Skip to main content
SpringerLink
Log in

Increased ATFL–PTFL angle could be an indirect MRI sign in diagnosis of chronic ATFL injury

  • ANKLE
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Magnetic resonance imaging (MRI) has relatively low accuracy in diagnosing chronic anterior talofibular ligament (ATFL) injury. This study’s purpose was to evaluate the angle between the ATFL and posterior talofibular ligament (PTFL) as a new indirect MRI sign of chronic ATFL injury in patients with mechanical ankle instability (MAI).

Methods

This study included 200 participants: 105 patients with MAI and 95 patients seen at our institution for reasons unrelated to ankle instability. MR images of all 200 participants were reviewed. The ATFL–PTFL angle in the axial plane was measured and compared between groups. Receiver operating characteristic curves (ROC) were used to analyze ATFL–PTFL angles in participants with and without ATFL injury. The sensitivity and specificity of this method for diagnosing ATFL injury were calculated.

Results

The mean ATFL–PTFL angle was significantly larger among MAI patients than among control patients (81.5° ± 9.8° vs 75.2° ± 8.9°, respectively; P < 0.01). The area under the ROC was 0.789 (P < 0.01). The optimal cut-off point for diagnosing ATFL injury on the basis of the ATFL–PTFL angle was 79.0° (sensitivity 0.89, specificity 0.67).

Conclusion

The ATFL–PTFL angle was significantly larger among MAI patients than among those without MAI. Increased ATFL–PTFL angle offers a new indirect MRI sign for diagnosing chronic ATFL injury. The ATFL–PTFL angle can be used not only to improve the accuracy of diagnosis of chronic ATFL injury, but also to evaluate the restoration of normal ankle joint geometry after lateral ligament reconstruction.

Level of evidence

III.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Cao S, Wang C, Ma X, Wang X, Huang J, Zhang C (2018) Imaging diagnosis for chronic lateral ankle ligament injury: a systemic review with meta-analysis. J Orthop Surg Res 2018; 13:122

    Article  Google Scholar 

  2. Caputo AM, Lee JY, Spritzer CE, Easley ME, DeOrio JK, Nunley JA IInd, DeFrate LE (2009) In vivo kinematics of the tibiotalar joint after lateral ankle instability. Am J Sports Med 37:2241–2248

    Article  Google Scholar 

  3. Cho JH, Lee DH, Song HK, Bang JY, Lee KT, Park YU (2016) Value of stress ultrasound for the diagnosis of chronic ankle instability compared to manual anterior drawer test, stress radiography, magnetic resonance imaging, and arthroscopy. Knee Surg Sports Traumatol Arthrosc 24:1022–1028

    Article  Google Scholar 

  4. Elkaïm M, Thès A, Lopes R, Andrieu M, Cordier G, Molinier F, Benoist J, Colin F, Boniface O, Guillo S, Bauer T; French Arthroscopy Society (2018) Agreement between arthroscopic and imaging study findings in chronic anterior talo-fibular ligament injuries. Orthop Traumatol Surg Res. https://doi.org/10.1016/j.otsr.2018.09.008

    Article  PubMed  Google Scholar 

  5. Gentili A, Seeger LL, Yao L, Do HM (1994) Anterior cruciate ligament tear: indirect signs at MR imaging. Radiology 193:835–840

    Article  CAS  Google Scholar 

  6. Hertel J (2002) Functional anatomy, pathomechanics, and pathophysiology of lateral ankle instability. J Athl Train 37:364–375

    PubMed  PubMed Central  Google Scholar 

  7. Holmes A, Delahunt E (2009) Treatment of common deficits associated with chronic ankle instability. Sports Med 39:207–224

    Article  Google Scholar 

  8. Jolman S, Robbins J, Lewis L, Wilkes M, Ryan P (2017) Comparison of magnetic resonance imaging and stress radiographs in the evaluation of chronic lateral ankle instability. Foot Ankle Int 38:397–404

    Article  Google Scholar 

  9. Jung HG, Kim NR, Kim TH, Eom JS, Lee DO (2017) Magnetic resonance imaging and stress radiography in chronic lateral ankle instability. Foot Ankle Int 38:621–626

    Article  Google Scholar 

  10. Kanamoto T, Shiozaki Y, Tanaka Y, Yonetani Y, Horibe S (2014) The use of MRI in pre-operative evaluation of anterior talofibular ligament in chronic ankle instability. Bone Jt Res 3:241–245

    Article  CAS  Google Scholar 

  11. Kim YS, Kim YB, Kim TG, Lee SW, Park SH, Lee HJ, Choi YJ, Koh YG (2015) Reliability and validity of magnetic resonance imaging for the evaluation of the anterior talofibular ligament in patients undergoing ankle arthroscopy. Arthroscopy 31:1540–1547

    Article  Google Scholar 

  12. Kumar V, Triantafyllopoulos I, Panagopoulos A, Fitzgerald S, van Niekerk L (2007) Deficiencies of MRI in the diagnosis of chronic symptomatic lateral ankle ligament injuries. Foot Ankle Surg 13:171–176

    Article  Google Scholar 

  13. Lefevre N, Naouri JF, Bohu Y, Klouche S, Herman S (2014) Sensitivity and specificity of bell-hammer tear as an indirect sign of partial anterior cruciate ligament rupture on magnetic resonance imaging. Knee Surg Sports Traumatol Arthrosc 22:1112–1118

