting, allowing dynamic and non-invasive evaluation. The primary aim of this study was to assess the anterior translation and tilting of the talus with PUS in various stages of lateral ankle ligamentous injury. Secondary, we compared the instability values measured with PUS with those measured on fluoroscopy. Third, we aimed to determine the optimal cutoff values of the PUS that distinguish stable from unstable state. Methods: 8 fresh-frozen cadaveric specimens underwent PUS and fluoroscopic evaluation for lateral ankle stability. The assessment was done with all ligaments intact and later with sequential transection of the anterior-talofibular ligament (ATFL), the calcaneofibular ligament (CFL), and the posterior-talofibular ligament (PTFL). In all scenarios, 2 loading conditions were considered; 1) Performing the anterior drawer test under 50N and 80N of force, anterior translation was measured with PUS and fluoroscopy; 2) Performing the talar tilt test under 1.7Nm of torque, the lateral clear space (the distance between the fibular tip and lateral process of the talus) was measured with PUS, and the talar tilt angle was measured with fluoroscopy (Figure1). Pearson’s and Spearman’s rank correlation was used to determine the correlation. Youden’s J statistic was used to determine the optimal cutoff values for the PUS to distinguish intact or ATFL injury versus ATFL-CFL or ATFL-CFL-PTFL injuries under various loading conditions. Results: Strong positive correlations were found between PUS and fluoroscopic measurements (Pearson correlation:r=0.78- 0.85). PUS and fluoroscopic measurements during anterior translation and talar tilt test increased as additional ligaments were transected (Spearman’s rank correlation: anterior translation; r=0.74, p < 0.001: talar tilt; r=0.81, p<0.001). Inter-rater and intra- rater reliability for PUS and fluoroscopic measurements were all excellent (ICCs >=0.8). The optimal PUS cutoff values for distinguishing intact or ATFL injury from ATFL-CFL or ATFL-CFL-PTFL injuries were >=3.40mm (sensitivity 87.5%, specificity 81.25%) and >=4.78mm (sensitivity 87.5%, specificity 81.25%) of anterior talar translation under 50N and 80N of force respectively, as well as >=3.09mm (sensitivity 75%, specificity 93.75%) of the lateral clear space under 1.7Nm of torque. Conclusion: Portable ultrasonography for the diagnosis of lateral ankle instability was strongly correlated with fluoroscopic findings, and thus, can be a valuable diagnostic tool at the point of care. We recommend future in vivo research to investigate the accuracy of this new ultrasound application in a clinical setting.

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Comparison between Absorbable and Nonabsorbable Suture Material in Modified Broström Operation

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000228 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0002

Author(s):

Chan Kang ◽

Donghun Kang ◽

Jaehwang Song ◽

Chang-Kyun Noh ◽

Ki-Jun Ahn ◽

...

Keyword(s):

