J Korean Foot Ankle Soc.  2021 Sep;25(3):117-125. 10.14193/jkfas.2021.25.3.117.

Magnetic Resonance Imaging Analysis of Biological Ligament Healing after Suture-Tape Augmentation for Chronic Lateral Ankle Instability

• Cho BK
• An MY
• Kim YH
• Ahn BH

• KMID: 2520102
• DOI: http://doi.org/10.14193/jkfas.2021.25.3.117

Abstract

Purpose
The aim of this study was to evaluate biological ligament healing quantitatively after suture-tape augmentation for chronic lateral ankle instability.
Materials and Methods
Thirty-two patients underwent magnetic resonance imaging (MRI) at a minimum of 2 years after lateral ligament augmentation using suture-tape. Signal/noise ratios (SNRs) and widths of anterior talofibular ligaments (ATFLs) were measured on preoperative and postoperative MRI by three researchers. ATFL biological healing degrees were analyzed using changes in SNRs and widths of ATFLs and by comparing these metrics with those of normal contralateral ankles. Clinical evaluations were performed using foot and ankle outcome scores (FAOSs), Foot and Ankle Ability Measure (FAAM) scores, and ankle stress radiographs.
Results
Mean FAOS and FAAM scores improved significantly from 62.4 to 93.6 and 58.3 to 92.3, respectively, at final follow-up (p<0.001). Mean SNRs and ATFL widths improved insignificantly from 8.49 to 8.21 and 2.07 to 2.15 mm, respectively, at final followup (p=0.424, p=0.718). Significant differences in mean SNRs and ATFL widths were found between ipsilateral and contralateral sides (p<0.001, p=0.002). Spearman’s correlation analysis revealed no significant association between clinical outcomes and degrees of biological healing of ATFLs based on MRI findings.
Conclusion
Despite improvements in clinical outcome measures, the effects of suture-tape augmentation for chronic lateral ankle instability on biological ligament healing were insignificant. In addition, no significant correlation was found between clinical outcomes and degrees of biological healing of ATFLs.

Keyword

Ankle; Instability; Suture tape; Augmentation; Healing

Figure

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  Figure. 1 Intraoperative fluoroscopic image (A) and photograph (B) show the entry points of the suture-tape.

• 

  Figure. 2 (A, B) Intraoperative photographs show the anterior talofibular and calcaneofibular ligaments augmentation using the suture-tape.

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  Figure. 3 (A, B) Measurement of signal intensity of the anterior talofibular ligament and the background using a region of interest function on T1-weighted axial magnetic resonance imaging. The signal intensity of the anterior talofibular ligament (ATFL) was directly measured by drawing the contour of the whole ATFL. The signal intensity of background was directly measured by drawing a circle (diameter: 1 cm) approximately 2 cm outside from skin near the ATFL.

• 

  Figure. 4 Measurement of width of the anterior talofibular ligament (ATFL) on T1-weighted axial magnetic resonance imaging.

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