Anterior Talofibular Ligament Thickness Research Articles

Evaluation of the Healing Status of Lateral Ankle Ligaments 6 Weeks After an Acute Ankle Sprain

We aimed to investigate whether there is clinical and MRI evidence of healing of lateral ligaments 6 weeks after acute lateral ankle sprain (LAS). We prospectively enrolled 18 participants (age 32.7 ± 7.5 years) who sustained an acute LAS and underwent conservative treatment. An ankle MRI was acquired up to 48 hours and 6 weeks following the LAS. A partial tear of the anterior talofibular ligament (ATFL) was observed in 10/18 and a complete tear in 8/18 of the patients. The calcaneofibular ligament (CFL) was partially torn in 11/18 and completely torn in 1/18 of the patients. The healing status, intensity, and thickness of the ligaments, Anterior Drawer Test (ADT), and FAOS scale were assessed. A control group (CG) was composed by 17 participants (age 40 ± 13.9 years). Six weeks after the LAS, 89% of the participants presented MRI evidence of ATFL healing. The repaired ATFL was thicker in comparison with the CG (p < .001). The cut-off of 2.5 mm for ATFL thickness in the 6th week maximized sensitivity (62.5%) and specificity (100%). CFL and PTFL presented 94% and 100% of healing signs, respectively. In the 6th week, 11/18 (61%) participants showed mild residual instability and a mean FAOS of 80 ± 11. The MRI revealed signs of the repair process in 89% of ATFL and 94% of CFL tears, 6 weeks after a moderate or severe LAS. The MRI findings were concomitant with enhancements in mechanical ankle stability and function.

Postoperative Magnetic Resonance Evaluation of Anterior Talofibular Ligament Following Arthroscopic Brostrom Procedure: Analysis and Outcomes of 40 Repairs at 12 Months

Lateral ankle sprains are one of the most common orthopedic injuries. When conservative treatment fails, surgical correction is often performed using either open or arthroscopic techniques. We hypothesize that MRI evaluation of the arthroscopic brostrom repair will show intact repair and decrease in thickness of the anterior talofibular ligament (ATFL) at 1 year, with statistically significant improvement of patient function and pain scores. Postoperative MRI was utilized at minimum 1-year follow-up to evaluate the integrity of the arthroscopic brostrom repair, as well as comparison of ATFL thickness to literature validated average thickness. A musculoskeletal fellowship trained radiologist performed all MRI reads. In addition, 3 fellowship trained foot and ankle specialists from a single institution all performed measurements of the ATFL. Surgical satisfaction using 1 to 100 scale, and Karlsson-Peterson (KP) were measured at 1 year postoperatively. In addition, pre- and postoperative Foot Function Index (FFI), American Orthopedic Foot and Ankle (AOFAS) hindfoot scores, and Visual Analog Scale (VAS) were measured using unpaired t tests. All repairs were shown to be intact at minimum 1-year follow-up via MRI evaluation, with ATFL thickness of 2.21 mm. Preoperative FFI, AOFAS, and VAS were 54.9, 46.4, and 7.1 respectively. Postoperative scores were 11.0, 91.7, and 1.3 respectively. Surgical satisfaction was 88.2, KP was 75.3. Comparison of pre- and postoperative scores (VAS, FFI, AOFAS) were shown to be statistically significant, p < .05. No significant difference in demographic data was observed at 1 year. The data from this study offers evidence that the arthroscopic brostrom repair provides patients with good outcomes as well as an intact ATFL with normal morphology at 1 year postoperatively.

