Accessory anterolateral talar facet: analysis of the morphologic features on MRI

To analyze the morphologic features of accessory anterolateral talar facet (AALTF) on MRI that can assist in detecting this entity, identify any associated structural changes and also define its MRI prevalence.

Two radiologists retrospectively evaluated 140 ankle MRI scans for the presence of AALTF, complimentary anterior calcaneal extension facet and angle of Gissane measurement. One observer evaluated the scans for other structural details including AALTF length, cartilage thickness, bone marrow edema, hind foot coalition and talar beaking.

There was a good inter-observer agreement for the detection of AALTF on MRI (Kappa = 0.64). AALTF was present in 33 out of 140 (23.6%) scans. There was no significant difference in the prevalence of AALTF between male and female subjects (P = 0.71). No significant difference in age between those with and those without AALTF (P = 0.96). Angle of Gissane was significantly smaller in ankles with AALTF (P = 0.0367, observer 1 and 0.0003, observer 2). AALTF had a mean length of 7 mm and was covered with cartilage in 25/33 (75.8%) with mean cartilage thickness of 1.4 mm. Complimentary cartilage covered anterior calcaneal facet was demonstrated in 10/33 (30.3%) and had a mean cartilage thickness of 2.5 mm. Talar beaking was more prevalent in ankles with AALTF showing an anterior calcaneal extension facet than those without the latter feature (P = 0.02).

AALTF is a frequently observed feature on ankle MRI, with good inter-observer reliability for its detection. When present, it is often opposed by a cartilage covered anterior calcaneal extension facet, which can be associated with talar beaking.