Foot & Ankle International - June 2017 - 623

Jung et al

Figure 2. Other morphologies of the ATFL observed in MRI of
CLAI patients: (A) discontinuity of the ATFL; (B) wavy-shaped
ATFL; (C) increased ATFL signal. ATFL, anterior talofibular
ligament; CLAI, chronic lateral ankle instability; MRI, magnetic
resonance imaging.

623
anterior talar translation were measured up to 0.1° and 0.1
mm, respectively, as determined by a picture archiving and
communication system workstation (PACS; GE Healthcare,
Mt Prospect, IL). Anterior talar displacement was defined
as the distance between the anteroinferior margin of the distal tibia and the anterosuperior tip of the talar head.
MR images in our hospital (110 ankles, 71.9%) were
obtained using a 3-Tesla system (MagnetomSkyra, Siemens)
and a dedicated ankle-coil (foot/ankle 16; MagnetomSkyra,
Siemens). Coronal T2-weighted (TR/TE, 5070/76) and sagittal T2-weighted sequences (3, 160/48) were performed at
3-mm slice thickness, at 3-mm slice spacing, in a 140-mm2
field of view and a 256×205 imaging matrix, whereas axial
T2-weighted (TR/TE, 4770/76) images were obtained in a
140-mm2 field of view and 512×229 imaging matrix.
Although the other images (35 ankles, 26.5%) were obtained
from outside radiology clinics, they were reinterpreted by
the same musculoskeletal radiologist at our institution. All
images were digitally obtained using PACS.

Statistical Analysis

Figure 3. Four categories according to the thickness of
the CFL in CLAI patients: (A) normal-thickness CFL (B)
nonvisualized CFL (C) attenuated CFL (D) thickened CFL.
CFL, calcaneofibular ligament; CLAI, chronic lateral ankle
instability.

Figure 4. Other morphologies of the CFL observed in MRI of
CLAI patients: (A) discontinuity of the CFL; (B) wavy-shaped
CFL; (C) increased CFL signal. CFL, calcaneofibular ligament;
CLAI, chronic lateral ankle instability; MRI, magnetic resonance
imaging.

To investigate the clinical implications of these classifications, correlation analysis was performed on those factors
associated with the talar tilt angle on the varus stress view. For
this analysis, we included only the amount of ligament thickness (4 categories) as independent variables and excluded the
others, "discontinuity," "waviness," and "high signal intensity," because ligament discontinuity may interfere with determining the effect of ligament thickness on the stress views;
additionally, waviness and high signal intensity might be confounding factors. The thickness of the ATFL or CFL was
coded as 1 to 4 according to the amount of thickness: 1 for
nonvisualized, 2 for attenuated, 3 for normal, and 4 for thickened. We used the Pearson correlation test to analyze correlation between variables.
Additionally, receiver operating characteristic (ROC)
curves were drawn to investigate whether the state of an
ATFL or CFL on MRI could be predicted by the talar tilt
angle on the varus stress radiographs. When the curve was
drawn, "nonvisualized" or "attenuated" was considered
positive, and "normal" or "thickened" was considered negative. These curves were used to attempt to determine a cutoff talar tilt angle on the varus stress view to distinguish
"nonvisualized" or "attenuated" ligament state from "normal" or "thickened."
P values less than .05 indicated statistical significance,
and statistics software (SPSS, version 20; IBM Inc, Armonk,
NY) was utilized for statistical analyses throughout the study.

Results
Ligament discontinuity, a wavy or irregular contour, and
increased signal intensity of both ligaments on T2-weighted



Table of Contents for the Digital Edition of Foot & Ankle International - June 2017

Contents
Foot & Ankle International - June 2017 - Intro
Foot & Ankle International - June 2017 - Cover1
Foot & Ankle International - June 2017 - Cover2
Foot & Ankle International - June 2017 - i
Foot & Ankle International - June 2017 - ii
Foot & Ankle International - June 2017 - Contents
Foot & Ankle International - June 2017 - iv
Foot & Ankle International - June 2017 - v
Foot & Ankle International - June 2017 - vi
Foot & Ankle International - June 2017 - vii
Foot & Ankle International - June 2017 - viii
Foot & Ankle International - June 2017 - 1A
Foot & Ankle International - June 2017 - 1B
Foot & Ankle International - June 2017 - ix
Foot & Ankle International - June 2017 - x
Foot & Ankle International - June 2017 - xi
Foot & Ankle International - June 2017 - xii
Foot & Ankle International - June 2017 - 2A
Foot & Ankle International - June 2017 - 2B
Foot & Ankle International - June 2017 - xiii
Foot & Ankle International - June 2017 - xiv
Foot & Ankle International - June 2017 - xv
Foot & Ankle International - June 2017 - xvi
Foot & Ankle International - June 2017 - 3A
Foot & Ankle International - June 2017 - 3B
Foot & Ankle International - June 2017 - xvii
Foot & Ankle International - June 2017 - xviii
Foot & Ankle International - June 2017 - xix
Foot & Ankle International - June 2017 - xx
Foot & Ankle International - June 2017 - xxi
Foot & Ankle International - June 2017 - xxii
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Foot & Ankle International - June 2017 - 593
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Foot & Ankle International - June 2017 - 669
Foot & Ankle International - June 2017 - 670
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Foot & Ankle International - June 2017 - 673
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Foot & Ankle International - June 2017 - 688
Foot & Ankle International - June 2017 - 689
Foot & Ankle International - June 2017 - 690
Foot & Ankle International - June 2017 - 691
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Foot & Ankle International - June 2017 - 693
Foot & Ankle International - June 2017 - 694
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Foot & Ankle International - June 2017 - 702
Foot & Ankle International - June 2017 - CT1
Foot & Ankle International - June 2017 - CT2
Foot & Ankle International - June 2017 - 4A
Foot & Ankle International - June 2017 - 4B
Foot & Ankle International - June 2017 - Cover3
Foot & Ankle International - June 2017 - Cover4
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