Tilt Angle ◽

Suture Material ◽

Ankle Instability ◽

Tilt Test ◽

Absorbable Suture ◽

Lateral Ankle ◽

Lateral Ankle Instability ◽

Suture Group ◽

Talar Tilt

Category: Ankle, Trauma Introduction/Purpose: The current clinical standard for the surgical treatment of lateral ankle instability remains the modified Broström procedure. Almost surgeons are using non-absorbable suture material because of their strength & permanent. But this has several complications such as irritation, surface tenderness, etc. So we compare the clinical result between nonabsorbable and absorbable suture material. Methods: All patients who underwent the modified Broström operation of the anterior talofibular ligament and/or the calcaneofibular ligament by a single surgeon between July 2011 and May 2015 were included in this study. A total of 96 patients were included in this study: 63 men and 33 women (mean age, 33.16 years; range, 14-72 years). Non-absorbable suture(2-0 Fiberwire®, Arthrex, Naples, FL) patient were 50 (33 men, 17 women) and absorbable suture(0-Vicryl®, Ethicon, Sommerville, NJ) patient were 46(30 men, 16 women). Mean follow-up duration was 2.5 years (range, 1.0-4.7 years). Patients completed a subjective questionnaire. Outcomes measures included the Foot and Ankle Disability Index (FADI), American Orthopaedic Foot and Ankle Society (AOFAS) and Reoperation cases by the recurred lateral ankle instability. All data were collected prospectively and reviewed retrospectively. Results: In non-absorbable suture group, The mean talar tilt angle in preoperative talar tilt test was 14.4 and in absorbable suture group, 13.7, respectively. The mean talar tilt angle in postoperative talar tilt test was 5.3 and in absorbable suture group, 6.1, respectively. There were no significant differences between non-absorbable suture method and absorbable suture method with talar tilt angle in varus stress x-ray (P > .05). There was no significant difference in FADI (87 vs 91; P = .553), AOFAS (83 vs 87; P = .372) score between non-absorable suture method group and the absorbable suture method group. During follow up, Except of 2 patients, they were no clinical symptom. Each one patient in non-absorbable and absorbable suture group underwent revision lateral ligament surgery. Conclusion: As compared with non-absorbable suture in open modified Broström procedure, absorbable suture method produced similarly favorable outcomes.

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Demographic Predictors of Concomitant Osteochondral Lesion of the Talus in Patients With Chronic Lateral Ankle Instability

Foot & Ankle Orthopaedics ◽

10.1177/24730114211013344 ◽

2021 ◽

Vol 6 (2) ◽

pp. 247301142110133

Author(s):

Yong Sang Kim ◽

Tae Yong Kim ◽

Yong Gon Koh

Keyword(s):

Tilt Angle ◽

Ankle Instability ◽

Osteochondral Lesion ◽

Case Series ◽

Level Of Evidence ◽

Lateral Ankle ◽

Chronic Lateral Ankle Instability ◽

Female Patients ◽

Lateral Ankle Instability ◽

Talar Tilt

Background: Osteochondral lesion of the talus (OLT) is commonly found as a concomitant pathologic lesion in a large proportion of patients with chronic lateral ankle instability (CLAI). This study investigated which characteristics in a patient with CLAI increase the risk for OLT. Methods: Three hundred sixty-four patients who underwent a modified Broström operation for their CLAI were reviewed retrospectively. The characteristics of each patient and variables associated with OLTs were investigated. Statistical analyses were performed to determine the effect of each potential predictor on the incidence of OLT, and to evaluate the associations between the patient characteristics and variables associated with OLTs. Results: Patients with OLTs were more frequently female (female vs male: 63.1% vs 43.9%, P = .003). In addition, the lesion sizes were larger in female patients (female vs male: 113.9 ± 24.9 mm2 vs 100.7 ± 18.0 mm2, P = .002), and medial lesions were more common in female patients (female vs male; 93.3% vs 81.8%, P = .036). The lesion sizes were larger in patients with a wider talar tilt angle ( P < .001), and patients with a medial OLT showed a wider talar tilt angle (12.0 ± 2.0 degrees vs 10.3 ± 2.2 degrees, P = .002). Conclusion: In this CLAI patient cohort, we found female patients to be at greater risk for OLTs than male patients. Furthermore, CLAI female patients with concomitant OLT had on average a larger lesion size, more frequent OLT medial position, and were associated with wider talar tilt angles, suggesting that females had more intrinsic ankle instability than males. Level of Evidence: Level IV, retrospective case series.

