This article is more than 5 years old. Information may no longer be current.

Many lesions associated with ankle instability missed on preoperative MRI

Add topic to email alerts

Receive an email when new articles are posted on

Please provide your email address to receive an email when new articles are posted on .

Subscribe

Added to email alerts

You've successfully added to your alerts. You will receive an email when new content is published.

Click Here to Manage Email Alerts

You've successfully added to your alerts. You will receive an email when new content is published.

Click Here to Manage Email Alerts

Back to Healio

We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com.

Back to Healio

VANCOUVER, British Columbia — Recent research indicates that preoperative MRI may miss a substantial number of associated lesions intraoperatively in patients with chronic ankle instability, and surgeons may be better than radiologists at indentifying these lesions on preoperative images.

“The results of our study support routine arthroscopy and peroneal tendon exploration,” Patrick J. O’Neill, MD, said during his presentation at the 25th Annual Summer Meeting of the American Orthopaedic Foot and Ankle Society, here. “When it comes to MRI, it is important to discuss with patients that even though they had an MRI that was negative, there are could be lesions that need to be addressed in the OR.”

It is also important that surgeons read their own MRIs, he said.

In a retrospective chart review, O’Neill and his colleagues compared the preoperative MRI reports of a community radiologist and the attending foot and ankle surgeon to the intraoperative findings of 133 consecutive patients who underwent 135 lateral ankle ligament reconstruction procedures for chronic ankle instability.

Intraoperatively, the researchers found 72 associated lesions, including 38 chondral injuries, 18 brevis tears, seven loose bodies, and nine other pathologies. Compared to the preoperative MRI reports, the investigators discovered that the radiologist missed 50% of the associated lesions found intraoperatively and the attending surgeon missed 33%. The radiologist missed 61% of the chondral injuries, 44% of the brevis tears, 43% of loose bodies and 29% of the other pathologies. The surgeon missed 53% of the chondral injuries, 11% of the brevis tears, 29% of the loose bodies and none of the other pathologies.

O’Neill said many of the lesions might have been missed on MRI due to a potentially high number of superficial lesions that lack bony edema, as well as the inherent challenges in visualizing peroneal tears. He also said the surgeon may have had the advantage of performing patient exams, while the medical community at large may not be as attuned to examining foot and ankle pathology.

Reference:

• O’Neill PJ, Aman SV, Guyton GP. Comparison of operative findings and preoperative MRI in patients with ankle instability. Presented at the 25th Annual Summer Meeting of the American Orthopaedic Foot and Ankle Society. July 15-18, 2009. Vancouver, British Columbia.