Reliability and validity of preoperative MRI for surgical decision making in chronic lateral ankle instability.
Reliability and validity of preoperative MRI for surgical decision making in chronic lateral ankle instability.
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DOI：
10.1007/s00590-017-2116-4
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发表时间：
2018-05-01
期刊：
影响因子：
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通讯作者：
Bauer, Thomas
中科院分区：
文献类型：
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作者：
Morvan, Antoine;Klouche, Shahnaz;Bauer, Thomas
目的：评价MRI对距腓前韧带(ATFL)的分析在确定慢性外踝不稳患者手术方法中的应用价值。纳入了2013至2016年间因关节镜稳定脚踝而接受手术的所有患者。由两名对关节镜检查结果视而不见的读者在术前MRI包括轴位T2加权图像上对ATFL进行评估。关节镜评估被认为是参考检查，由一名资深外科医生执行。主要判断标准为：(1)无或薄(直径3.2 mm)伴或不伴高信号；结果：22例患者中，男15例，女7例，平均年龄30.3±9.5岁。14例患者(63.6%)接受了关节镜下ATFL修复(Brostrom-Gould术)，8例患者(36.4%)接受了关节镜下解剖重建ATFL。观察者内MRI表现的重复性相当好(k=0.68)，观察者间的重复性中等(k=0.55)至接近完美(k=0.87)。MRI和关节镜检查结果基本一致(k=0.70)。术前MRI对两位观察者的诊断参数均为良好：SE=85.7-87.5%，Sp=86.7-92.9%，PPV=75-87.5%，NPV=92.9%，患者分类良好=86.4-90.9%。结论：ATFL术前MRI是选择手术方法稳定慢性外侧踝不稳的可靠、有效的决策工具。证据水平：II级；诊断性研究-在连续病例的基础上制定诊断标准。
PURPOSE: To evaluate the value of analyzing the anterior talofibular ligament (ATFL) on preoperative MRI as a decision-making tool to determine the surgical technique in patients undergoing surgery for chronic lateral ankle instability.METHODS: A retrospective study of prospective data was performed. All patients who underwent surgery between 2013 and 2016 for arthroscopic stabilization of the ankle were included. The ATFL was evaluated on preoperative MRI including axial T2-weighted images by two readers who were blinded to arthroscopic results. The arthroscopic evaluation, which was considered to be the reference examination, was performed by one senior surgeon. The main judgment criteria were two features of the ATFL: (1) absent or thin (3.2mm in diameter) with or without a high intensity intraligamentous signal. Inter- and intraobserver reproducibility was evaluated by the kappa coefficient (k), and parameters of the diagnostic accuracy of preoperative MRI were analyzed.RESULTS: Twenty-two patients were included, 15 men/7 women mean age 30.3±9.5years. Fourteen patients (63.6%) underwent arthroscopic repair of the ATFL (Brostrom-Gould technique) and 8 patients (36.4%) an arthroscopic anatomical reconstruction of the ATFL. Intraobserver reproducibility of MRI findings was substantial (k=0.68) and interobserver reproducibility moderate (k=0.55) to nearly perfect (k=0.87). Agreement between MRI and arthroscopic findings was substantial (k=0.70). Diagnostic parameters of preoperative MRI were good for both observers: Se=85.7-87.5%, Sp=86.7-92.9%, PPV=75-87.5%, NPV=92.9%, and classification of patients was good=86.4-90.9%.CONCLUSION: Preoperative MRI of the ATFL is a reliable and valid decisional tool to choose the surgical technique for stabilization of chronic lateral ankle instability.LEVEL OF EVIDENCE: Level II; Diagnostic study-development of diagnostic criteria on the basis of consecutive patients.