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Early Outcomes of Arthroscopic Modified Brostrom Operation for Chronic Ankle Instability

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000372 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0003

Author(s):

Dong-Woo Shim ◽

Yeokgu Hwang ◽

Yoo Jung Park ◽

Jin Woo Lee

Keyword(s):

Clinical Outcomes ◽

Gold Standard ◽

Ankle Instability ◽

Lateral Ankle ◽

Vas Score ◽

Lateral Ankle Instability ◽

Talar Tilt ◽

Outcome Evaluations ◽

Modified Broström Procedure

Category: Ankle, Arthroscopy Introduction/Purpose: The gold standard for the surgical treatment of chronic lateral ankle instability is the modified Brostrom procedure. Surgery aims to re-establish ankle stability and function, without compromising ankle motion. Recently introduced all inside arthroscopic modified Brostrom procedure coincide with the goal on that aspect. The purpose of this study was to investigate the early outcomes of all inside arthroscopic modified Brostrom operation for chronic ankle instability. Methods: From January 2015 to August 2016, 30 patients were included. The visual analog scale (VAS) score, American Orthopaedic Foot & Ankle Society (AOFAS) ankle–hindfoot score, Foot and Ankle Outcome Score (FAOS), and Karlsson score were used to evaluate clinical outcomes. Anterior talar translation and talar tilt were used to evaluate radiologic outcomes. All patients had lateral ankle instability. All patients had giving way, persistent pain, and an inability to resume their preinjury activity level for more than 6 months. Clinical outcome evaluations were performed preoperatively, at 3 months and 6 months postoperatively, and at a final follow-up using the VAS score, the AOFAS ankle-hindfoot score, FAOS, and Karlsson score. Radiologic outcome evaluations were performed preoperatively and at 1 year postoperatively at final follow-up using anterior talar translation, and talar tilt angle. Results: Thirty patients (19 males and 11 females) were followed up for a mean of 11.0 (range 4 – 23) months. The VAS, AOFAS, 1 FAOS subscale (Quality-of-life) and the Karlsson scores were improved significantly at the each follow-up period of 3 month, 6 month and 1 year postoperatively. Other 4 subscales of FAOS showed no significant outcomes (Table 1). The mean anterior talar translation and talar tilt showed significant improvements from 5.8 mm (SD = 0.4) and 7.9° (SD = 1.0) to 5.3 mm (SD = 0.3) and 5.7° (SD = 0.6) at the final follow-up each (p = 0.034, p=0.034). Conclusion: The arthroscopic modified Brostrom technique could be a viable alternative to the gold-standard open modified Brostrom procedure for anatomic repair of chronic lateral ankle instability. It can yield outstanding functional and clinical outcomes without adverse effects in terms of pain.

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Use of portable ultrasonography for the diagnosis of lateral ankle instability

Journal of Orthopaedic Research® ◽

10.1002/jor.25256 ◽

2022 ◽

Author(s):

Jirawat Saengsin ◽

Rohan Bhimani ◽

Go Sato ◽

Noortje Hagemeijer ◽

Karina Mirochnik ◽

...

Keyword(s):

Ankle Instability ◽

Lateral Ankle ◽

Lateral Ankle Instability ◽

Portable Ultrasonography

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A Retrospective Chart Review to Examine Failed Modified Brostrom Procedures for Chronic Lateral Ankle Instability

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00406 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0040

Author(s):

Kaitlyn Rizzo ◽

Greggory Brandle ◽

Nicholas A. Cheney ◽

Brian C. Clark

Keyword(s):

