{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,7]],"date-time":"2026-03-07T12:45:43Z","timestamp":1772887543579,"version":"3.50.1"},"reference-count":30,"publisher":"Springer Science and Business Media LLC","issue":"10","license":[{"start":{"date-parts":[[2023,7,10]],"date-time":"2023-07-10T00:00:00Z","timestamp":1688947200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,7,10]],"date-time":"2023-07-10T00:00:00Z","timestamp":1688947200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100001809","name":"the National Natural Science Foundation of China","doi-asserted-by":"crossref","award":["82004458"],"award-info":[{"award-number":["82004458"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Central Funds Guiding the Local Science and Technology Development General Program of Sichuan Provincial Science and Technology Department","award":["2021ZYD0078"],"award-info":[{"award-number":["2021ZYD0078"]}]},{"name":"Scientific Research Cultivation Project of The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University","award":["2022-CXTD-08"],"award-info":[{"award-number":["2022-CXTD-08"]}]},{"name":"Hejiang People's Hospital - Southwest Medical University Science and Technology Strategic Cooperation Project","award":["2022HJXNYD04"],"award-info":[{"award-number":["2022HJXNYD04"]}]},{"name":"General Project of Sichuan Traditional Chinese Medicine Administration Traditional Chinese Medicine Research Special Project","award":["2023MS248"],"award-info":[{"award-number":["2023MS248"]}]},{"name":"Sichuan Science and Technology Program","award":["2022YFS0609"],"award-info":[{"award-number":["2022YFS0609"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Surg Radiol Anat"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Purpose<\/jats:title>\n                <jats:p>This study intended to compare the difference between the anterior talofibular ligament (ATFL) and posterior talofibular ligament (PTFL) angle with chronic ankle instability (CAI) patients and healthy volunteers, and to confirm whether using the ATFL\u2013PTFL angle could be a reliable assessment method for CAI, so as to improve the accuracy and specificity of clinical diagnosis.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>This retrospective study included 240 participants: 120 CAI patients and 120 healthy volunteers between 2015 and 2021. The ATFL\u2013PTFL angle of the ankle region was gaged in the cross-sectional supine position on MRI between two groups. After participants undergoing a comprehensive MRI scanning, ATFL\u2013PTFL angles were regarded as the main indicator of patients with the injured ATFLs and healthy volunteers to compare, and were measured by an experienced musculoskeletal radiologist. Moreover, other qualitative and quantitative indicators referring to anatomical and morphological characteristics of the AFTL were included in this study with MRI, such as the length, width, thickness, shape, continuity, and signal intensity of the ATFL, which can be used as secondary indicators.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>In the CAI group, the ATFL\u2013PTFL angle was 90.8\u00b0\u2009\u00b1\u20095.7\u00b0, which was significantly different from the non-CAI group where the ATFL\u2013PTFL angle for 80.0\u00b0\u2009\u00b1\u20093.7\u00b0 (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). As for the ATFL-MRI characteristics, the length (<jats:italic>p<\/jats:italic>\u2009=\u20090.003), width (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), and thickness (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) in the CAI group were also significantly different from the non-CAI group. Over 90% of the cases, patients of the CAI group had injured ATFL with an irregular shape, non-continuous, and high or mixed signal intensity.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Compared with healthy people, the ATFL\u2013PTFL angle of most CAI patients is larger, which can be used as a secondary index to diagnose CAI. However, the MRI characteristic changes of ATFL may not relate to the increased ATFL\u2013PTFL angle.