Radiography Stress views are not routinely used for the evaluation of suspected tendon abnormality. Variant 5: Chronic ankle pain. Ankle radiographs normal or nonspecific, suspected ankle instability. Next study. In the absence of findings on routine radiography, imaging options to evaluate ligamentous integrity include stress radiography, MRI, MR arthrography, CT arthrography, and US. MRI One study evaluating anterior talofibular ligament injury demonstrated a diagnostic accuracy of 97% for MRI when compared to arthroscopic findings. Additionally, MRI identified the exact location of the injury in 93% of the cases [15]. Comparing MRI with arthroscopy, studies have shown a range of accuracies of chronic lateral ligament tearing (either partial or complete), ranging from 77% to 92% for the anterior talofibular ligament and 88% to 92% for the calcaneofibular ligament [14,52]. For the evaluation of deep deltoid ligament tears, MRI is both sensitive and specific compared with arthroscopy, with reported values of 96% and 98%, respectively [53]. With regard to tears of the tibiofibular ligaments of the tibiofibular syndesmosis, MRI has a reported accuracy of 100% [54]. Additionally, MRI can also demonstrate interosseous membrane tears [55]. MRI offers the advantage of evaluating for injuries associated with or mimicking lateral instability that may not be diagnosed on stress radiography such as tenosynovitis, tendon injury, and osteochondral lesions [56]. MRI may also be used to evaluate the ankle after lateral ligament reconstruction [57]. MR Arthrography MR arthrography can be helpful for the assessment of chronic ankle instability due to lateral collateral ligament injuries [12]. US One study evaluating anterior talofibular ligament injury demonstrated a diagnostic accuracy of 91% for US when compared to arthroscopic findings. Additionally, US identified the exact location of the injury in 63% of cases [15].
Chronic Ankle Pain. Radiography Stress views are not routinely used for the evaluation of suspected tendon abnormality. Variant 5: Chronic ankle pain. Ankle radiographs normal or nonspecific, suspected ankle instability. Next study. In the absence of findings on routine radiography, imaging options to evaluate ligamentous integrity include stress radiography, MRI, MR arthrography, CT arthrography, and US. MRI One study evaluating anterior talofibular ligament injury demonstrated a diagnostic accuracy of 97% for MRI when compared to arthroscopic findings. Additionally, MRI identified the exact location of the injury in 93% of the cases [15]. Comparing MRI with arthroscopy, studies have shown a range of accuracies of chronic lateral ligament tearing (either partial or complete), ranging from 77% to 92% for the anterior talofibular ligament and 88% to 92% for the calcaneofibular ligament [14,52]. For the evaluation of deep deltoid ligament tears, MRI is both sensitive and specific compared with arthroscopy, with reported values of 96% and 98%, respectively [53]. With regard to tears of the tibiofibular ligaments of the tibiofibular syndesmosis, MRI has a reported accuracy of 100% [54]. Additionally, MRI can also demonstrate interosseous membrane tears [55]. MRI offers the advantage of evaluating for injuries associated with or mimicking lateral instability that may not be diagnosed on stress radiography such as tenosynovitis, tendon injury, and osteochondral lesions [56]. MRI may also be used to evaluate the ankle after lateral ligament reconstruction [57]. MR Arthrography MR arthrography can be helpful for the assessment of chronic ankle instability due to lateral collateral ligament injuries [12]. US One study evaluating anterior talofibular ligament injury demonstrated a diagnostic accuracy of 91% for US when compared to arthroscopic findings. Additionally, US identified the exact location of the injury in 63% of cases [15].