Chart Review ◽

Ankle Instability ◽

Retrospective Chart Review ◽

Tilt Test ◽

Recurrent Instability ◽

Lateral Ankle ◽

Anterior Drawer ◽

Chronic Lateral Ankle Instability ◽

Lateral Ankle Instability ◽

Modified Broström Procedure

Category: Ankle; Other Introduction/Purpose: Recurrent ankle injuries can lead to chronic ankle instability requiring surgical stabilization. Since the anterior talofibular ligament (ATFL) is the weakest of the lateral ankle ligaments, repair is often required in cases of chronic lateral ankle instability. Damage to the calcaneofibular ligament (CFL) is less common than the ATFL, but additional repair of it in these cases may be necessary to avoid this recurrent instability. A modified Brostrom procedure has been a widely accepted surgical approach to chronic lateral ankle instability if conservative measures fail. However, cases of recurrent instability even after initial stabilization surgery can present. The purpose was to examine reasoning for and rate of revision surgeries attempting to fix chronic lateral ankle instability as it relates to the ATFL and CFL integrity. Methods: A retrospective chart review was conducted to assess outcomes of a modified Brostrom procedure to determine underlying reasoning of the need for revision surgery by utilizing results of the anterior drawer and varus tilt tests. The files of these patients were examined via electronic health records to determine the reasoning for surgery. The preoperative and postoperative results of the anterior drawer test (ADT) and varus tilt test were used to examine ATFL and CFL integrity, respectively, in addition to operative notes. Results: 172 patients met criteria having undergone a modified Brostrom dual ligament repair procedure for lateral ankle instability by a single orthopedic foot and ankle surgeon. With a 3.49% revision rate in the patient population, the only similarity found in all of the patients was the presence of a positive varus tilt test indicating the CFL was a major contributor of failed correction via the modified Brostrom procedure. One patient had a positive ADT, and one had a mildly positive ADT. These ADT and varus tests were performed at various time points in the care of the patients. The average length between surgeries was calculated to be 624.2 days. This revision rate is higher than past studies but was limited to a few years under examination. Conclusion: In conclusion, the anterior drawer and varus tilt tests are utilized to determine the integrity of the ATFL and CFL in the lateral ankle ligament complex. In failed modified Brostrom procedures examined, the positive result was consistently in the varus tilt test, indicating that the CFL is the ligament most affected in these patients requiring additional surgery. However, these physical exam tests are only one way to examine the ankle and do not take additional pathologies of the lateral ankle into account. Additional studies are needed to examine long-term outcomes of the modified Brostrom procedure and reasoning for failure.

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Comparison of Clinical Outcomes in Patients with Generalized Ligamentous Laxity and without Generalized Laxity in the Arthroscopic Modified Broström Operation for Chronic Lateral Ankle Instability

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000261 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0002

Author(s):

YoungKoo Lee ◽

Jungwoo Yoo ◽

Keon Hee Yun ◽

Ji Yong Park

Keyword(s):

Clinical Outcome ◽

Clinical Outcomes ◽

Tilt Angle ◽

Ankle Instability ◽

Lateral Ankle ◽

Chronic Lateral Ankle Instability ◽

Ligamentous Laxity ◽

Lateral Ankle Instability ◽

Talar Tilt

Category: Sports Introduction/Purpose: The arthroscopic modified Broström operation (MBO) has been developed and frequently used to treat chronic lateral ankle instability (CLAI). Clinical outcome of arthroscopic MBO was reported as good or excellent. But there were no report about comparison of clinical outcomes between patients with generalized ligamentous laxity (laxity) and without generalized ligamentous laxity (no laxity). The purpose of this study is to compare the clinical outcomes of the group with generalized ligamentous laxity and without generalized ligamentous laxity in chronic lateral ankle instability. Methods: From January 2013 to November 2015, Arthroscopic MBO was performed in 99 patients for CLAI. We retrospectively analyzed 99 consecutive patients were included in terms of inclusion criteria. All patients had giving way, persistent pain and an inability to resume one’s preinjury activity level for more than 6 months. Patients were divided into 2 groups: laxity group (24 ankles) and no laxity group (75 ankles). Evaluation was performed preoperatively and at a final follow-up a minimum of 12 months postoperatively using the American Orthopedic Foot and Ankle Society (AOFAS) hindfoot ankle score, pain Visual Analogue Scale (VAS)(0~100), and talar tilt angle. Results: In terms of radiological outcomes, the preoperatively talar tilt angle was greater in patients in laxity group than in no laxity group (p < .001). The last follow-up talar tilt angle was the same between in patients in laxity group and in no laxity group (p=0.413). But preoperative-last follow up difference was found between two groups (p=0.03). The variation from preoperative to last follow up talar tilt angle showed significant greater value in laxity group (-6.9 ± 5.2) than in no laxity group (-4.2 ± 4.2)(p=0.03). In terms of clinical outcome, last follow up AOFAS and VAS in all groups were improved than preoperative scores (27.5 ± 23.7, 24.1 ± 18.4, respectively). But preoperative-last follow up differences were not found between two groups (P=0.52). Conclusion: In terms of radiologic outcomes, there was difference outcome variation between two groups, in terms of clinical outcomes, there were no difference outcome variations between two groups. All groups achieved successful clinical and radiological last follow up outcomes even though there was difference outcome variation in talar tilt. Arthroscopic MBO should be considered as a reasonable method in patients who have chronic lateral ankle instability regardless of generalized ligamentous laxity.