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00276-023-03196-7","type":"journal-article","created":{"date-parts":[[2023,7,10]],"date-time":"2023-07-10T02:01:31Z","timestamp":1688954491000},"page":"1205-1211","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["The increased anterior talofibular ligament\u2013posterior talofibular ligament angle on MRI may help evaluate chronic ankle instability"],"prefix":"10.1007","volume":"45","author":[{"given":"Lei","family":"Zhang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ting","family":"Lan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Junyao","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zidong","family":"Wei","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Houyin","family":"Shi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guoyou","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2023,7,10]]},"reference":[{"key":"3196_CR1","doi-asserted-by":"publisher","first-page":"1369","DOI":"10.29271\/jcpsp.2021.11.1369","volume":"31","author":"L An","year":"2021","unstructured":"An L, Yan Y (2021) MRI-based diagnosis of anterior talofibular ligament injury. J Coll Physicians Surg Pak 31:1369\u20131371","journal-title":"J Coll Physicians Surg Pak"},{"key":"3196_CR2","doi-asserted-by":"publisher","first-page":"1535","DOI":"10.1007\/s00167-020-06208-w","volume":"29","author":"J Ahn","year":"2021","unstructured":"Ahn J, Choi JG, Jeong BO (2021) The signal intensity of preoperative magnetic resonance imaging has predictive value for determining the arthroscopic reparability of the anterior talofibular ligament. Knee Surg Sports Traumatol Arthrosc 29:1535\u20131543","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"3196_CR3","doi-asserted-by":"publisher","first-page":"2524","DOI":"10.3390\/jcm11092524","volume":"11","author":"JN Altmeppen","year":"2022","unstructured":"Altmeppen JN, Colcuc C, Balser C et al (2022) A 10-year follow-up of ankle syndesmotic injuries: prospective comparison of knotless suture-button fixation and syndesmotic screw fixation. J Clin Med 11:2524","journal-title":"J Clin Med"},{"key":"3196_CR4","doi-asserted-by":"publisher","first-page":"313","DOI":"10.1007\/s10396-019-00993-9","volume":"47","author":"C Alvarez","year":"2020","unstructured":"Alvarez C, Hattori S, Kato Y et al (2020) Dynamic high-resolution ultrasound in the diagnosis of calcaneofibular ligament injury in chronic lateral ankle injury: a comparison with three-dimensional magnetic resonance imaging. J Med Ultrason 47:313\u2013317","journal-title":"J Med Ultrason"},{"key":"3196_CR5","doi-asserted-by":"publisher","first-page":"1782","DOI":"10.3390\/diagnostics11101782","volume":"11","author":"M Barini","year":"2021","unstructured":"Barini M, Zagaria D, Licandro D et al (2021) Magnetic Resonance accuracy in the diagnosis of anterior talo-fibular ligament acute injury: a systematic review and meta-analysis. Diagnostics (Basel) 11:1782","journal-title":"Diagnostics (Basel)"},{"key":"3196_CR6","doi-asserted-by":"publisher","first-page":"122","DOI":"10.1186\/s13018-018-0811-4","volume":"13","author":"S Cao","year":"2018","unstructured":"Cao S, Wang C, Ma X et al (2018) Imaging diagnosis for chronic lateral ankle ligament injury: a systemic review with meta-analysis. J Orthop Surg Res 13:122","journal-title":"J Orthop Surg Res"},{"key":"3196_CR7","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1186\/s13018-019-1102-4","volume":"14","author":"S Cao","year":"2019","unstructured":"Cao S, Wang C, Ma X et al (2019) Reliability and validity of different ankle MRI scanning planes for the anterior talofibular ligament injury diagnosis: a cadaveric study. J Orthop Surg Res 14:69","journal-title":"J Orthop Surg Res"},{"key":"3196_CR8","doi-asserted-by":"publisher","first-page":"84","DOI":"10.21037\/qims-20-5","volume":"11","author":"I Casado-Hern\u00e1ndez","year":"2021","unstructured":"Casado-Hern\u00e1ndez I, Becerro-de-Bengoa-Vallejo R, Losa-Iglesias ME et al (2021) Association between anterior talofibular ligament injury and ankle tendon, ligament, and joint conditions revealed by magnetic resonance imaging. Quant Imaging Med Surg 11:84\u201394","journal-title":"Quant Imaging Med Surg"},{"key":"3196_CR9","doi-asserted-by":"publisher","first-page":"957","DOI":"10.1053\/j.jfas.2021.12.020","volume":"61","author":"SM Choi","year":"2022","unstructured":"Choi SM, Cho BK, Kim SH (2022) The Influence of suture-tape augmentation on biological healing of the anterior talofibular ligament in chronic ankle instability: a quantitative analysis using MRI. J Foot Ankle Surg 61:957\u2013963","journal-title":"J Foot Ankle Surg"},{"key":"3196_CR10","doi-asserted-by":"publisher","first-page":"1022","DOI":"10.1007\/s00167-015-3828-9","volume":"24","author":"JH Cho","year":"2016","unstructured":"Cho JH, Lee DH, Song HK et al (2016) Value of stress ultrasound for the diagnosis of chronic ankle instability compared to manual anterior drawer test, stress radiography, magnetic resonance imaging, and arthroscopy. Knee Surg Sports Traumatol Arthrosc 24:1022\u20131028","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"3196_CR11","doi-asserted-by":"crossref","unstructured":"Dalmau-Pastor M, El-Daou H, Stephen JM, Vega