ABSTRACT
OBJECTIVE: To evaluate the prevalence of deltoid ligament and distal tibiofibular syndesmosis injury on 3T magnetic resonance imaging (MRI) in patients with chronic lateral ankle instability (CLAI). MATERIALS AND METHODS: Fifty patients (mean age, 35 years) who had undergone preoperative 3T MRI and surgical treatment for CLAI were enrolled. The prevalence of deltoid ligament and syndesmosis injury were assessed. The complexity of lateral collateral ligament complex (LCLC) injury was correlated with prevalence of deltoid or syndesmosis injuries. The diagnostic accuracy of ankle ligament imaging at 3T MRI was analyzed using arthroscopy as a reference standard. RESULTS: On MRI, deltoid ligament injury was identified in 18 (36%) patients as follows: superficial ligament alone, 9 (50%); deep ligament alone 2 (11%); and both ligaments 7 (39%). Syndesmosis abnormality was found in 21 (42%) patients as follows: anterior inferior tibiofibular ligament (AITFL) alone, 19 (90%); and AITFL and interosseous ligament, 2 (10%). There was no correlation between LCLC injury complexity and the prevalence of an accompanying deltoid or syndesmosis injury on both MRI and arthroscopic findings. MRI sensitivity and specificity for detection of deltoid ligament injury were 84% and 93.5%, and those for detection of syndesmosis injury were 91% and 100%, respectively. CONCLUSION: Deltoid ligament or syndesmosis injuries were common in patients undergoing surgery for CLAI, regardless of the LCLC injury complexity. 3T MRI is helpful for the detection of all types of ankle ligament injury. Therefore, careful interpretation of pre-operative MRI is essential.
Subject(s)
Adolescent , Adult , Female , Humans , Male , Middle Aged , Young Adult , Ankle Injuries/pathology , Ankle Joint/diagnostic imaging , Arthroscopy , Chronic Disease , Joint Instability/pathology , Ligaments, Articular/pathology , Magnetic Resonance ImagingABSTRACT
A sprained ankle is a common musculoskeletal sports injury and it is often treated by immobilization of the joint. Despite the beneficial effects of this therapeutic measure, the high prevalence of residual symptoms affects the quality of life, and remobilization of the joint can reverse this situation. The aim of this study was to analyze the effects of immobilization and remobilization on the ankle joint of Wistar rats. Eighteen male rats had their right hindlimb immobilized for 15 days, and were divided into the following groups: G1, immobilized; G2, remobilized freely for 14 days; and G3, remobilized by swimming and jumping in water for 14 days, performed on alternate days, with progression of time and a series of exercises. The contralateral limb was the control. After the experimental period, the ankle joints were processed for microscopic analysis. Histomorphometry did not show any significant differences between the control and immobilized/remobilized groups and members, in terms of number of chondrocytes and thickness of the articular cartilage of the tibia and talus. Morphological analysis of animals from G1 showed significant degenerative lesions in the talus, such as exposure of the subchondral bone, flocculation, and cracks between the anterior and mid-regions of the articular cartilage and the synovial membrane. Remobilization by therapeutic exercise in water led to recovery in the articular cartilage and synovial membrane of the ankle joint when compared with free remobilization, and it was shown to be an effective therapeutic measure in the recovery of the ankle joint.
Subject(s)
Animals , Male , Ankle Injuries/pathology , Cartilage, Articular/pathology , Immobilization/adverse effects , Synovial Membrane/pathology , Ankle Injuries/therapy , Body Weight , Cartilage, Articular/growth & development , Chondrocytes/cytology , Early Ambulation , Rats, Wistar , Sprains and Strains/therapy , Swimming/physiology , Time Factors , Tarsal Joints/pathology , Weight LossABSTRACT
El Os trigonum (OT) y el Proceso de Stieda (PS), corresponden a la osificación separada o extensiva del tubérculo lateral de la cara posterior del talus (TA), respectivamente. Son indicados como factores causales del Síndrome del Impacto Posterior del Tobillo (SIPT), disturbio, agudo o crónico, con dolor en la región posterior del tobillo a los movimientos del pie. El objetivo fue analizar la importancia morfológica de la presencia del OT y/o PS y su posible relación con el SIPT. Fueron utilizados 80 TA secos. La morfometría del TA y del Tubérculo Lateral del TA (TL) fueron calculadas y expresas como: LTA = largo total del TA; ATA = ancho total del TA; LTL/LPS = largo total de TL/PS; ETL = espesor total de TL/PS. Los análisis mostraron valores de LTA: 55,22 (+/-4,16) mm; ATA: 39,51 (+/-2,46) mm; LTL/LPS: 8,06 mm (+/-2,14) y ETL: 8,46 (+/-1,01) mm. Nuestros resultados ofrecen informaciones no encontradas en la literatura especializada y ayudan en el diagnóstico y tratamiento del SIPT.
Os Trigonum (OT) and Stieda Process (SP), separate or extensive ossification of the lateral tubercule of posterior face of Talus (TA), respectively, are indicative of causal factors of the Posterior Impingement Syndrome of The Ankle (PISA) - disturbance, sharp or chronic pain, with pain in the posterior region of the ankle caused by foot movements. The objective of this study was to analyze the morphological importance of the presence of OT and or SP and the possible relationship with PISA for which we used 80 dry TA. The morphometry of TA and Lateral Tubercule of TA (LT) were calculated and expressed as mean: LTA= total length of TA; WTA= total width of TA; LLT/LPS= total length of LT/SP; TLT= total thickness of LT/SP. The measures were LTA: 55.22 (+/-4.16) mm; WTA: 39.51 (+/-2.46) mm; LLT/LPS: 8.06 (+/-2.14) mm; TLT: 8.46 (+/-1.01) mm. Our results provide useful information not found in the specialized literature and are of assistance in the diagnosis and treatment of PISA.
Subject(s)
Humans , Talus , Ankle Injuries/pathology , Ankle Joint/pathology , SyndromeABSTRACT
A síndrome do impacto do tornozelo é uma condição dolorosa causada por atrito de tecidos articulares, que é tanto causa quanto consequência de uma biomecânica alterada desta articulação. A sua principal causa são as lesões pós-traumáticas, principalmente lesões ligamentares, resultando em dor crônica no tornozelo. Do ponto de vista anatômico e clínico, estas síndromes são classificadas em: ântero-lateral, anterior, ântero-medial, póstero-medial e posterior. A ressonância magnética é um ótimo método diagnóstico para demonstrar as alterações ósseas e as partes moles dos vários tipos de impacto do tornozelo, fornecendo dados que auxiliam não só na comprovação desse diagnóstico, como na diferenciação com outras causas de dor articular. Os autores objetivam ilustrar os principais achados de ressonância magnética na síndrome do impacto do tornozelo.
Ankle impingement syndrome is a painful condition resulting from friction of joint tissues that is both cause and effect of an altered joint biomechanics. The leading causes of such condition are post-traumatic lesions, particularly the ligamentous ones, resulting in chronic ankle pain. From an anatomic and clinical point of view, these syndromes may be classified as anterolateral, anterior, anteromedial, posteromedial, and posterior. Magnetic resonance imaging is an excellent diagnostic method for demonstrating bone and soft tissue abnormalities resulting from different types of ankle impingement, providing useful data to confirm the diagnosis as well as to rule out other possible causes of joint pain. The present essay is aimed at illustrating the main magnetic resonance imaging findings in ankle impingement syndrome.