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Anatomic reconstruction of anterior talofibular ligament with tibial tuberosity–patellar tendon autograft for chronic lateral ankle instability

Journal of Orthopaedic Surgery ◽

10.1177/2309499018780874 ◽

2018 ◽

Vol 26 (2) ◽

pp. 230949901878087 ◽

Cited By ~ 6

Author(s):

Can Chen ◽

Hongbin Lu ◽

Jianzhong Hu ◽

Xuqiang Qiu ◽

Xiong Li ◽

...

Keyword(s):

Bone Healing ◽

Ankle Instability ◽

Activity Level ◽

Anatomic Reconstruction ◽

Anterior Talofibular Ligament ◽

Lateral Ankle ◽

Lateral Ankle Instability ◽

Talar Tilt ◽

Tegner Activity Level

Introduction: Anatomic repair of the anterior talofibular ligament (ATFL) is challenging when the local ligamentous tissue is severely attenuated. Anatomic reconstruction of the ATFL with tibial tuberosity–patellar tendon (TT-PT) autograft is a feasible choice that can avoid the complicated tendon–bone healing and restore ankle stability. Materials and methods: From 2009 to 2015, 31 chronic lateral ankle instability (CLAI) patients (31 ankles), who had a serious injury on the ATFL only, were treated with anatomic reconstruction of ATFL with TT-PT. American orthopedic foot and ankle society ankle–hindfoot score (AHS), visual analog scale for pain score (VAS), Karlsson–Peterson score, Tegner activity level, and objective examination comprehending range of motion were used to evaluate the clinical outcomes before and after operation. Radiographically, talar tilt angles and anterior drawer were assessed in pre- and postoperative ankle stress views. Results: Among the 31 ankles, 17 ankles with single-bundle ATFL and 14 ankles with double-bundle ATFL were found at operation. At a mean follow-up of 42 months (24–82 months), all patients were satisfied with the procedure. Mean AHS significantly increased from 60.5 ± 8.2 to 93.5 ± 4.8. Mean Karlsson–Peterson score significantly increased from 55.2 ± 11.0 preoperatively to 91.2 ± 6.9 at final follow-up. Average VAS significantly decreased from 5.9 ± 1.6 preoperatively to 1.4 ± 1.0 at the latest follow-up. Mean Tegner activity level was 3.7 ± 0.9 before operation, compared with 7.0 ± 0.8 after operation. On stress radiographs, mean talar tilt angle was 17.0 ± 3.4° before operation and 3.8 ± 2.1° at the latest follow-up. In addition, mean anterior tibiotalar translation was 7.5 ± 2.2 mm before operation and 1.8 ± 1.1 mm at the latest follow-up. Conclusion: Anatomic reconstruction of the ATFL using a TT-PT autograft allows bone–bone healing in talus and tendon–tendon/periosteum healing in fibula rather than requiring tendon–bone healing, which is an alternative choice for treating CLAI caused by single ATFL insufficiency.

