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The Anatomic Variations And Concomitant Pathologies Of The Ligament

2289 words - 9 pages

Materials and methods
This retrospective study was approved by the Institutional Review Board at our hospital. Due
to the retrospective nature of the study, informed consent by patients and providers was not
required.
Patient Inclusion
Our objective was to compare two groups with regard to the anatomy of PTFL (origin and
insertion of the ligament) and concurrent PTFL pathologies, one group with patients who had
an os trigonum (the study group) and another group with normal patients with the absence of
an os trigonum (the control group). Consecutive 70 patients with a presence of an os trigonum
on the ankle MRI evaluated in the past five years were identified via a radiology information
system keyword search. The ankle MRIs and medical data including demographics
information (age and gender) and clinical history of all patients who had an os trigonum were
analyzed.
We excluded cases with: (1) the history of acute trauma (the injury was considered as acute if
less than 4 weeks had elapsed between time of trauma and the MRI examination),(2) MRI
exams with poor image quality, (3) incomplete demographics or clinical information in both
groups, 4) the MRI features suggestive of acute trauma although there was no history of
trauma.
MRI review
3
The scans were obtained on a 1.5 Tesla Signa MR unit (General Electric Medical Systems,
Milwaukee, WI) in conjunction with the extremity coil in a supine position. Standard
sequences were obtained for all the ankle MRI scans, which included sagittal, axial and
coronal proton density (PD) fat-suppressed images, axial fast-spin-echo T2-weighted fatsuppressed
images and axial and coronal fast-spin-echo T1-weighted images. T1-weighted
images were obtained with 500/20 (TR/TE), a 320x288 acquisition matrix, a 16 cm field of
view, and two excitations. PD fat-suppressed images were obtained with 2840/42 (TR/TE), a
320x256 acquisition matrix, a 16 cm field of view, and two excitations. T2-weighted images
were obtained with 3550/60 (TR/TE), a 320x256 acquisition matrix, a 16 cm field of view,
and two excitations. In all cases, the slice thickness was 3 mm and interslice gap was 1 mm
routinely. MR images were also digitally obtained, using a picture archiving communication
system (PACS), and MRI evaluation was performed using PACS software. Ankle MRIs were
blindly reviewed by an attending musculoskeletal radiologist with 10 years of experience for
characteristics of the os trigonum, looking specifically for the anatomy of PTFL in cases
which the os trigonum presents. The anatomy of the 2 parts of the PTFL (anterior and
posterior fibers) and origin and insertion of this ligament was reviewed on axial MRI images.
Concurrent PTFL pathologies were also reviewed and categorized as normal or pathologic
(increased intraligamentous signal intensity representing oedema, partial tear or complete
tear). PTFL often appears striated on MRI secondary to its fibrofatty composition and it was
accepted as normal in our study. PTFL was...

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