title: The use of MRI in pre-operative evaluation of anterior talofibular ligament in chronic ankle instability.
abstract: OBJECTIVE
  To evaluate the applicability of MRI for the quantitative assessment of anterior talofibular ligaments (ATFLs) in symptomatic chronic ankle instability (CAI).
  
  
  METHODS
  Between 1997 and 2010, 39 patients with symptomatic CAI underwent surgical treatment (22 male, 17 female, mean age 25.4 years (15 to 40)). In all patients, the maximum diameters of the ATFLs were measured on pre-operative T2-weighted MR images in planes parallel to the path of the ATFL. They were classified into three groups based on a previously published method with modifications: 'normal', diameter = 1.0 - 3.2 mm; 'thickened', diameter > 3.2 mm; 'thin or absent', diameter < 1.0 mm. Stress radiography was performed with the maximum manual force in inversion under general anaesthesia immediately prior to surgery. In surgery, ATFLs were macroscopically divided into two categories: 'thickened', an obvious thickened ligament and 'thin or absent'. The imaging results were compared with the macroscopic results that are considered to be of a gold standard.
  
  
  RESULTS
  Agreement was reached when comparison was made between groups, based on MRI and macroscopic findings. ATFLs were abnormal in all 39 cases and classified as ten 'thickened' and 29 'thin or absent'. As to talar tilt stress radiography, a clear cut-off angle, which would allow discrimination between 'thickened' and 'thin or absent' patients, was not identified.
  
  
  CONCLUSIONS
  MRI is valuable as a pre-operative assessment tool that can provide the quantitative information of ATFLs in patients with CAI. Cite this article Bone Joint Res 2014;3:241-5.
authors.affiliation: Osaka Rosai Hospital, Department of Rehabilitation, 1179-3, Nagasone-cho, Kita-ku, Sakai, Osaka 591-8025, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Kanamoto
authors.affiliation: Seifu Hospital, Department of Orthopedic Surgery, 1-4, Kitahanada-cho, Kita-ku, Sakai, Osaka 591-8002, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Shiozaki
authors.affiliation: Osaka Rosai Hospital, Department of Sports Orthopedics, 1179-3 Nagasone-cho, Kita-ku, Sakai, Osaka, 591-8025, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Tanaka
authors.affiliation: Osaka University Graduate School of Medicine, Department of Orthopedic Surgery, 1-1, Yamadaoka, Suita, Osaka 565-0871, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Yonetani
authors.affiliation: Osaka Prefecture University, Faculty of Comprehensive Rehabilitation, 3-7-30, Habikino, Habikino, Osaka 583-8555, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Horibe
keywords: Anterior talofibular ligament (ATFL); Chronic ankle instability (CAI); MRI; Stress radiography
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