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All-inside Arthroscopic Modified Broström Operation for Lateral Ankle Instability with Os Subfibulare

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00292 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0029

Author(s):

Woo Jong Kim ◽

Young Koo Lee

Keyword(s):

Tilt Angle ◽

Ankle Instability ◽

Lateral Ankle ◽

Chronic Lateral Ankle Instability ◽

Lateral Ankle Instability ◽

Varus Stress ◽

Accessory Ossicle ◽

Vas Scores ◽

Talar Tilt

Category: Sports Introduction/Purpose: Os Subfibulare(OSF) is an accessory ossicle that lies at the tip of the lateral malleolus of the ankle. Patients with chronic lateral ankle instability (CLAI) have a high incidence of OSF, and there relationship implies that there is a correlation between OSF and CLAI. The all-inside arthroscopic Modified Broström Operation (MBO) has been developed for the treatment of chronic lateral ankle instability (CLAI) and the outcome was reported as good or excellent. But there were no report about comparison of the outcome between OSF and non-OSF patients with chronic lateral ankle instability treated by all-inside arthroscopic MBO. The purpose of this study was to evaluate the clinical and radiologic outcomes of the arthroscopic MBO procedure for CLAI with or without OSF. Methods: From January 2013 to september 2016, arthroscopic MBO was performed on 133 patients with CLAI. Of these, 126 ankles were evaluated for this study. Patients were divided into two groups: the OSF group (26 patients), without OSF group (100 patients). Evaluation tools included the American Orthopedic Foot and Ankle Society (AOFAS) hindfoot ankle score and pain Visual Analogue Scale (VAS) at preoperatively, 6 and 12 months postoperatively for clinical outcomes. And we also evaluated the talar tilt angle in the varus stress radiograph at preoperatively, 6 and 12 months postoperatively for radiologic outcomes. Results: There were no difference in age, sex, preoperative AOFAS hindfoot ankle scores and VAS scores and talar tilt angle between the two groups preoperatively(P >.05). And there also were no difference at the final follow-up (P >.05).The final follow-up AOFAS hindfoot ankle score and Vas in both group showed improvement compared with preoperaive values. Conclusion: There were no difference in both clinical and radiologic outcomes between OSF group and non-OSF group at a minimum 12 months follow-up. We achieved similar successful outcomes in both groups using All-inside arthroscopic MBO. Arthroscopic MBO should be considered as a reasonable alternative method in patients who have chronic lateral ankle instability regardless of the presence of OSF.

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Comparison of Mid-term Outcomes Between an Arthroscopic and an Open Modified Broström Procedure for Ankle Instability

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00318 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0031

Author(s):

Young Koo Lee ◽

SungBum Park ◽

SangWoo Lee

Keyword(s):

Ankle Instability ◽

Symptom Duration ◽

Lateral Ankle ◽

Long Term Stability ◽

Lateral Ankle Instability ◽

Vas Scores ◽

Talar Tilt ◽

Good Treatment Option ◽

American Orthopaedic

Category: Arthroscopy Introduction/Purpose: Although the short-term results of an all-inside arthroscopic Modified Broström operation (MBO) have been as satisfactory as open MBO, there is always a concern about the long-term stability of an arthroscopic MBO. The purpose of this study was to compare clinical and radiologic outcomes of all-inside arthroscopic and open MBOs at mid-term follow up. Methods: From August 2012 to July 2014, totally 87 patients underwent an arthroscopic MBO and an open MBO. Of these, we retrospectively reviewed 48 patients who had a more than 3 years follow-up period. They were divided into two groups: all-inside arthroscopic MBO goup (26 patients), open MBO group (22 patients). The American Orthopaedic Foot & Ankle Society (AOFAS) ankle–hindfoot score, visual analog scale (VAS) score, and Karlsson score were used to evaluate clinical outcomes. Anterior talar translation and talar tilt were used to evaluate radiologic outcomes. Clinical and radiologic outcome evaluations were performed preoperatively, at 12 months postoperatively, and at a final follow-up at a minimum of 36 months postoperatively. Results: Evaluations were performed for 26 ankles in the all-inside arthroscopic MBO group and 22 in the open MBO group. There was no difference in age, gender, symptom duration, preoperative AOFAS, VAS, Karlsson scores, anterior talar translation, or talar tilt between the 2 groups (all P > .05). At the final follow-up, the AOFAS, VAS, and the Karlsson scores had improved significantly in both groups (P < .001). There was no difference in the Karlsson, AOFAS, or VAS scores, anterior talar translation, or talar tilt between the 2 groups at final follow-up (all P > .05). Conclusion: There was no difference in the clinical and radiologic outcome between the all-inside arthroscopic MBO and open MBO for the treatment of lateral ankle instability at up to 3 years after surgery. An all-inside arthroscopic MBO should be a good treatment option in patients who have lateral ankle instability.