Decreased Physical Activity Levels Relates To Ligament Thickness After Injury

PURPOSE: To examine thickness of the anterior talofibular ligament (ATFL) and if that thickness relates to physical activity levels one year after an ankle sprain. METHODS: Twenty college students (8 males and 12 females, age = 21.2 ± 2.4 yr., mass = 80.9 ± 21.6 kg, ht = 173.3 ± 10.6 cm) with an acute LAS and 20 healthy matched controls (8 males and 12 females, age = 21.9 ± 2.8 yr., mass = 79.1 ± 20.2 kg, ht = 172.5 ± 9.8 cm) participated in the study. ATFL thickness was measured with a LOGIQ Book (GE Healthcare, Waukesha, WI) diagnostic ultrasound. The examiner orientated the probe to view the cross sectional view of the lateral malleolus and the lateral talar articular surface cartilage and the neck of the talus. Measurements of ATFL thickness were made using ImageJ software (National Institutes of Health, Bethesda, MD). Thickness of the ATFL was measured at the midpoint of the ligament between the attachments of the lateral malleolus and talus. The main outcome measures were the thickness of the ATFL (mm) at 3 days post LAS and 1 year post LAS, and physical activity levels as measured by the IPAQ and NASA physical activity scales. RESULTS: There was a significant relationship between ATFL thickness and both the IPAQ and NASA physical activity scales. As ligament thickness increased, “average time spent performing vigorous physical activity” significantly decreased (p = .04, r2 = -.86) and “average time spent performing moderate physical activity” (p = .02, r2 = -.84) one year after injury. Subjects with a LAS also had a significant relationship with time spent walking (p = .01, r2 = -.92), and days per week where they pursued vigorous activity (p = .02, r2 = -.81) or moderate activity (p = .04 r2 = -.85) one year after their sprain. As ligament thickness increased, overall subjective physical activity scores significantly decreased. CONCLUSIONS: One year after a LAS subjects had a significant relationship with ATFL thickness and activity levels. The changes in ATFL morphology may lead to the decreased physical activity levels due to the feeling of the ankle being unstable. Future research needs to focus on early interventions to ensure proper ligament healing occurs to restore joint function after an ankle sprain.

Increased ATFL Thickness Associates To Decreased Physical Activity Levels After Acute Lateral Ankle Sprain

Lateral ankle sprains remain one of the most common orthopedic injuries. Most concerning are the number of patients that develop long term ankle instability and have decreased activity levels. Despite these problems there are limited long-term studies examining changes after an acute lateral ankle sprain (LAS). PURPOSE: To examine the post-injury thickness of the anterior talofibular ligament (ATFL) and if that thickness relates to physical activity levels one year after an ankle sprain. METHODS: Twenty college students (8 males and 12 females, age=21.2 ± 2.4yr., mass=80.9±21.6kg, ht=173.3±10.6cm) with an acute LAS and 20 healthy matched controls (8 males and 12 females, age=21.9± 2.8yr., mass=79.1±20.2kg, ht=172.5±9.8cm) participated in the study. ATFL thickness was measured with a LOGIQ Book diagnostic ultrasound. The examiner orientated the probe to visualize the cross sectional view of the lateral malleolus, lateral talar articular surface, and the neck of the talus. Once those landmarks and the ATFL were located, images were saved. Thickness of the ATFL was measured at the midpoint of the ligament between the attachments on the lateral malleolus and talus. The main outcome measures were the thickness of the ATFL (mm) at 3 days post LAS and 1 year post LAS, and physical activity levels as measured by the IPAQ and NASA physical activity scales. RESULTS: There was a significant relationship between post-injury ATFL thickness and both the IPAQ and NASA physical activity scales. As ligament thickness increased, “average time spent performing vigorous physical activity” significantly decreased (p=.04, r2=-.86) and “average time spent performing moderate physical activity” (p=.02, r2=-.84) also decreased one year after injury. As ligament thickness increased in subjects with a LAS, time spent walking (p=.01, r2=-.92), days per week where vigorous activity (p=.02, r2=-.81) or moderate activity (p=.04 r2=-.85) was pursued one year after their sprain significantly decreased. CONCLUSIONS: The changes in ATFL morphology may lead to the decreased physical activity levels by contributing to ligamentous laxity and/or perceptions of instability. Future research needs to focus on early interventions to ensure proper ligament healing occurs to restore joint function.

