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Kinematic MRI of the Normal Ankle Ligaments Using a Specially Designed Passive Device

Background: Knowledge of the normal MRI appearances of the ankle ligaments and tendons is particularly important in the diagnosis of ankle sprains. In most clinical practices, the ankle is imaged in a neutral position with standard imaging planes and sequences. The purpose of our study was to investigate whether passive positioning influences the MRI appearances of the ligaments of the ankle. Methods: The axial and coronal T1- weighted MR images obtained from 10 subjects were reviewed by two musculoskeletal radiologists. The following imaging planes were used: dorsiflexion with inversion, dorsiflexion with neutral, dorsiflexion with eversion, neutral with inversion, neutral, neutral with eversion, plantarflexion with inversion, plantarflexion with neutral, and plantarflexion with eversion. A subjective rating system was used to determine the optimal imaging plane and position for individual ligaments in each volunteer. Each ligament was rated on a scale (of 1 to 6). Results: There were significant differences in the appearances of the anterior talofibular (p = 0.0002), calcaneofibular (p < 0.0001), and posterior talofibular (p 0.0001) ligaments between the optimal and least optimal ankle positions in the axial plane, and in those of the (plantar calcaneonavicular) spring (p 0.0001), tibiocalcaneal (p 0.0001), posterior tibiotalar (p = 0.0087) and posterior talofibular (p = 0.0213) ligaments in the coronal plane. Conclusions: Kinematic MRI of the ankle is feasible and appears to improve visualization of ankle ligaments compared to MRI.