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Preoperative MRI is helpful but not sufficient to detect associated lesions in patients with chronic ankle
Kevin Staats1, Manuel Sabeti-Aschraf1, Sebastian Apprich1
1Department of Orthopaedic Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
Purpose:
The aim of this study was to determine the reliability and validity of preoperative magnetic resonance imaging (MRI) scans for the detection of additional pathologies in patients with chronic ankle instability (CAI) compared to arthroscopic findings.
Methods:
Preoperative MRI images of 30 patients were evaluated regarding articular and periarticular comorbidities and compared to intraoperative findings. The reliability of MRI was determined by calculating specificity, sensitivity, as well as positive and negative predictive values. The accuracy of the classification of cartilage lesions by Outerbridge and Berndt and Harty rating scales was determined by calculating the area under the receiver operating curve (AUC).
Results:
In total, 72 additional pathologies were found arthroscopically compared to 73 lesions gathered from MRI images. Sensitivity ranged from 89% for peroneal tendinopathy to 28% for additional ligamentous lesions. Specificity ranged from 100% for anterolateral impingement, loose bodies and peroneal tendinopathy to 38% for additional ligamentous lesions. For cartilage lesions, sensitivity was at 91% and specificity was at 55% for the Outerbridge grading scale. For the Berndt and Harty classification system, sensitivity was at 91% and specificity was at 28%. Correlation of additional pathologies ranged from weak (r s = 0.48; p = 0.02) to moderate results (r s = 0.67; p < 0.001).
Conclusion:
CAI is associated with a high incidence of additional pathologies. In some cases, MRI delivers insufficient results, which may lead to misinterpretation of present comorbidities. MRI is a helpful tool for preoperative evaluation, but arthroscopy remains gold standard in the diagnosis of associated lesions in patients with CAI.
Level Of Evidence:
III.
Insights
Magnetic resonance imaging (MRI) is useful for detecting additional pathologies in chronic ankle instability (CAI) but has limitations. Arthroscopy remains the gold standard for diagnosing associated lesions in CAI patients.
Area of Science:
- Orthopedic Surgery
- Radiology
- Sports Medicine
Background:
- Chronic ankle instability (CAI) often involves associated pathologies.
- Accurate preoperative diagnosis is crucial for effective treatment planning.
Purpose of the Study:
- To assess the reliability and validity of preoperative magnetic resonance imaging (MRI) for detecting additional pathologies in patients with CAI.
- To compare MRI findings with arthroscopic results.
Main Methods:
- Evaluated preoperative MRI scans of 30 CAI patients for articular and periarticular comorbidities.
- Compared MRI findings with intraoperative arthroscopic results.
- Calculated sensitivity, specificity, and predictive values for MRI accuracy; assessed cartilage lesion classification using AUC.
Main Results:
- MRI detected 73 lesions, while arthroscopy identified 72 additional pathologies.
- Sensitivity varied by pathology (e.g., 89% for peroneal tendinopathy, 28% for ligamentous lesions).
- Specificity also varied (e.g., 100% for anterolateral impingement, 38% for ligamentous lesions); cartilage lesion detection showed moderate accuracy.
Conclusions:
- CAI is linked to a high rate of additional pathologies.
- MRI can be insufficient in some cases, potentially leading to misinterpretation.
- While MRI is a valuable preoperative tool, arthroscopy remains the gold standard for diagnosing associated lesions in CAI.
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