Chronic ankle instability: a cadaveric anatomical and 3D high-resolution MRI study for surgical reconstruction procedures.

IF 4.1 2区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Insights into Imaging Pub Date : 2024-10-14 DOI:10.1186/s13244-024-01824-3

Meng Dai, Hu Zhao, Peng Sun, Jiazheng Wang, Caixia Kong, Xiaoming Liu, Deyu Duan, Xi Liu

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引用次数: 0

Abstract

Objectives: To quantitatively investigate the anatomy of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) for surgical reconstruction procedures in chronic ankle instability (CAI).

Methods: 3D MRI was performed on five fresh-frozen cadaveric ankles using six different spatial resolutions (0.3 × 0.3 × 0.3 mm³, 0.45 × 0.45 × 0.45 mm³, 0.6 × 0.6 × 0.6 mm³, 0.75 × 0.75 × 0.75 mm³, 0.9 × 0.9 × 0.9 mm³, 1.05 × 1.05 × 1.05 mm³). After comparing the MRI results with cadaver dissection, a resolution of 0.45 × 0.45 × 0.45 mm³ was selected for bilateral ankles MRI on 24 volunteers. Classification of the ATFL and four distances of surgically relevant bony landmarkers were analyzed (distance 1 and 3, the fibular origin of the ATFL and CFL to the tip of fibula, respectively; distance 2, the talar insertion of the ATFL to the bare zone of talus; distance 4, the calcaneal insertion of the CFL to the peroneal tubercle).

Results: In subjective evaluation, the interobserver ICC was 0.95 (95% confidence interval (CI): 0.94-0.97) between two readers. The spatial resolution of 0.3 × 0.3 × 0.3 mm³ and 0.45 × 0.45 × 0.45 mm³ received highest subjective score on average and demonstrated highest consistency with autopsy measurements in objective evaluation. Measurements on the 48 volunteer ankles, distance 1 in type I and II were 12.65 ± 2.08 mm, 13.43 ± 2.06 mm (superior-banded in Type II) and 7.69 ± 2.56 mm (inferior-banded in Type II) (means ± SD), respectively. Distance 2 in type I and II were 10.90 ± 2.24 mm, 11.07 ± 2.66 mm (superior-banded in Type II), and 18.44 ± 3.28 mm (inferior-banded in Type II), respectively. Distance 3 and 4 were 4.71 ± 1.04 mm and 14.35 ± 2.22 mm, respectively.

Conclusion: We demonstrated the feasibility of quantifying the distances between bony landmarkers for surgical reconstruction surgery in CAI using high-resolution 3D MRI.

Critical relevance statement: High-resolution 3D MRI examination may have a guiding effect on the preoperative evaluation of chronic ankle instability patients.

Key points: Spatial resolutions of 0.3 × 0.3 × 0.3 mm³ and 0.45 × 0.45 × 0.45 mm³ demonstrated highest consistency with autopsy measurements. The spatial resolution of 0.45 × 0.45 × 0.45 mm³ was conformed more to clinical needs. 3D MRI can assist surgeons in developing preoperative plans for chronic ankle instability.

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慢性踝关节不稳：用于手术重建程序的尸体解剖和三维高分辨率磁共振成像研究。

目的定量研究距腓前韧带（ATFL）和小方腓韧带（CFL）的解剖结构，以用于慢性踝关节不稳定（CAI）的手术重建。方法：使用六种不同的空间分辨率（0.3 × 0.3 × 0.3 mm3、0.45 × 0.45 × 0.45 mm3、0.6 × 0.6 × 0.6 mm3、0.75 × 0.75 × 0.75 mm3、0.9 × 0.9 × 0.9 mm3、1.05 × 1.05 × 1.05 mm3）对五只新鲜冷冻的尸体踝关节进行三维核磁共振成像。将核磁共振成像结果与尸体解剖结果进行比较后，选择 0.45 × 0.45 × 0.45 mm³ 的分辨率对 24 名志愿者的双侧脚踝进行核磁共振成像。分析了ATFL的分类和四个手术相关骨性标志物的距离（距离1和3，分别为ATFL和CFL的腓骨起源到腓骨尖；距离2，ATFL的距骨插入到距骨裸露区；距离4，CFL的小腿插入到腓骨结节）：结果：在主观评价中，两名读者的观察者间 ICC 为 0.95（95% 置信区间 (CI)：0.94-0.97）。0.3 × 0.3 × 0.3 mm3 和 0.45 × 0.45 × 0.45 mm3 的空间分辨率平均主观得分最高，客观评价中与尸检测量结果的一致性最高。对 48 名志愿者脚踝的测量结果显示，I 型和 II 型的距离 1 分别为 12.65 ± 2.08 毫米、13.43 ± 2.06 毫米（II 型为上带状）和 7.69 ± 2.56 毫米（II 型为下带状）（均值 ± 标度）。I 型和 II 型的距离 2 分别为 10.90 ± 2.24 毫米、11.07 ± 2.66 毫米（II 型为上带式）和 18.44 ± 3.28 毫米（II 型为下带式）。距离 3 和 4 分别为 4.71 ± 1.04 毫米和 14.35 ± 2.22 毫米：我们证明了使用高分辨率三维核磁共振成像量化 CAI 骨性标志物之间的距离用于外科重建手术的可行性：高分辨率三维磁共振成像检查可能对慢性踝关节不稳患者的术前评估具有指导作用：0.3 × 0.3 × 0.3 mm3 和 0.45 × 0.45 × 0.45 mm3 的空间分辨率与尸检测量结果的一致性最高。0.45 × 0.45 × 0.45 mm3的空间分辨率更符合临床需要。三维核磁共振成像可帮助外科医生制定慢性踝关节不稳的术前计划。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Insights into Imaging Medicine-Radiology, Nuclear Medicine and Imaging

CiteScore

7.30

自引率

4.30%

发文量

182

审稿时长

13 weeks

期刊介绍： Insights into Imaging (I³) is a peer-reviewed open access journal published under the brand SpringerOpen. All content published in the journal is freely available online to anyone, anywhere! I³ continuously updates scientific knowledge and progress in best-practice standards in radiology through the publication of original articles and state-of-the-art reviews and opinions, along with recommendations and statements from the leading radiological societies in Europe. Founded by the European Society of Radiology (ESR), I³ creates a platform for educational material, guidelines and recommendations, and a forum for topics of controversy. A balanced combination of review articles, original papers, short communications from European radiological congresses and information on society matters makes I³ an indispensable source for current information in this field. I³ is owned by the ESR, however authors retain copyright to their article according to the Creative Commons Attribution License (see Copyright and License Agreement). All articles can be read, redistributed and reused for free, as long as the author of the original work is cited properly. The open access fees (article-processing charges) for this journal are kindly sponsored by ESR for all Members. The journal went open access in 2012, which means that all articles published since then are freely available online.