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The horizontal calcaneofibular ligament: a sign of hindfoot valgus on ankle MRI

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Abstract

Objective

Hindfoot valgus malalignment has been assessed on coronal MRI by the measurement of the tibio-calcaneal (TC) angle and apparent moment arm (AMA). This study aimed to determine if the calcaneofibular ligament (CFL) angle could be used as a further marker of hindfoot valgus malalignment on routine non-weight-bearing ankle MRI.

Material and methods

One hundred ninety-five consecutive 3-T ankle MRI studies were identified from the hospital PACS system. The TC and CFL angles could be measured in 155 cases (78%), and the AMA on 153 cases.

Results

The study group comprised 56 males and 72 females with a mean age of 46 years (range 4–89 years). In 27 patients, both ankles had been imaged. The Pearson correlation between the TC and CFL angles was −0.43, with a corresponding p value of 0.001 indicating a strong negative correlation between the TC and CFL angles. The CFL angle was significantly lower in those with hindfoot valgus (113 ± 14) compared with those without (123° ± 15°) (p = 0.001). The optimal cut-off point of the CFL angle for hindfoot valgus was ≤119°, with a sensitivity and specificity of 66% and 63% respectively. The Pearson correlation between the CFL angle and AMA was −0.10, with a corresponding p value of 0.21 indicating a weak negative correlation that did not reach statistical significance.

Conclusion

Hindfoot valgus as estimated by the increased TC angle on coronal non-weight-bearing ankle MRI is associated with a reduced CFL angle on sagittal MR images, but is not associated with AMA. Therefore, a horizontal orientation of the CFL on sagittal MR images may be a further useful sign of hindfoot valgus.

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Authors and Affiliations

  1. Department of Clinical Imaging, Imperial College Healthcare NHS Trust, Praed Street, London, W2 1NY, UK

    Sangoh Lee

  2. Royal National Orthopaedic Hospital NHS Trust, Brockley Hill Stanmore, HA7 4LP, UK

    Sangoh Lee, Ines Oliveira, Ian Pressney, Matthew Welck & Asif Saifuddin

  3. Everlight Radiology, Level 6, West, 350 Euston Rd, London, UK

    Asif Saifuddin

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  1. Sangoh Lee
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  2. Ines Oliveira
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  3. Ian Pressney
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  4. Matthew Welck
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  5. Asif Saifuddin
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Correspondence to Sangoh Lee, Ines Oliveira, Matthew Welck or Asif Saifuddin.

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The study was approved by the local Research and Development Committee with no requirement for informed patient consent.

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Lee, S., Oliveira, I., Pressney, I. et al. The horizontal calcaneofibular ligament: a sign of hindfoot valgus on ankle MRI. Skeletal Radiol 49, 739–746 (2020). https://doi.org/10.1007/s00256-019-03347-1

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  • DOI: https://doi.org/10.1007/s00256-019-03347-1

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