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A Retrospective Comparison of MRI and Manual Inversion Stress Radiograph Studies in the Diagnosis of Chronic Lateral Ankle Instability

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00223 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0022

Author(s):

Pearson Huggins ◽

Joseph Long ◽

Conner Yancey ◽

Adam Rabe ◽

Brent Whitehead ◽

...

Keyword(s):

Ankle Instability ◽

Acute Injury ◽

Mri Imaging ◽

Lateral Ankle ◽

Chronic Lateral Ankle Instability ◽

Stress Radiographs ◽

Stress Radiograph ◽

Lateral Ankle Instability ◽

Talar Tilt ◽

Lateral Ankle Ligaments

Category: Ankle, Sports Introduction/Purpose: Chronic lateral ankle instability (LAI) is a common cause of ankle pain. Surgical interventions have been shown to be highly effective in alleviating patient’s symptoms once conservative care has failed. Stress radiographs have not demonstrated a clear efficacy in diagnosing ankle instability. Currently, MRI is considered to be superior to stress radiographs in the available literature. Unfortunately, the literature comparing these methods is limited. The purpose of this study is to compare the results of an MRI and manual inversion stress radiographs, in order to assess the accuracy of each modality in assessing the lateral ankle ligament competence. We believe that stress radiographs may have more value in confirming chronic ankle instability than the more expensive MRI imaging. Methods: A retrospective chart review was performed between January 2016 - July 2018 for patients diagnosed with LAI. The review identified 318 cases, of which 57 met the study criteria of having both an AP manual inversion stress radiographs, assessed by the senior author, and MRI, interpreted by a musculoskeletal radiologist, occurring within 6 months of each other without an acute injury within 12 weeks of the first image. For the remaining 57 cases, the imaging was reviewed in the following manner. For the MRI studies, the report was read from the radiologist assessing the lateral ankle complex. A positive MRI was denoted as pathology being reported by the radiologist. For the manual inversion stress radiograph, measurements were made to assess the degree of talar tilt while being stressed. A positive stress radiograph was identified based on asymmetry of the ankle joint during the stress. Results: The average time between imaging studies was 7.2±7.4 weeks (range 0.5-24 weeks). Of the 57 cases that qualified for the study, 43 (75%) had a positive stress radiograph, and 21(37%) had a positive MRI. 24 cases (42%) demonstrated a positive stress radiograph with a negative MRI, while 2 cases (4%) demonstrated a negative stress radiograph with a positive MRI. In respect to talar tilt, those patients identified as having a positive stress radiograph also had a higher average talar tilt when compared to those who did not. The degree of talar tilt for each set of criteria is summarized in Table 1. Conclusion: Historically, lateral ankle instability has been a clinical diagnosis. When further imaging is needed, our data suggests stress radiographs may demonstrate a higher reliability than MRI when assessing the competence of the lateral ankle ligaments. Asymmetry in a joint during an inversion stress examination has been shown to be indicative of multi ligament involvement. Few studies have attempted to define a talar tilt consistent with instability and our data does not meet those numbers. However, with the addition of bundled care and rising health care costs, we believe this provides a potential alternative in confirming a diagnosis of ankle instability.

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