Rationale and Objectives
This study aims to quantitatively compare T2* measurements of the talar cartilage between chronic lateral ankle instability (LAI) patients with lateral ligament injury and healthy volunteers, and to assess the association of T2* value with American Orthopedic Foot and Ankle Society (AOFAS) score.
Materials and Methods
Nineteen consecutive patients with chronic LAI (LAI group) and 19 healthy individuals (control group) were enrolled. Biochemical magnetic resonance examination of the ankle was performed in all participants using three-dimensional gradient-echo T2* mapping. Total talar cartilage was divided into six subcompartments, including medial anterior (MA), central medial, medial posterior, lateral anterior, central lateral (LC), and lateral posterior regions. T2* values of respective cartilage areas were measured and compared between the two groups using Student t test. AOFAS scoring was performed for clinical evaluation. Then, the association of T2* value with AOFAS score was evaluated by Pearson correlation.
Results
The T2* values of total talar cartilage, as well as MA and LC cartilage compartments, in the chronic LAI group were significantly higher than control values ( P < .001, P = .039, and P = .014, respectively). Furthermore, the T2* value of MA in the chronic LAI group was negatively correlated with AOFAS score ( r = −0.8089, P < .001).
Conclusions
Chronic LAI with lateral ligament injury may have a causal connection with early cartilage degeneration in the ankle joint, especially in MA and LC cartilage compartments, as assessed by quantitative T2* measurements. The clinical score correlates highly with T2* value of the MA cartilage compartment, indicating that MA may be the principal cartilage area conferring clinical symptoms.
Introduction
Ankle sprain is one of the most common musculoskeletal injuries in sporting activities, accounting for 20% of all individuals with joint injury . It often affects active and working individuals between 15 and 45 years old . Three-quarters of sprains involve the lateral ligament complex of the ankle, constituting 75% of all ankle injuries . A previous study with about 6.5 years of follow-up after ankle sprain found that 5% and 4% of patients have to change or abandon their sports because of continuous symptoms in the injured ankle . Although nonoperative treatments are effective for acute lateral ankle sprains, 10%–30% of patients with repeated ankle sprains may develop chronic lateral ankle instability (LAI) . LAI alters tibiotalar kinematics, causing chondral degeneration and subsequently osteoarthritis (OA) . The rate of OA development in patients with chronic LAI is as high as 78% beyond 10 years .
Previous studies indicated that the course of OA may be slowed down or even reversed if treated at very early stages . Much effort has therefore been directed toward exploring noninvasive ways for early diagnosis and treatment. Over the past decades, magnetic resonance imaging (MRI) has been widely used to assess cartilage degeneration and seems to be a sensitive alternative . However, conventional MRI is limited in identifying biochemical changes in the early stage of cartilage degeneration, for example, massive loss of proteoglycans, collagen disorganization, and increase in water content and mobility of free water molecules in the cartilage extracellular matrix . Because of recent advances in new promising “biochemical” magnetic resonance (MR) techniques, quantitative MR modalities, such as T2 mapping, T2* mapping, T1rho mapping, and delayed gadolinium-enhanced MRI of cartilage, allow for quantitative detection of cartilage lesions at a subclinical stage when changes are potentially still reversible . The advantages of biochemical imaging over conventional MRI could be maximized in T2/T2* mapping. Although T2 mapping is well established for diagnosing cartilage degeneration and regeneration , talar cartilage imaging also faces challenges, since the talar cartilage is definitely thin. T2* mapping, similar to T2 mapping, is a subclinical indicator of articular cartilage degeneration, with additional potential advantages of short scan time and three-dimensional (3D) acquisition . Such 3D gradient-echo sequence offers inherently higher resolution for the thin ankle cartilage layer compared to T2 mapping . Meanwhile, previous findings showed that T2* mapping, with short echo times (TEs), is highly sensitive to collagen architecture and provides improved sensitivity to the deepest zone of cartilage alteration . T2* quantification is sensitive to cartilage matrix changes in ankle osteochondrosis dissecans and hip femoroacetabular impingement .
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Materials and Methods
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Participant Selection
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TABLE 1
Demographic Data of Patients and Healthy Volunteers
Parameter Control Subjects ( n = 19) Chronic LAI Group ( n = 19)P Value Mean age, mean ± SD, y 26.4 ± 1.1 29.0 ± 1.5 .1838 Sex, male/female, n 11/8 10/9 .7442 BMI, mean ± SD 23.0 ± 0.5 23.1 ± 0.6 .9224
BMI, body mass index; LAI, lateral ankle instability; SD, standard deviation.
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Imaging Acquisition
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TABLE 2
Magnetic Resonance Parameters of the Sequences Used in the Study
Pulse Sequence FS-PD in Ax FS-PD in Cor FS-PD in Sag T1 in Ax T2* Mapping Repetition time (ms) 650 843 737 600 50 Echo time (ms) 15.0 9.9 18.0 18.0 2.46, 7.38, 12.30, 17.22, 22.14, 27.06, 31.78, 36.90 Flip angle (degrees) 90 150 140 140 60 Bandwidth (Hz) 250 250 260 260 260 Field of view (mm) 150 × 150 150 × 150 150 × 150 150 × 150 160 × 160 Section thickness (mm) 2.0 2.0 2.0 2.0 2.0 Matrix phase (%) 80 73 75 75 100 Matrix 256 × 205 256 × 187 256 × 192 256 × 192 320 × 320 No. of signals acquired 1 1 1 1 1 Imaging time 2 min 17 s 2 min 32 s 1 min 17 s 1 min 57 s 2 min 52 s
Ax, axial; Cor, coronal; FS-PD, fat-suppressed proton density; Sag, sagittal; No., number.
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Clinical Evaluation
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Data Analysis
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Results
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TABLE 3
Comparison of Zonal T2* Values of Talar Cartilage Between Patients and Control
Zone Chronic LAI Group (ms) Control Subjects (ms)P Value ΔT2* Value MA 22.18 18.18<.001 22.00% # MC 18.98 17.40 .073 9.10% MP 17.21 16.86 .700 2.10% LA 19.53 18.46 .127 5.80% LC 18.31 16.89.039 8.41% # LP 16.92 17.49 .392 −3.37% TTC 18.85 17.55.014 7.47% #
LA, lateral anterior; LC, central lateral; LP, lateral posterior; MA, medial anterior; MC, central medial; MP, medial posterior; TTC, talus trochlear cartilage.
ΔT2* value = [T2* value(“chronic LAI”) − T2* value(“control group”)]/T2* value(“control group”).
The P value less than 0.05 are bold.
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Discussion
Results Discussion
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Limitations of This Study
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Conclusions
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