The role of the anterior talofibular ligament area as a morphological parameter of the chronic ankle sprain

BackgroundRepetitive microtrauma can result in a hypertrophied ATFL. Previous studies have found that the anterior talofibular ligament thickness (ATFLT) is correlated with lateral ankle sprains, ligament injuries and chronic stroke in patients, and thickened anterior talofibular ligament (ATFL) has been considered to be a major morphologic parameter of hypertrophied ATFL. However, hypertrophy is different from thickness. Thus, we devised the anterior talofibular ligament area (ATFLA) as a new morphological parameter to evaluate the hypertrophy of the whole ATFL. MethodsATFL samples were collected from 53 patients with sprain group and from 50 control subjects who underwent magnetic resonance imaging (MRI) of the ankle and revealed no evidence of lateral ankle injury. Axial T1-weighted MRI images were collected at the ankle level from all subjects. We measured the ATFLA and ATFLT at the anterior margin of the fibular malleolus to the talus bone on the MRI using a picture archiving and communications system. The ATFLA was measured as the whole cross-sectional ligament area of the ATFL that was most hypertrophied in the axial MR images. The ATFLT was measured as the thickest point between the lateral malleolus and the talus of the ankle. ResultsThe average ATFLA was 25.0 ± 6.0 mm2 in the control group and 47.1 ± 10.4 mm2 in the sprain group. The average ATFLT was 2.3 ± 0.6 mm in the control group and 3.8 ± 0.6 mm in the hypertrophied group. Patients in sprain group had significantly greater ATFLA (p < 0.001) and ATFLT (p < 0.001) than the control subjects. A Receiver Operator Characteristics curve analysis showed that the best cut-off point of the ATFLA was 34.8 mm2, with 94.3% sensitivity, 94.0% specificity, and an AUC of 0.97 (95% CI, 0.94–1.00). The optimal cut-off point of the ATFLT was 3.1 mm, with 86.8% sensitivity, 86.0% specificity, and AUC of 0.95 (95% CI, 0.92–0.99). ConclusionATFLA is a new morphological parameter for evaluating chronic ankle sprain, and may even be more sensitive than ATFLT.

Assessment of the Anterior Talofibular Ligament(ATFL) Thickness in Chronic Stroke Patients by Ultrasound

Stroke is one of the commonest diseases affecting people world-wide. Spastic equino varus foot is one of most common disabling deformities observed among hemiparesis patients. The aim of the study is to compare ATFL thickness on the affected and unaffected sides of chronic stroke patients with that of healthy individuals using ultrasonography.

Arthroscopic classification of chronic anterior talo-fibular ligament lesions in chronic ankle instability

BackgroundThe surgical treatment of chronic ankle instability (CAI) relies chiefly on anterior talo-fibular ligament (ATFL) repair (with or without augmentation) or anatomical reconstruction with a tendon graft. Arthroscopy enables not only a complete assessment and the same-stage treatment of concomitant articular lesions, but also an accurate assessment of ligament lesions. Pre-operative imaging studies (MRI, CT, US) may fail to provide sufficient detail about chronic ATFL lesions to guide the decision between repair and reconstruction. The aim of this study was to develop an arthroscopic classification of chronic ATFL lesions designed to assist in selecting the optimal surgical technique. Material and methodsSixty-nine anterior ankle arthroscopy videos recorded before surgery for CAI were studied retrospectively. ATFL dissection was performed in all patients. Based on the video analysis, five ATFL grades were identified: 0, normal ATFL thickness and tension; 1, ATFL distension with normal thickness; 2, ATFL avulsion with normal thickness; 3, thin ATFL with no resistance during the hook test; and 4, no ATFL, with a bald malleolus. Intra- and interobserver reproducibility of the arthroscopic classification of chronic ATFL lesions was evaluated by computing the kappa coefficients (κ) after assessment by two independent observers. ResultsAll 69 ATFLs were classified as abnormal (none was grade 0). Each ATFL could be matched to a grade. Intra-observer agreement was good for both observers: κ was 0.67 with 75% of agreement for one observer and 0.68 with 76% of agreement for the other observer. Inter-observer agreement was fair to good, with κ values ranging from 0.59 to 0.88 and agreement from 70% to 91%. DiscussionArthroscopic ATFL dissection is a simple procedure that provides a highly accurate assessment of ATFL lesions and mechanical resistance, focussing chiefly on the superior ATFL. Grade 1 and 2 lesions can be repaired using the Broström-Gould procedure, whereas grade 3 and 4 lesions require anatomic reconstruction with grafting. ConclusionThis arthroscopic classification of chronic ATFL lesions confirms the diagnostic role for arthroscopy in assessing the ligaments in patients with CAI. It is helpful for determining the best surgical technique for stabilising the ankle. These results must be confirmed in a larger study.

