title: Anatomic Relationship and Imaging Relevance of the Perforating Branches of the Peroneal Vessels to the Anterior Talofibular Ligament.
abstract: BACKGROUND
  Patients frequently present to the emergency department after ankle injuries, and the anterior talofibular ligament (ATFL) is commonly damaged. Musculoskeletal ultrasound (US) can help to make a rapid diagnosis. There is a paucity of literature describing techniques to image the ATFL with US, and the complex ankle anatomy and potential pitfalls make imaging challenging.
  
  
  OBJECTIVE
  Our aim was to estimate prevalence of perforating branches (PBs) of the peroneal vessels and determine their most frequent position relative to the ATFL. If these vessels are located in a predictable position at the level of the ATFL, they may serve as a sonographic landmark for the correct imaging plane.
  
  
  METHODS
  Magnetic resonance imaging (MRI) scans of 105 ankles were reviewed to determine the PB prevalence and location at the ATFL. Inter-observer agreement was determined. Additionally, 16 ankles from 8 asymptomatic subjects were scanned using a high-frequency linear transducer and PB prevalence and location were noted.
  
  
  RESULTS
  By MRI, PBs were detected in 85% of the ankles and 93% of ankles after consensus. In 73% of cases with agreed PB visualization, vessels assumed a medial position with respect to the ATFL. By US, PBs could be seen in 100% of cases, with the arterial PB seen in 81% of cases and assuming a medial position in 88%.
  
  
  CONCLUSIONS
  PBs are often present, have a predictable course, and may be useful to help optimize US probe positioning when assessing the ATFL.
authors.affiliation: Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia.
authors.forename: Yara
authors.initials: Y
authors.lastname: Younan
authors.affiliation: Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia.
authors.forename: Matthew
authors.initials: M
authors.lastname: Uriell
authors.affiliation: Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia.
authors.forename: Walter
authors.initials: W
authors.lastname: Carpenter
authors.affiliation: Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia.
authors.forename: Monica
authors.initials: M
authors.lastname: Umpierrez
authors.affiliation: Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia.
authors.forename: Aparna
authors.initials: A
authors.lastname: Kakarala
authors.affiliation: Department of Radiology, University of Miami, Miami, Florida.
authors.forename: Jean
authors.initials: J
authors.lastname: Jose
authors.affiliation: Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia.
authors.forename: Douglas D
authors.initials: DD
authors.lastname: Robertson
authors.affiliation: Department of Radiology, University of Miami, Miami, Florida.
authors.forename: Ty K
authors.initials: TK
authors.lastname: Subhawong
authors.affiliation: Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia.
authors.forename: Adam Daniel
authors.initials: AD
authors.lastname: Singer
mesh_terms: D000328:Adult; D016512:Ankle Injuries / Q000175:diagnosis* / Q000453:epidemiology; D000843:Ankle Joint / Q000002:abnormalities / Q000033:anatomy & histology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D015995:Prevalence; D012189:Retrospective Studies; D014463:Ultrasonography / Q000379:methods* / Q000706:statistics & numerical data
keywords: ATFL; MRI; anterior talofibular ligament; artery; emergency medicine; peroneal; radiology; ultrasound