足部力线X线测量与胫后肌腱、弹簧韧带及三角韧带撕裂的关联

OBJECTIVE: This study assesses whether an association exists between radiographic measurements of progressive collapsing foot deformity and MRI assessment of posterior tibial tendon (PTT) dysfunction.

MATERIALS AND METHODS: After institutional approval, a retrospective search was conducted for patients who presented between 2017 and 2023 with foot and ankle pain and for whom 3D ankle MRIs and weight-bearing ankle radiographs were performed within 3 months of each other. One hundred fifty-seven feet that met the criteria were identified. The talonavicular uncoverage angle (TU), Meary's angle, calcaneal pitch, cuneiform-fifth metatarsal height (C-5MT), and Djian-Annonier's angle (DA) were calculated on weight-bearing ankle radiographs. MRI was used to assess the PTT, spring ligament (SL), and superficial and deep deltoid ligament (DL). Associations between radiographic measurements and MRI findings were explored through pairwise Wilcoxon rank-sum tests with Holm's adjustment. Secondary analysis included multivariable regression for covariate adjustment and reader agreement.

RESULTS: Patients with complete PTT tears exhibited a statistically significantly increased TU (38.5 ± 9.2), decreased Meary's angle (-26.7 ± 9.1) and decreased C-5MT (-3.9 ± 5.7) than patients with partial tear (TU 16.3 ± 9.9; Meary's angle -5.6 ± 8.7; C-5MT 10.5 ± 5.0) and without tear (TU 115.8 ± 10.7; Meary's angle -5.6 ± 7.7; C-5MT 9.5 ± 6.6). Meary's angle and C-5MT were statistically different in the superficial DL groups complete tear versus partial tear and non-tear (Meary's angle -26.1 ± 15.4 versus -8.0 ± 8.5 and -5.6 ± 8.2, respectively, both p < 0.001; C-5MT -2.9 ± 8.3 versus 9.8 ± 6.3, p = 0.007, and 8.7 ± 7.0, p = 0.002, respectively). DA was associated with superficial deltoid ligament complete tear versus non-tear (DA 144.9 ± 14.4 versus 127.1 ± 11.8, p = 0.037). Although not statistically significant, a considerable difference in mean values of TU was found between SL complete tear and partial tear and non-tear with marginal p values (TU 2.6 ± 7.9 versus 18.6 ± 14.4, p = 0.051, and 16.6 ± 10.4, p = 0.056, respectively). None of the radiographic measurements were associated with deep DL status or PTT tenosynovitis.

CONCLUSION: Forefoot abduction measured by TU, as well as medial longitudinal arch collapse measured by Meary's angle and C-5MT, is associated with PTT complete tear versus non-tear or partial tear. Meary's angle, DA, and C-5MT also demonstrated implications for superficial DL status. Additional research with larger sample sizes will be helpful to clarify the statistical tendency of association between SL and TU.