[Trauma of the ligaments and tendons. Examination technique and detection in MRI]

For stress radiography, the inversion stress test can be performed during radiographic examination and widening of the lateral joint space can be measured quite accurately. However, there is no general agreement on the meaning of various degrees of talar tilt. Today MRI allows evaluation of the integrity of injured ankle ligaments. The major difficulty in MRI is inconsistency in visualization by inadequate appreciation of the three-dimensional orientation of each ankle ligament. The appropriate combination of foot position and imaging plane is very important to achieve the best visualization of each ligament. Using this technique, 52 patients with sprained ankles underwent MRI. The integrity of rupture of the collateral lateral ligaments was obtained in all 52 ankles. Full-length visualization is essential for evaluation of the ankle ligaments with MRI. In these 52 patients the ankle of tilt on the stress X-ray was compared with the rate of MRI findings showing an injury affecting two ligaments We found that none of the patients in whom the angle of lateral tilt was less than 5 degrees had rupture of two lateral ligaments, while 32% of patients with angles of tilt of 6-14 degrees and 42% of those with angles of tilt over 15 degrees on stress X-ray had two ruptured lateral ligaments. When a stress X-ray with a 6-14 degrees angle of tilt suggests only slight ligamentous injury, MRI could be indicated in specific cases to allow identification of the 32% with rupture of two ligaments. The only practical means of imaging tendons is high-frequency ultrasound and MRI.(ABSTRACT TRUNCATED AT 250 WORDS)