    Article  CAS  Google Scholar 

  14. Lee MH, Cha JG, Lee YK, Choi GC, Paik SH, Lee HK, Park SJ, Kim HJ (2012) The bright rim sign on MRI for anterior talofibular ligament injury with arthroscopic correlation. AJR Am J Roentgenol 198:885–890

    Article  Google Scholar 

  15. Li HY, Zhou RS, Hua YH, Chen SY (2017) MRI identification of the fibular and talus position in patients with mechanical ankle instability. Int J Sports Med 38:546–550

    Article  Google Scholar 

  16. McKeon PO, Hertel J (2008) Systematic review of postural control and lateral ankle instability, part II: is balance training clinically effective? J Athl Train 43:305–315

    Article  Google Scholar 

  17. Miller JR, Dunn KW, Ciliberti LJ Jr, Eldridge SW, Reed LD (2017) Diagnostic value of early magnetic resonance imaging after acute lateral ankle injury. J Foot Ankle Surg 56:1143–1146

    Article  Google Scholar 

  18. Morvan A, Klouche S, Thes A, Hardy P, Bauer T (2018) Reliability and validity of preoperative MRI for surgical decision making in chronic lateral ankle instability. Eur J Orthop Surg Traumatol 28:713–719

    Article  Google Scholar 

  19. Oae K, Takao M, Uchio Y, Ochi M (2010) Evaluation of anterior talofibular ligament injury with stress radiography, ultrasonography and MR imaging. Skelet Radiol 39:41–47

    Article  Google Scholar 

  20. O’Loughlin PF, Murawski CD, Egan C, Kennedy JG (2009) Ankle instability in sports. Phys Sportsmed 37:93–103

    Article  Google Scholar 

  21. Palle L, Reddy B, Reddy J (2010) Sensitivity and specificity of vertically oriented lateral collateral ligament as an indirect sign of anterior cruciate ligament tear on magnetic resonance imaging. Skelet Radiol 39:1123–1127

    Article  Google Scholar 

  22. Park HJ, Cha SD, Kim SS, Rho MH, Kwag HJ, Park NH, Lee SY (2012) Accuracy of MRI findings in chronic lateral ankle ligament injury: comparison with surgical findings. Clin Radiol 67:313–318

    Article  Google Scholar 

  23. Perrich KD, Goodwin DW, Hecht PJ, Cheung Y (2009) Ankle ligaments on MRI: appearance of normal and injured ligaments. AJR Am J Roentgenol 193:687–695

    Article  Google Scholar 

  24. Raheem OA, O’Brien M (2011) Anatomical review of the lateral collateral ligaments of the ankle: a cadaveric study. Anat Sci Int 86:189–193

    Article  Google Scholar 

  25. Schneck CD, Mesgarzadeh M, Bonakdarpour A, Ross GJ (1992) MR imaging of the most commonly injured ankle ligaments. Part I. Normal anatomy. Radiology 184:499–506

    Article  CAS  Google Scholar 

  26. Tan DW, Teh DJW, Chee YH (2016) Accuracy of magnetic resonance imaging in diagnosing lateral ankle ligament injuries: a comparative study with surgical findings and timings of scans. Asia Pac J Sports Med Arthrosc Rehabil Technol 7:15–20

    PubMed  PubMed Central  Google Scholar 

  27. Vassalou EE, Klontzas ME, Kouvidis GK, Matalliotaki PI, Karantanas AH (2016) Rotational knee laxity in anterior cruciate ligament deficiency: an additional secondary sign on MRI. AJR Am J Roentgenol 206:151–154

    Article  Google Scholar 

  28. Verhagen RA, de Keizer G, van Dijk CN (1995) Long-term follow-up of inversion trauma of the ankle. Arch Orthop Trauma Surg 114:92–96

    Article  CAS  Google Scholar 

  29. Witchalls J, Blanch P, Waddington G, Adams R (2012) Intrinsic functional deficits associated with increased risk of ankle injuries: a systematic review with meta-analysis. Br J Sports Med 46:515–523

    Article  Google Scholar 

Download references

Acknowledgements

This work was supported by a grant awarded to Ying-Hui Hua from the National Natural Science Foundation of China (NSFC81572209).

Funding

This study was funded by National Natural Science Foundation of China (NSFC81572209).

Author information

Author notes

  1. Hong-Yun Li and Wen-Long Li have contributed equally to this work.

Authors and Affiliations

  1. Department of Sports Medicine and Arthroscopy Surgery, Huashan Hospital, Sports Medicine Center of Fudan University, No. 12 Urumq Middle Road, Shanghai, 200040, China

    Hong-Yun Li, Shi-Yi Chen & Ying-hui Hua

  2. Department of Orthopaedics, Penglai Traditional Chinese Medicine Hospital, Yantai, 265600, Shandong, China

    Wen-Long Li

Authors
  1. Hong-Yun Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wen-Long Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shi-Yi Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ying-hui Hua
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ying-hui Hua.

Ethics declarations

Conflict of interest

The authors declare that they have no potential conflict of interest.

Ethical approval

This study was approved by the Research Ethics Committee of Huashan Hospital, Fudan University (KY2016-002).

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Li, HY., Li, WL., Chen, SY. et al. Increased ATFL–PTFL angle could be an indirect MRI sign in diagnosis of chronic ATFL injury. Knee Surg Sports Traumatol Arthrosc 28, 208–212 (2020). https://doi.org/10.1007/s00167-018-5252-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-018-5252-4

Keywords

Search

Navigation