J, Malagelada F, Calder J (2023) Clinical relevance and function of anterior talofibular ligament superior and inferior fascicles: a robotic study. Am J Sports Med. 3635465231172196.","DOI":"10.1177\/03635465231172196"},{"key":"3196_CR12","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1007\/s00167-019-05794-8","volume":"28","author":"M Dalmau-Pastor","year":"2020","unstructured":"Dalmau-Pastor M, Malagelada F, Calder J et al (2020) The lateral ankle ligaments are interconnected: the medial connecting fibres between the anterior talofibular, calcaneofibular and posterior talofibular ligaments. Knee Surg Sports Traumatol Arthrosc 28:34\u201339","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"3196_CR13","doi-asserted-by":"publisher","first-page":"12","DOI":"10.15557\/JoU.2021.0003","volume":"21","author":"EE Drakonaki","year":"2021","unstructured":"Drakonaki EE, Gataa KG, Solidakis N (2021) Anatomical variations and interconnections of the superior peroneal retinaculum to adjacent lateral ankle structures: a preliminary imaging anatomy study. J Ultrason 21:12\u201321","journal-title":"J Ultrason"},{"key":"3196_CR14","doi-asserted-by":"publisher","first-page":"371","DOI":"10.1016\/j.fcl.2021.11.025","volume":"27","author":"D Ma","year":"2022","unstructured":"Ma D, Hansen O, Kukadia S (2022) Ankle Instability. Foot Ankle Clin 27:371\u2013384","journal-title":"Foot Ankle Clin"},{"key":"3196_CR15","doi-asserted-by":"publisher","first-page":"617","DOI":"10.4085\/1062-6050-484-17","volume":"54","author":"PA Gribble","year":"2019","unstructured":"Gribble PA (2019) Evaluating and differentiating ankle instability. J Athl Train 54:617\u2013627","journal-title":"J Athl Train"},{"key":"3196_CR16","doi-asserted-by":"publisher","first-page":"572","DOI":"10.4085\/1062-6050-344-18","volume":"54","author":"J Hertel","year":"2019","unstructured":"Hertel J, Corbett RO (2019) An updated model of chronic ankle instability. J Athl Train 54:572\u2013588","journal-title":"J Athl Train"},{"key":"3196_CR17","doi-asserted-by":"publisher","first-page":"397","DOI":"10.1177\/1071100716685526","volume":"38","author":"S Jolman","year":"2017","unstructured":"Jolman S, Robbins J, Lewis L et al (2017) Comparison of magnetic resonance imaging and stress radiographs in the evaluation of chronic lateral ankle instability. Foot Ankle Int 38:397\u2013404","journal-title":"Foot Ankle Int"},{"key":"3196_CR18","doi-asserted-by":"publisher","first-page":"621","DOI":"10.1177\/1071100717693207","volume":"38","author":"HG Jung","year":"2017","unstructured":"Jung HG, Kim NR, Kim TH et al (2017) Magnetic resonance imaging and stress radiography in chronic lateral ankle instability. Foot Ankle Int 38:621\u2013626","journal-title":"Foot Ankle Int"},{"key":"3196_CR19","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1007\/s00276-021-02851-1","volume":"44","author":"A Kakegawa","year":"2022","unstructured":"Kakegawa A, Fukushima N, Sumitomo N, Nagira A, Ichinose Y, Moriizumi T (2022) Relationship between inferior fascicle of anterior talofibular ligament and articular capsule in lateral ankle ligament complex. Surg Radiol Anat 44:253\u2013259","journal-title":"Surg Radiol Anat"},{"key":"3196_CR20","doi-asserted-by":"publisher","first-page":"1121","DOI":"10.1007\/s00276-022-02987-8","volume":"44","author":"JH Kim","year":"2022","unstructured":"Kim JH, Jin ZW, Hayashi S, Murakami G, Rodr\u00edguez-V\u00e1zquez JF, Abe H (2022) Major change in morphology of the talofibular ligaments during fetal development and growth. Surg Radiol Anat 44:1121\u20131129","journal-title":"Surg Radiol Anat"},{"key":"3196_CR21","doi-asserted-by":"publisher","first-page":"683","DOI":"10.1186\/s12891-021-04537-6","volume":"22","author":"T Kobayashi","year":"2021","unstructured":"Kobayashi T, Koshino Y, Miki T (2021) Abnormalities of foot and ankle alignment in individuals with chronic ankle instability: a systematic review. BMC Musculoskelet Disord 22:683","journal-title":"BMC Musculoskelet Disord"},{"key":"3196_CR22","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1016\/j.fcl.2022.11.003","volume":"28","author":"M Lalev\u00e9e","year":"2023","unstructured":"Lalev\u00e9e M, Anderson DD, Wilken JM (2023) Current challenges in chronic ankle instability: review and perspective. Foot Ankle Clin 28:129\u2013143","journal-title":"Foot Ankle Clin"},{"key":"3196_CR23","doi-asserted-by":"publisher","first-page":"208","DOI":"10.1007\/s00167-018-5252-4","volume":"28","author":"HY Li","year":"2020","unstructured":"Li HY, Li WL, Chen SY et al (2020) Increased ATFL-PTFL angle could be an indirect MRI sign in diagnosis of chronic ATFL injury. Knee Surg Sports