title: Intra-articular lesions in chronic lateral ankle instability: comparison of arthroscopy with magnetic resonance imaging findings.
abstract: BACKGROUND
  Chronic lateral ankle instability often accompanies intra-articular lesions, and arthroscopy is often useful in diagnosis and treatment of intra-articular lesions.
  
  
  METHODS
  Preoperative magnetic resonance imaging (MRI) examinations and arthroscopic findings were reviewed retrospectively and compared in 65 patients who underwent surgery for chronic lateral ankle instability from January 2006 to January 2010. MR images obtained were assessed by two radiologists, and the inter- and intra-observer reliability was calculated. American Orthopedic Foot and Ankle Society (AOFAS) and visual analogue scale (VAS) scores were evaluated.
  
  
  RESULTS
  Abnormalities of the anterior talofibular ligament (ATFL) were found in all 65 (100%) cases. In arthroscopy examinations, 33 (51%) cases had talar cartilage lesions, and 3 (5%) cases had 'tram-track' cartilage lesion. Additionally, 39 (60%) cases of synovitis, 9 (14%) cases of anterior impingement syndrome caused by osteophyte, 14 (22%) cases of impingement syndrome caused by fibrotic band and tissue were found. Sensitivity of MRI examination for each abnormality was: ATFL, 60%; osteochondral lesion of talus (OLT), 46%; syndesmosis injury, 21%; synovitis, 21%; anterior impingement syndrome caused by osteophyte, 22%. Paired intra-observer reliability was measured by a kappa statistic of 0.787 (95% confidence interval [CI], 0.641 to 0.864) for ATFL injury, 0.818 (95% CI, 0.743 to 0.908) for OLT, 0.713 (95% CI, 0.605 to 0.821) for synovitis, and 0.739 (95% CI, 0.642 to 0.817) for impingement. Paired inter-observer reliability was measured by a kappa statistic of 0.381 (95% CI, 0.241 to 0.463) for ATFL injury, 0.613 (95% CI, 0.541 to 0.721) for OLT, 0.324 (95% CI, 0.217 to 0.441) for synovitis, and 0.394 (95% CI, 0.249 to 0.471) for impingement. Mean AOFAS score increased from 64.5 to 87.92 (p < 0.001) when there was no intra-articular lesion, from 61.07 to 89.04 (p < 0.001) in patients who had one intra-articular lesion, and from 61.12 to 87.6 (p < 0.001) in patients who had more than two intra-articular lesions.
  
  
  CONCLUSIONS
  Although intra-articular lesion in patients with chronic lateral ankle instability is usually diagnosed with MRI, its sensitivity and inter-observer reliability are low. Therefore, arthroscopic examination is strongly recommended because it improved patients' residual symptoms and significantly increased patient satisfaction.
authors.affiliation: Department of Orthopaedic Surgery, Myongji Hospital, Kwandong University College of Medicine, Goyang, Korea. bladeplate@hanmail.net
authors.forename: Seung Do
authors.initials: SD
authors.lastname: Cha
authors.forename: Hyoung Soo
authors.initials: HS
authors.lastname: Kim
authors.forename: Soo Tai
authors.initials: ST
authors.lastname: Chung
authors.forename: Jeong Hyun
authors.initials: JH
authors.lastname: Yoo
authors.forename: Jai Hyung
authors.initials: JH
authors.lastname: Park
authors.forename: Joo Hak
authors.initials: JH
authors.lastname: Kim
authors.forename: Jae Won
authors.initials: JW
authors.lastname: Hyung
mesh_terms: D000843:Ankle Joint / Q000473:pathology* / Q000503:physiopathology*; D001182:Arthroscopy / Q000379:methods; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007592:Joint Diseases / Q000175:diagnosis* / Q000473:pathology; D007593:Joint Instability / Q000175:diagnosis* / Q000473:pathology; D017844:Lateral Ligament, Ankle / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D015588:Observer Variation; D010147:Pain Measurement; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013585:Synovitis / Q000473:pathology