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Posterior tibial tendon dysfunction: Imperfect specificity of magnetic resonance imaging

Alex C Lesiak1, James D Michelson1

  • 1Department of Orthopaedic Surgery and Rehabilitation, University of Vermont College of Medicine, Robert T. Stafford Hall, 4th Floor, 95 Carrigan Drive, Burlington, VT 05405-0084 United States.

Foot and Ankle Surgery : Official Journal of the European Society of Foot and Ankle Surgeons
|March 26, 2019
PubMed

Insights

Magnetic resonance imaging (MRI) can overestimate tibialis posterior tendon (PTT) ruptures. External inflammation near the PTT may mimic tears on MRI, leading to misdiagnosis and unnecessary surgery.

Area of Science:

  • Orthopedics
  • Radiology
  • Musculoskeletal Imaging

Background:

  • Tibialis posterior tendon (PTT) dysfunction is commonly evaluated using MRI.
  • MRI demonstrates high sensitivity and specificity for detecting PTT ruptures.

Observation:

  • Three cases presented with MRI findings suggestive of complete or partial PTT rupture.
  • Surgical exploration revealed intact PTTs with tenosynovitis in all cases.
  • External sources of inflammation adjacent to the PTT were identified in all cases.

Findings:

  • External inflammation can alter MRI signals within the PTT, mimicking rupture.
  • MRI may yield false-positive results for high-grade PTT ruptures when adjacent inflammation is present.

Implications:

  • Consider external inflammation as a confounding factor in MRI interpretation of PTT injuries.
  • Recommendations for managing suspected PTT rupture in the presence of significant adjacent inflammation are proposed.
Keywords:
AnkleMRITendon ruptureTenosynovitisTibialis posterior tendon

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