Traumatol Arthrosc 28:208\u2013212","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"3196_CR24","doi-asserted-by":"publisher","first-page":"455","DOI":"10.1016\/j.rcl.2012.11.004","volume":"51","author":"A Nazarenko","year":"2013","unstructured":"Nazarenko A, Beltran LS, Bencardino JT (2013) Imaging evaluation of traumatic ligamentous injuries of the ankle and foot. Radiol Clin North Am 51:455\u2013478","journal-title":"Radiol Clin North Am"},{"key":"3196_CR25","doi-asserted-by":"publisher","first-page":"20801","DOI":"10.1038\/s41598-020-77856-8","volume":"10","author":"P Szaro","year":"2020","unstructured":"Szaro P, Ghali GK, Polaczek M et al (2020) The double fascicular variations of the anterior talofibular ligament and the calcaneofibular ligament correlate with interconnections between lateral ankle structures revealed on magnetic resonance imaging. Sci Rep 10:20801","journal-title":"Sci Rep"},{"key":"3196_CR26","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1186\/s40634-021-00406-2","volume":"8","author":"P Szaro","year":"2021","unstructured":"Szaro P, Ghali GK, Solidakis N et al (2021) Morphometric relationships between dimensions the anterior talofibular ligament and calcaneofibular ligament in routine magnetic resonance imaging. J Exp Orthop 8:90","journal-title":"J Exp Orthop"},{"key":"3196_CR27","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1016\/j.jos.2019.02.018","volume":"25","author":"A Teramoto","year":"2020","unstructured":"Teramoto A, Akatsuka Y, Takashima H et al (2020) 3D MRI evaluation of morphological characteristics of lateral ankle ligaments in injured patients and uninjured controls. J Orthop Sci 25:183\u2013187","journal-title":"J Orthop Sci"},{"key":"3196_CR28","doi-asserted-by":"publisher","first-page":"198","DOI":"10.1186\/s12891-021-03998-z","volume":"22","author":"M Wenning","year":"2021","unstructured":"Wenning M, Gehring D, Lange T et al (2021) Clinical evaluation of manual stress testing, stress ultrasound and 3D stress MRI in chronic mechanical ankle instability. BMC Musculoskelet Disord 22:198","journal-title":"BMC Musculoskelet Disord"},{"key":"3196_CR29","doi-asserted-by":"publisher","first-page":"920","DOI":"10.12659\/MSM.927920","volume":"27","author":"Y Xu","year":"2021","unstructured":"Xu Y, He L, Han Y et al (2021) Evaluation of 3-Dimensional Magnetic Resonance Imaging (3D MRI) in Diagnosing Anterior Talofibular Ligament Injury. Med Sci Monit 27:920\u2013927","journal-title":"Med Sci Monit"},{"key":"3196_CR30","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1186\/s12880-021-00660-x","volume":"21","author":"W Yan","year":"2021","unstructured":"Yan W, Meng X, Sun J et al (2021) Intelligent localization and quantitative evaluation of anterior talofibular ligament injury using magnetic resonance imaging of ankle. BMC Med Imaging 21:130","journal-title":"BMC Med Imaging"}],"container-title":["Surgical and Radiologic Anatomy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00276-023-03196-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00276-023-03196-7\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00276-023-03196-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,27]],"date-time":"2023-09-27T13:08:42Z","timestamp":1695820122000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00276-023-03196-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,10]]},"references-count":30,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2023,10]]}},"alternative-id":["3196"],"URL":"https:\/\/doi.org\/10.1007\/s00276-023-03196-7","relation":{},"ISSN":["1279-8517"],"issn-type":[{"value":"1279-8517","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7,10]]},"assertion":[{"value":"6 May 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 June 2023","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 July 2023","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Approval was granted by the Ethical Committee of The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University (NO.KY2022041). This study conforms to recognized standards of Helsinki Declaration.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Informed consent was obtained from all individual participants included in the study.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"The authors affirm that human research participants provided informed consent for publication of the images in Fig.\u00a0 (1) and Fig.\u00a0 (2). All study participants provided verbal consent to take part in the study and all authors agree to publication. This manuscript has not been published in any journals.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to publish"}}]}}