Abstract
The purposes of this study were to classify anterior talofibular ligament injuries
(ATFL), to find out the feasibility of arthroscopic ATFL repair according to injury
type and to investigate the diagnostic validity of magnetic resonance imaging (MRI)
of ATFL injuries by comparing MRI and arthroscopic findings. The 197 ankles (93 right,
104 left; 12 bilateral) of 185 patients (90 men and 107 women; mean age, 33.5 years,
range: 15–68 years) were treated by arthroscopic modified Broström procedure (MBP)
after a diagnosis of chronic lateral ankle instability (CLAI). ATFL injuries were
classified according to their grade and location (type P: partial rupture, type C1:
fibular detachment, type C2: talar detachment, type C3: midsubstance rupture, type
C4: absence of ATFL, type C5: os subfibulare). Among the 197 injured ankles, according
to ankle arthroscopy, 67 were type P (34%), 28 were type C1 (14%), 13 were type C2
(7%), 29 were type C3 (15%), 26 were type C4 (13%), and 34 were type C5 (17%). The
kappa value for the agreement between the arthroscopic findings and MRI findings was
also high (0.85; 95% CI, 0.79–0.91). Our results also supported the use of MRI for
diagnosing ATFL injuries and showed that it is an informative tool during the preoperative
period.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The Journal of Foot and Ankle SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Epidemiology of sprains of the lateral ankle ligament complex.Foot Ankle Clin. 2006; 11
- Management and rehabilitation of ligamentous injuries to the ankle.Sports Med. 1987; 4: 364
- Surgical treatment of the unstable ankle.J Am Acad Orthop Surg. 1998; 6: 368
- Sprained ankles. VI. Surgical treatment of" chronic" ligament ruptures.Acta chirurgica Scandinavica. 1966; 132: 551
- Extensor retinaculum augmentation reinforces anterior talofibular ligament repair.Clin Orthop Relat Res. 2006; 442
- Arthroscopic-assisted Broström-Gould for chronic ankle instability: a long-term follow-up.Am J Sports Med. 2011; 39: 2381
- Modified Brostrom-Evans-Gould technique for recurrent lateral ankle ligament instability.Journal of orthopaedic surgery. 2007; 15: 306
- All-inside arthroscopic lateral collateral ligament repair for ankle instability with a knotless suture anchor technique.Foot Ankle Int. 2013; 34: 1701
- Ankle Instability G. Arthroscopic anterior talofibular ligament repair for lateral instability of the ankle.Knee Surg Sports Traumatol Arthrosc. 2016; 24: 1003
- Arthroscopic repair of chronic lateral ankle instability.Foot Ankle Int. 2009; 30: 213
- Activity level and function 2 years after anterior talofibular ligament repair: a comparison between arthroscopic repair and open repair procedures.The American journal of sports medicine. 2017; 45: 2044
- Current Methods for the Evaluation of Ankle Ligament Injuries.J Bone Joint Surg Am. 1994; 76a: 1103
- Relationship between stress ankle radiographs and injured ligaments on MRI.Skeletal Radiol. 2013; 42: 1537
- MRI of the anterior talofibular ligament, talar cartilage and os subfibulare: Comparison of isotropic resolution 3D and conventional 2D T2-weighted fast spin-echo sequences at 3.0 T.Skeletal Radiol. 2016; 45: 899
- Reliability and validity of magnetic resonance imaging for the evaluation of the anterior talofibular ligament in patients undergoing ankle arthroscopy.Arthroscopy. 2015; 31: 1540
- Comparison of Magnetic Resonance Imaging and Stress Radiographs in the Evaluation of Chronic Lateral Ankle Instability.Foot Ankle Int. 2017; 38: 397
- Magnetic Resonance Imaging and Stress Radiography in Chronic Lateral Ankle Instability.Foot Ankle Int. 2017; 38: 621
- Evaluation of the anterior inferior tibiofibular and anterior talofibular ligaments using 2D oblique coronal imaging and 3D isotropic resolution T2-weighted fast spin-echo sequences at 3.0 T: Is there additional diagnostic value?.J Med Imaging Radiat Oncol. 2020; 64: 338
- Accuracy of MRI findings in chronic lateral ankle ligament injury: comparison with surgical findings.Clinical radiology. 2012; 67: 313
- Accuracy of MRI scan in the diagnosis of ligamentous and chondral pathology in the ankle.Foot and Ankle Surgery. 2010; 16: 78
- Reliability and validity of preoperative MRI for surgical decision making in chronic lateral ankle instability.European Journal of Orthopaedic Surgery & Traumatology. 2018; 28: 713
- The use of MRI in pre-operative evaluation of anterior talofibular ligament in chronic ankle instability.Bone & joint research. 2014; 3: 241
- An ultrasound classification of anterior talofibular ligament (ATFL) injury.Open Orthop J. 2017; 11: 610
- A new classification of anterior talofibular ligament injuries based on ultrasonography findings.J Orthop Sci. 2016; 21: 770
- Ankle microinstability: arthroscopic findings reveal four types of lesion to the anterior talofibular ligament's superior fascicle.Knee Surg Sports Traumatol Arthrosc. 2021; 29: 1294
- Comparison of All-Inside Arthroscopic and Open Techniques for the Modified Brostrom Procedure for Ankle Instability.Foot Ankle Int. 2016; 37: 1037
- MRI appearance of the lateral fibulotalocalcaneal ligament complex injury in the patients with chronic lateral ankle instability.Foot Ankle Surg. 2022;
- Standard nomenclature of athletic injuries.AMA. 1966;
- A coefficient of agreement for nominal scales.Educational and psychological measurement. 1960; 20: 37
- The measurement of observer agreement for categorical data.Biometrics. 1977; 33: 159
- Activity level and function 2 years after anterior talofibular ligament repair: A comparison between arthroscopic repair and open repair procedures.Am J Sports Med. 2017; 45: 2044
- Rigby RB. The "all inside" arthroscopic Broström procedure: a prospective study of 40 consecutive patients.J Foot Ankle Surg. 2013; 52: 568
- Arthroscopic suture anchor repair of the lateral ligament ankle complex: a cadaveric study.Am J Sports Med. 2013; 41: 2567
- Arthroscopic anterior talofibular ligament repair for chronic ankle instability with a suture anchor technique.Orthopedics. 2011; 34: 273
- Arthroscopic lateral ankle ligament reconstruction.Techniques in Foot & Ankle Surgery. 2011; 10: 111
- Functional instability following lateral ankle sprain.Sports medicine. 2000; 29: 361
- Generalized ligamentous laxity is an independent predictor of poor outcomes after the modified Broström procedure for chronic lateral ankle instability.The American Journal of Sports Medicine. 2016; 44: 2975
- Comparison of outcomes in patients with generalized ligamentous laxity and without generalized laxity in the arthroscopic modified Broström operation for chronic lateral ankle instability.Foot Ankle Int. 2017; 38: 1318
- The signal intensity of preoperative magnetic resonance imaging has predictive value for determining the arthroscopic reparability of the anterior talofibular ligament.Knee Surg Sports Traumatol Arthrosc. 2020;
Article info
Publication history
Publication stage
In Press Accepted ManuscriptIdentification
Copyright
Published by Elsevier Inc. on behalf of the American College of Foot and Ankle Surgeons.
