Advertisement

Skeletal Radiology

, Volume 37, Issue 1, pp 27–33 | Cite as

MRI appearance of surgically proven abnormal accessory anterior–inferior tibiofibular ligament (Bassett’s ligament)

  • Naveen SubhasEmail author
  • Emily N. Vinson
  • R. Lee Cothran
  • James R. Santangelo
  • James A. NunleyII
  • Clyde A. Helms
Scientific Article

Abstract

Objective

A thickened accessory anterior–inferior tibiofibular ligament (Bassett’s ligament) of the ankle can be a cause of ankle impingement. Its imaging appearance is not well described. The purpose of this study was to determine if the ligament could be identified on magnetic resonance imaging (MRI), to determine associated abnormalities, and to determine if MRI could be used to differentiate normal from abnormal.

Materials and methods

Eighteen patients with a preoperative ankle MRI and an abnormal Bassett’s ligament reported at surgery were found retrospectively. A separate cohort of 18 patients was selected as a control population. The presence of Bassett’s ligament and its thickness were noted. The integrity and appearance of the lateral ankle ligaments, talar dome cartilage, and anterolateral gutter were also noted.

Results

In 34 of the 36 cases (94%), Bassett’s ligament was identified on MRI. The ligament was seen in all three imaging planes and most frequently in the axial plane. The mean thickness of the ligament in the surgically abnormal cases was 2.37 mm, compared with 1.87 mm in the control with a p value = 0.015 (t test). Nine of the 18 abnormal cases (50%) had talar dome cartilage lesions as a result of contact with the ligament at surgery, with only 3 cases of high-grade defects seen on MRI. Fourteen of the 18 abnormal cases (78%) had of synovitis or scarring in the lateral gutter at surgery, with only 5 cases with scarring seen on MRI. The anterior–inferior tibiofibular ligament was abnormal or torn in 8 of the 18 abnormal cases (44%) by MRI and confirmed in only 3 cases at surgery.

Discussion

Bassett’s ligament can be routinely identified on MRI and was significantly thicker in patients who had it resected at surgery. An abnormal Bassett’s ligament is often present in the setting of a normal anterior–inferior tibiofibular ligament. The cartilage abnormalities and synovitis associated with an abnormal Bassett’s ligament are poorly detected by conventional MRI.

Keywords

Ankle MRI Tibiofibular ligament Accessory ligament Impingement 

References

  1. 1.
    Robinson P, White LM. Soft-tissue and osseous impingement syndromes of the ankle: role of imaging in diagnosis and management. Radiographics 2002; 22: 1457–1469; discussion 1470–1471.PubMedCrossRefGoogle Scholar
  2. 2.
    Urguden M, Soyuncu Y, Ozdemir H, Sekban H, Akyildiz FF, Aydin AT. Arthroscopic treatment of anterolateral soft tissue impingement of the ankle: evaluation of factors affecting outcome. Arthroscopy 2005; 21: 317–322.PubMedCrossRefGoogle Scholar
  3. 3.
    Bassett FH III, Gates HS 3rd, Billys JB, Morris HB, Nikolaou PK. Talar impingement by the anteroinferior tibiofibular ligament. A cause of chronic pain in the ankle after inversion sprain. J Bone Joint Surg Am 1990; 72: 55–59.PubMedGoogle Scholar
  4. 4.
    Akseki D, Pinar H, Bozkurt M, Yaldiz K, Arac S. The distal fascicle of the anterior inferior tibio-fibular ligament as a cause of anterolateral ankle impingement: results of arthroscopic resection. Acta Orthop Scand 1999; 70: 478–482.PubMedCrossRefGoogle Scholar
  5. 5.
    Akseki D, Pinar H, Yaldiz K, Akseki NG, Arman C. The anterior inferior tibiofibular ligament and talar impingement: a cadaveric study. Knee Surg Sports Traumatol Arthrosc 2002; 10: 321–326.PubMedGoogle Scholar
  6. 6.
    Nikolopoulos CE, Tsirikos AI, Sourmelis S, Papachristou G. The accessory anteroinferior tibiofibular ligament as a cause of talar impingement: a cadaveric study. Am J Sports Med 2004; 32: 389–395.PubMedCrossRefGoogle Scholar
  7. 7.
    Ray RG, Kriz BM. Anterior inferior tibiofibular ligament. Variations and relationship to the talus. J Am Podiatr Med Assoc 1991; 81: 479–485.PubMedGoogle Scholar
  8. 8.
    Hauger O, Moinard M, Lasalarie JC, Chauveaux D, Diard F. Anterolateral compartment of the ankle in the lateral impingement syndrome: appearance on CT arthrography. AJR Am J Roentgenol 1999; 173: 685–690.PubMedGoogle Scholar
  9. 9.
    Duncan D, Mologne T, Hildebrand H, Stanley M, Schreckengaust R, Sitler D. The usefulness of magnetic resonance imaging in the diagnosis of anterolateral impingement of the ankle. J Foot Ankle Surg 2006; 45: 304–307.PubMedCrossRefGoogle Scholar
  10. 10.
    Farooki S, Yao L, Seeger LL. Anterolateral impingement of the ankle: effectiveness of MR imaging. Radiology 1998; 207: 357–360.PubMedGoogle Scholar
  11. 11.
    Haller J, Bernt R, Seeger T, Weissenback A, Tuchler H, Resnick D. MR-imaging of anterior tibiotalar impingement syndrome: agreement, sensitivity and specificity of MR-imaging and indirect MR-arthrography. Eur J Radiol 2006; 58: 450–460.PubMedCrossRefGoogle Scholar
  12. 12.
    Jordan LK 3rd, Helms CA, Cooperman AE, Speer KP. Magnetic resonance imaging findings in anterolateral impingement of the ankle. Skeletal Radiol 2000; 29: 34–39.PubMedCrossRefGoogle Scholar
  13. 13.
    Rubin DA, Tishkoff NW, Britton CA, Conti SF, Towers JD. Anterolateral soft-tissue impingement in the ankle: diagnosis using MR imaging. AJR Am J Roentgenol 1997; 169: 829–835.PubMedGoogle Scholar
  14. 14.
    Robinson P, White LM, Salonen DC, Daniels TR, Ogilvie-Harris D. Anterolateral ankle impingement: MR arthrographic assessment of the anterolateral recess. Radiology 2001; 221: 186–190.PubMedCrossRefGoogle Scholar

Copyright information

© ISS 2007

Authors and Affiliations

  • Naveen Subhas
    • 1
    Email author
  • Emily N. Vinson
    • 2
  • R. Lee Cothran
    • 2
  • James R. Santangelo
    • 3
  • James A. NunleyII
    • 4
  • Clyde A. Helms
    • 2
  1. 1.Department of RadiologyCleveland ClinicClevelandUSA
  2. 2.Department of RadiologyDuke University Medical CenterDurhamUSA
  3. 3.Orthopedics and RehabilitationWomack Army Medical CenterFort BraggUSA
  4. 4.Division of Orthopedic SurgeryDuke University Medical CenterDurhamUSA

Personalised recommendations