Chondral lesions, peroneal tendon tears, and other disorders in patients with chronic ankle instability may not be detected by preoperative MRI. This study assessed the accuracy of the radiologistsâ€™ and orthopaedic surgeonâ€™s reading of preoperative MRI for diagnosing ankle lesions in patients with ankle instability warranting surgery.Â 133 patients who underwent 135 surgeries for lateral ankle ligament reconstruction with concomitant ankle arthroscopy and who had preoperative MRI were retrospectively reviewed.Â 72 associated lesions in 66 of the 135 surgeries, including 38 chondral injuries, 18 peroneus brevis tears, seven loose bodies, and nine other miscellaneous abnormalities were found. Eliminating eight lesions for which the decision to operate was not based on operative findings, there were 127 surgeries with 64 associated lesions that required intraoperative confirmation or were detected intraoperatively. In the original reports, the radiologists identified 39% (15) of the chondral injuries, 56% (10) of the peroneal tears, and 57% (four) of the loose bodies. Radiologistsâ€™ MRI sensitivity for detecting lesions was 45%. The attending surgeon identified 47% (18) of the chondral injuries, 89% (16) of the loose bodies, 71% (five) of the peroneus brevis tears, and the posterior talus process lesion, with a sensitivity of 63%.
This data suggest orthopaedic surgeons should review preoperative MRIs and also suggest the sensitivity of MRI may not be adequate to detect lesions in these patients before surgery.
Patrick J. Oâ€™Neill, Scott E. Van Aman and Gregory P. Guyton. Is MRI Adequate to Detect Lesions in Patients with Ankle Instability? Clinical Orthopaedics and Related Research, October 22 2009, online article ahead of print