Magnetic resonance imaging characterization of individual ankle syndesmosis structures in asymptomatic and surgically treated cohorts
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Historically, syndesmosis injuries have been underdiagnosed. The purpose of this study was to characterize the 3.0-T MRI presentations of the distal tibiofibular syndesmosis and its individual structures in both asymptomatic and injured cohorts.
Ten age-matched asymptomatic volunteers were imaged to characterize the asymptomatic syndesmotic anatomy. A series of 21 consecutive patients with a pre-operative 3.0-T ankle MRI and subsequent arthroscopic evaluation for suspected syndesmotic injury were reviewed and analysed. Prospectively collected pre-operative MRI findings were correlated with arthroscopy to assess diagnostic accuracy [sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV)].
Pathology diagnosed on pre-operative MRI correlated strongly with arthroscopic findings. Syndesmotic ligament disruption was prospectively diagnosed on MRI with excellent sensitivity, specificity, PPV, NPV, and accuracy: anterior inferior tibiofibular ligament (87.5, 100, 100, 71.4, 90.5 %); posterior inferior tibiofibular ligament (N/A, 95.2, 0.0, 100, 95.2 %); and interosseous tibiofibular ligament (66.7, 86.7, 66.7, 86.7, 81.0 %).
Pre-operative 3.0-T MRI demonstrated excellent accuracy in the diagnosis of syndesmotic ligament tears and allowed for the visualization of relevant individual syndesmosis structures. Using a standard clinical ankle MRI protocol at 3.0-T, associated ligament injuries could be readily identified. Clinical implementation of optimal high-field MRI sequences in a standard clinical ankle MRI exam can aid in the diagnosis of syndesmotic injuries, augment pre-operative planning, and facilitate anatomic repair by providing additional details regarding the integrity of individual syndesmotic structures not discernible through physical examination and radiographic assessments.
Level of evidence
KeywordsSyndesmosis ligament tears Anatomy Magnetic resonance imaging (MRI) Arthroscopy Diagnostics (sensitivity, specificity, NPV, PPV)
- 4.Beumer A, Valstar ER, Garling EH, van Leeuwen WJ, Sikma W, Niesing R, Ranstam J, Swierstra BA (2003) External rotation stress imaging in syndesmotic injuries of the ankle: comparison of lateral radiography and radiostereometry in a cadaveric model. Acta Orthop Scand 74(2):201–205CrossRefPubMedGoogle Scholar
- 21.Hunt KJ, George E, Harris AH, Dragoo JL (2013) Epidemiology of syndesmosis injuries in intercollegiate football: incidence and risk factors from National Collegiate Athletic Association injury surveillance system data 2004–2005 to 2008–2009. Clin J Sport Med 23(4):278–282CrossRefPubMedGoogle Scholar
- 22.Kim S, Huh YM, Song HT, Lee SA, Lee JW, Lee JE, Chung IH, Suh JS (2007) Chronic tibiofibular syndesmosis injury of the ankle: evaluation with contrast-enhanced fat-suppressed 3D fast spoiled gradient-recalled acquisition in the steady state MR imaging. Radiology 242(1):225–235CrossRefPubMedGoogle Scholar
- 46.Zindrick MR, Hopkins DE, Knight GW (1985) The effects of lateral talar shift upon the biomechanics of the ankle joint. Orthop Trans 9:332–333Google Scholar