Routine 2D MRI identifies the anterior talofibular ligament fascicles and lateral fibulotalocalcaneal ligament complex with moderate to substantial interobserver reliability

IF 3.3 2区医学 Q1 ORTHOPEDICS

Knee Surgery, Sports Traumatology, Arthroscopy Pub Date : 2025-03-03 DOI:10.1002/ksa.12642

Choon Chiet Hong, James Thomas Patrick Decourcy Hallinan, Eugene Tze Chun Lau, Miki Dalmau-Pastor, James Calder, Gino M. M. J. Kerkhoffs, Shuliang Ge

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引用次数: 0

Abstract

Purpose

The anterior talofibular ligament (ATFL) consists of two fascicles, with the intra-articular superior fascicle and extra-articular inferior fascicle connected to the calcaneofibular ligament (CFL) via the arciform fibres, forming the lateral fibulotalocalcaneal ligament (LFTCL) complex. Accurate identification of which fascicles have been injured is useful for determining the optimal treatment of patients with lateral ligament injuries. There is a lack of imaging studies demonstrating the distinctive anatomy of these important structures on magnetic resonance imaging (MRI). Hence, the aim of this pilot study is to investigate interobserver reliability in identifying the fascicles of the ATFL and LFTCL complex on routine two-dimensional (2D) MRI scans.

Methods

This is a single-centre review of 100 consecutive routine 2D MRI ankles performed in our institution for reasons other than ankle sprain. The ATFL fascicles and LFTCL complex were independently reviewed by three clinicians, and interobserver reliability was analysed using Fleiss kappa.

Results

There were 46 males, and the average age was 47.7 years. In terms of the interobserver reliability, there was a substantial level of agreement in determining the number of fascicles for the ATFL (k = 0.688, p < 0.001, 95% confidence interval [CI]: 0.575–0.801) which was similar to the CFL (k = 0.747, p < 0.001, 95% CI: 0.633–0.860) while the arciform fibres had a moderate level of agreement (k = 0.489, p < 0.001, 95% CI: 0.377–0.603). There were 54 MRI scans with bifascicular ATFL, while the rest had a single inferior ATFL fascicle. The LFTCL complex was identified in 99 scans. No differences were noted in age, gender or MRI strength in the ability to visualize these structures on routine 2D MRI scans.

Conclusion

Routine 2D MRI can reliably identify the fascicles of the ATFL and LFTCL complex with moderate to substantial levels of agreement. This can help clinicians enhance their diagnostic accuracy and refine treatment strategies without relying on complex or costly imaging techniques.

Level of Evidence

Level III.

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常规二维MRI识别前距腓骨韧带束和外侧腓骨距跟韧带复合体，在观察者间具有中度至高度的可靠性。

目的：距腓骨前韧带（ATFL）由两个束组成，其中关节内上束和关节外下束通过弓形纤维与跟腓骨韧带（CFL）相连，形成外侧腓骨距骨韧带（LFTCL）复合体。准确识别哪些肌束已经受伤是有用的，以确定最佳治疗的患者外侧韧带损伤。在磁共振成像（MRI）上，缺乏成像研究证明这些重要结构的独特解剖。因此，本初步研究的目的是研究在常规二维（2D） MRI扫描中识别ATFL和LFTCL复合物束的观察者间可靠性。方法：这是一项单中心研究，对我院因踝关节扭伤以外的原因连续进行的100例常规2D MRI踝关节进行回顾性分析。ATFL束和LFTCL复合体由三位临床医生独立评估，并使用Fleiss kappa分析观察者间的可靠性。结果：男性46例，平均年龄47.7岁。在观察者之间的可靠性方面，在确定ATFL的束束数量方面存在相当程度的一致性（k = 0.688, p）。结论：常规二维MRI可以可靠地识别ATFL和LFTCL复合物的束束，具有中等到相当程度的一致性。这可以帮助临床医生提高他们的诊断准确性和完善治疗策略，而无需依赖复杂或昂贵的成像技术。证据等级：三级。

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

Knee Surgery, Sports Traumatology, Arthroscopy 医学-外科

CiteScore

8.10

自引率

18.40%

发文量

418

审稿时长

2 months

期刊介绍： Few other areas of orthopedic surgery and traumatology have undergone such a dramatic evolution in the last 10 years as knee surgery, arthroscopy and sports traumatology. Ranked among the top 33% of journals in both Orthopedics and Sports Sciences, the goal of this European journal is to publish papers about innovative knee surgery, sports trauma surgery and arthroscopy. Each issue features a series of peer-reviewed articles that deal with diagnosis and management and with basic research. Each issue also contains at least one review article about an important clinical problem. Case presentations or short notes about technical innovations are also accepted for publication. The articles cover all aspects of knee surgery and all types of sports trauma; in addition, epidemiology, diagnosis, treatment and prevention, and all types of arthroscopy (not only the knee but also the shoulder, elbow, wrist, hip, ankle, etc.) are addressed. Articles on new diagnostic techniques such as MRI and ultrasound and high-quality articles about the biomechanics of joints, muscles and tendons are included. Although this is largely a clinical journal, it is also open to basic research with clinical relevance. Because the journal is supported by a distinguished European Editorial Board, assisted by an international Advisory Board, you can be assured that the journal maintains the highest standards. Official Clinical Journal of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA).