Suscribirse

Agreement between arthroscopic and imaging study findings in chronic anterior talo-fibular ligament injuries - 14/11/18

Doi : 10.1016/j.otsr.2018.09.008 
Marc Elkaïm a, André Thès b, c, Ronny Lopes d, Michael Andrieu e, Guillaume Cordier f, François Molinier g, Jonathan Benoist h, Fabrice Colin i, Olivier Boniface k, Stéphane Guillo f, Thomas Bauer b,

French Arthroscopic Societyj

a Clinique de Tournan, 2, rue Jules-Lefebvre, 77220 Tournan-en-Brie, France 
b Service de chirurgie orthopédique et traumatologique, CHU Ambroise-Paré, AP–HP, groupe hospitalier universitaire Paris Île-de-France Ouest, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France 
c Hôpital privé d’Eure-et-Loir, 2, rue Roland-Buthier, 28300 Mainvilliers, France 
d PCNA, polyclinique de l’Atlantique, avenue Claude-Bernard, 44800 Saint-Herblain, France 
e Clinique Pont-de-Chaume, 330, avenue Marcel-Unal, 82000 Montauban, France 
f Clinique du sport Bordeaux-Mérignac, 2, rue Georges-Negrevergne, 33700 Mérignac, France 
g Clinique des Cèdres, route de Mondonville, 31700 Cornebarrieu, France 
h CHP Saint-Grégoire, 7, boulevard de la Boutière, 35760 Saint-Grégoire, France 
i Clinique mutualiste catalane, 60, rue Louis-Mouillard, 66000 Perpignan, France 
j 15, rue Ampère, 92500 Rueil Malmaison, France 
k Clinique Générale Annecy, 4, chemin de la Tour-la-Reine, 74000 Annecy, France 

Corresponding author.

Bienvenido a EM-consulte, la referencia de los profesionales de la salud.
Artículo gratuito.

Conéctese para beneficiarse!

Abstract

Background

Imaging studies done to evaluate chronic ankle instability (CAI) often fail to accurately detail injuries to the anterior talo-fibular ligament (ATFL) and may, therefore, also fail to provide guidance for selecting the most appropriate surgical procedure. Arthroscopy is now an indispensable tool for accurately diagnosing ATFL injuries. This study looked at agreement between arthroscopy and imaging study assessments of ATFL injuries. The primary objective was to adapt an arthroscopic classification of chronic ATFL lesions to the pre-operative imaging study findings in order to estimate the performance of computed tomography (CT)-arthrography, ultrasonography, and magnetic resonance imaging (MRI) in diagnosing ATFL lesions, using arthroscopy as the reference standard.

Hypothesis

Agreement between arthroscopic and imaging findings of chronic ATFL injuries can be assessed by using a shared classification developed from the arthroscopic evaluation, used as the reference standard.

Material and methods

A prospective multicentre study was conducted in 286 patients with arthroscopically-treated CAI. In each patient, the arthroscopic assessment of the ATFL was compared to the pre-operative findings by CT-arthrography, ultrasonography, and MRI. A classification of ATFL lesions based on the arthroscopic assessment was used to analyse the imaging studies. Using this classification, two independent observers compared the findings and evaluated the agreement between arthroscopy and imaging studies.

Results

Of the 286 patients, 157 had complete information on the arthroscopic assessment and on pre-operative imaging studies and were included in the analysis. Imaging studies were CT-arthrography in 49 patients, ultrasonography in 63 patients, and MRI in 45 patients; both ultrasonography and MRI were performed in 3 patients. Agreement with arthroscopy was 82% and 88.5% for CT-arthrography, 66.7% and 76.2% for ultrasonography, 70.5% and 79.5% for MRI, and 73.4% and 81.2% for all imaging studies pooled.

Discussion

Arthroscopy plays a crucial role in the definitive assessment of ligament lesions in patients with CAI, as it supplies far more accurate information than any of the current imaging studies and, in addition, provides a dynamic evaluation of the ligaments and assesses mechanical strength. In the study population, a simple arthroscopic evaluation consistently visualised ATFL lesions, thereby either correcting or confirming the pre-operative imaging study findings. Importantly, the arthroscopic assessment provided more accurate information on the lesions and quality of the ATFL compared to the imaging studies. Arthroscopy has improved our knowledge of chronic ATFL lesions and allowed the development of a simple but accurate four-grade classification of direct relevance to choosing the optimal therapeutic procedure. This classification must be disseminated among radiologists to improve the diagnostic performance of pre-operative imaging studies, assist surgeons in selecting the most appropriate ankle-stabilising procedure, and improve patient information. Further studies are needed to confirm the promising results reported here and the usefulness of this common arthroscopy and imaging-study classification for chronic ATFL lesions.

Level of evidence

II.

El texto completo de este artículo está disponible en PDF.

Keywords : Chronic ankle instability, Anterior talo-fibular ligament, Magnetic resonance imaging, Computed tomography-arthrography, Ultrasonography, Arthroscopy


Esquema


© 2018  Elsevier Masson SAS. Reservados todos los derechos.
Añadir a mi biblioteca Eliminar de mi biblioteca Imprimir
Exportación

    Exportación citas

  • Fichero

  • Contenido

Vol 104 - N° 8S

P. S213-S218 - décembre 2018 Regresar al número
Artículo precedente Artículo precedente
  • Arthroscopic classification of chronic anterior talo-fibular ligament lesions in chronic ankle instability
  • André Thès, Haruki Odagiri, Marc Elkaïm, Ronny Lopes, Michael Andrieu, Guillaume Cordier, François Molinier, Jonathan Benoist, Fabrice Colin, Olivier Boniface, Stéphane Guillo, Thomas Bauer, French Arthroscopic Society k
| Artículo siguiente Artículo siguiente
  • An orthopaedic surgeon's guide to ultrasound imaging of the healthy, pathological and postoperative shoulder
  • Chantal Plomb-Holmes, Philippe Clavert, Frank Kolo, Eileen Tay, Alexandre Lädermann, French Arthroscopic Society h

Bienvenido a EM-consulte, la referencia de los profesionales de la salud.

Mi cuenta


Declaración CNIL

EM-CONSULTE.COM se declara a la CNIL, la declaración N º 1286925.

En virtud de la Ley N º 78-17 del 6 de enero de 1978, relativa a las computadoras, archivos y libertades, usted tiene el derecho de oposición (art.26 de la ley), el acceso (art.34 a 38 Ley), y correcta (artículo 36 de la ley) los datos que le conciernen. Por lo tanto, usted puede pedir que se corrija, complementado, clarificado, actualizado o suprimido información sobre usted que son inexactos, incompletos, engañosos, obsoletos o cuya recogida o de conservación o uso está prohibido.
La información personal sobre los visitantes de nuestro sitio, incluyendo su identidad, son confidenciales.
El jefe del sitio en el honor se compromete a respetar la confidencialidad de los requisitos legales aplicables en Francia y no de revelar dicha información a terceros.


Todo el contenido en este sitio: Copyright © 2024 Elsevier, sus licenciantes y colaboradores. Se reservan todos los derechos, incluidos los de minería de texto y datos, entrenamiento de IA y tecnologías similares. Para todo el contenido de acceso abierto, se aplican los términos de licencia de Creative Commons.