MRI evaluation of ATFL and CFL ligamentization after anatomical surgical reconstruction with a hamstring graft

• Published in: Foot and ankle surgery
• Main Authors: Bilichtin, E., Rougereau, G., Rollet, M.E., De Rousiers, A., Elkaïm, M., Rousselin, B., Bauer, T., Hardy, A.
• Format: Journal Article
• Language: English
• Published: France Elsevier Ltd 10.07.2024
• Subjects: Chronic ankle instability – Anatomical reconstruction – MRI – SNQA – Ligamentisation; Chronic ankle instability – Anatomical reconstruction – MRI – SNQA – Ligamentisation
• ISSN: 1268-7731; 1460-9584; 1460-9584
• DOI: 10.1016/j.fas.2024.07.003

Chronic ankle instability is frequent complication following ankle sprains. Anatomical reconstruction of the anterior talofibular ligament (ATFL) and the calcaneofibular ligament (CFL) with a gracilis autograft is a validated reconstruction technique. The signal-to-noise quotient ankle (SNQA) score evaluates graft maturation with MRI and has been shown to be reproducible and reliable. The goal of this study was to evaluate the process of ligamentization of the anatomical reconstruction of the ankle using the SNQA. The hypothesis was that the SNQA signal of the ATFL and the CFL would decrease over time. A prospective cohort of patients who underwent arthroscopic anatomical ATFL-CFL reconstruction was included. All patients underwent a follow-up MRI examination 3, 6. and 12 months after surgery and the SNQA score was determined. Twenty consecutive patients were included. The SNQA score decreased significantly over time for the ATFL (p = 0.001), the CFL (p < 0.001) and for the fibular bone tunnel-graft interface (p = 0.02). The SNQA scores of the ATFL were significantly higher than those of the CFL at 3 months (p = 0.01), 6 months (p = 0.003) and 12 months (p < 0.001), and then those of the fibular tunnel-graft interface at 12 months (p = 0.003). There was no difference in the SNQA score between the CFL and in the fibular graft-bone tunnel interface at any of the follow up periods. There is a process of graft maturation following anatomical ATFL and CFL reconstruction over time, which is faster for the CFL than for the ATFL during the first year. II