Magnetic resonance imaging characterization of individual ankle syndesmosis structures in asymptomatic and surgically treated cohorts.
OBJECTIVE
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.


METHODS
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)].


RESULTS
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 %).


CONCLUSIONS
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.


METHODS
II.
Departments of BioMedical Engineering and Imaging Research, Steadman Philippon Research Institute, 181 W. Meadow Drive, Suite 1000, Vail, CO, 81657, USA.|The Steadman Clinic, Vail, CO, USA.
Thomas O
TO
Clanton
Departments of BioMedical Engineering and Imaging Research, Steadman Philippon Research Institute, 181 W. Meadow Drive, Suite 1000, Vail, CO, 81657, USA. charles.ho@sprivail.org.|The Steadman Clinic, Vail, CO, USA. charles.ho@sprivail.org.
Charles P
CP
Ho
Departments of BioMedical Engineering and Imaging Research, Steadman Philippon Research Institute, 181 W. Meadow Drive, Suite 1000, Vail, CO, 81657, USA.
Brady T
BT
Williams
Departments of BioMedical Engineering and Imaging Research, Steadman Philippon Research Institute, 181 W. Meadow Drive, Suite 1000, Vail, CO, 81657, USA.
Rachel K
RK
Surowiec
Departments of BioMedical Engineering and Imaging Research, Steadman Philippon Research Institute, 181 W. Meadow Drive, Suite 1000, Vail, CO, 81657, USA.|The Steadman Clinic, Vail, CO, USA.
Coley C
CC
Gatlin
Departments of BioMedical Engineering and Imaging Research, Steadman Philippon Research Institute, 181 W. Meadow Drive, Suite 1000, Vail, CO, 81657, USA.|The Steadman Clinic, Vail, CO, USA.
C Thomas
CT
Haytmanek
Departments of BioMedical Engineering and Imaging Research, Steadman Philippon Research Institute, 181 W. Meadow Drive, Suite 1000, Vail, CO, 81657, USA.|The Steadman Clinic, Vail, CO, USA.
Robert F
RF
LaPrade
D000293:Adolescent; D000328:Adult; D016512:Ankle Injuries / Q000000981:diagnostic imaging* / Q000601:surgery; D000843:Ankle Joint / Q000033:anatomy & histology / Q000000981:diagnostic imaging* / Q000601:surgery; D001182:Arthroscopy; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D017844:Lateral Ligament, Ankle / Q000033:anatomy & histology / Q000000981:diagnostic imaging* / Q000293:injuries; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D055815:Young Adult
Anatomy; Arthroscopy; Diagnostics (sensitivity, specificity, NPV, PPV); Magnetic resonance imaging (MRI); Syndesmosis ligament tears