Differences Between Subtalar Instability and Lateral Ankle Instability Focusing on Subtalar Ligaments Based on Three Dimensional Isotropic Magnetic Resonance Imaging.

The purpose of this study was to assess the differences between subtalar instability (STI) and lateral ankle instability (LAI) focusing on subtalar ligaments using 3-dimensional (3D) isotropic magnetic resonance imaging (MRI). Preoperative MRIs of 10 patients with STI who failed nonoperative treatment and consequently underwent arthroscopic subtalar reconstruction were compared with preoperative MRIs of 23 patients with LAI who underwent ligament repair or reconstruction. Dimensions of anterior capsular ligament (ACL), interosseous talocalcaneal ligament (ITCL), calcaneofibular ligament (CFL), and anterior talofibular ligament (ATFL) were measured. Tears of ACL, ITCL, CFL, ATFL, cervical ligament, and inferior extensor retinaculum were analyzed. Patients with subtalar instability had significantly lower ACL thickness and width than patients with LAI (thickness: 1.48 vs 2.12 mm, P = 0.045; width: 7.30 vs 8.64 mm, P = 0.029). An ACL thickness of 1.8 mm or less had sensitivity and specificity both at 75.0%, and an ACL width of 8 mm or less had sensitivity of 75.0% and specificity of 85.0% for discriminating STI from LAI. Absence or complete tear of ACL was more frequent in patients with STI than in patients with LAI (60.0% vs 13.0%, P = 0.010). The ATFL thickness was significantly greater in patients with LAI (P = 0.001). Complete tear of ATFL was more common in patients with LAI (P = 0.008). Complete tear of CFL was common in both the STI and LAI groups without significant difference (20.0% vs 21.7%). There was no significant difference in thickness and width of ITCL and in CFL thickness. Complete tear of ITCL, cervical ligament, and inferior extensor retinaculum were rare without significant difference. In patients with STI, the ACL is thin and narrow and more commonly absent or torn compared with patients with LAI. Complete tear of ATFL was more common in patients with LAI. Complete tear of CFL was commonly encountered in both the STI and LAI groups.

Subtalar instability: imaging features of subtalar ligaments on 3D isotropic ankle MRI

BackgroundMRI analysis of subtalar ligaments in the tarsal sinus has not been well performed. We retrospectively investigated the appearance of subtalar ligaments using 3D isotropic MRI and compared imaging findings of subtalar ligaments between patients with subtalar instability (STI) and controls.MethodsPreoperative MRIs of 23 STI patients treated with arthroscopic subtalar reconstruction were compared to MRIs of 23 age- and sex-matched control subjects without STI. Thickness and width of anterior capsular ligament (ACL) and interosseous talocalcaneal ligament (ITCL) as well as thickness of calcaneofibular ligament (CFL) and anterior talofibular ligament (ATFL) were measured. Abnormalities in ACL, ITCL, CFL, ATFL, cervical ligament, and inferior extensor retinaculum were analyzed.ResultsSTI patients had significantly smaller ACL thickness and ACL width than controls (ACL thickness: 1.73 mm vs. 2.22 mm, p = 0.007; ACL width: 7.21 mm vs. 8.80 mm, p = 0.004). ACL thickness of ≤2.1 mm had a sensitivity of 66.7% and a specificity of 66.7% for diagnosis of STI. ACL width of ≤7.9 mm had a sensitivity of 80.0% and a specificity of 76.2% for the diagnosis of STI. However, thickness and width of ITCL, thickness of CFL, or thickness of ATFL was not significantly different between the two groups. Absence or complete tear of ACL was significantly more frequent in STI patients than that in controls (34.8% vs. 8.7%, p = 0.035). Complete tear of CFL and ATFL was more common in STI patients than that in controls, although the difference between the two groups was not statistically significant. Abnormalities of ITCL, cervical ligament, or inferior extensor retinaculum were not significantly different between the two groups.ConclusionsMRI features of thin or narrow ACLs may suggest STI. Absence or complete tear of ACL was significantly more common in STI patients than that in controls.