Citation: Skeletal Radiology. 2013, 42(7), 969-73
Author: Williams G, Widnall J, Evans P, Platt S
Abstract: OBJECTIVES: The authors aim to present the common MRI appearances of surgically proven
spring ligament tears as minimal radiological literature exists regarding injury
to this increasingly important structure.
MATERIALS AND METHODS: Our retrospective review identified a treatment group comprising 13 cases of
surgically proven spring ligament injury and a 96-patient comparison group. All
patients underwent standard musculoskeletal MRI sequences of the foot and ankle.
Images were reviewed by a registrar-grade orthopedic surgeon and a consultant
musculoskeletal radiologist for abnormalities of the spring ligament
complex.
RESULTS: MRI findings in relation to surgically proven injury of the superior-medial
portion of the spring ligament included proximal thickening >5 mm in 92 % and
distal thinning <2 mm in 85 % of proven injures to the spring ligament
complex. Common abnormalities of the medio-plantar portion comprised ligament
thickening >7 mm in 31 % and intra-substance signal heterogenicity
demonstrated in 38 % of cases. CONCLUSIONS: The complex orientation of the medio-plantar ligament makes its evaluation
unreliable due to the difficulty obtaining diagnostic quality imaging and our
inability to correlate MRI findings in this portion of the ligament with
surgically proven injury. However, MRI abnormalities of the superior-medial
ligament are consistent, reproducible, and correlate with surgical pathology. As
our incomplete understanding of the flexible flatfoot deformity evolves, our
ability to recognize injury to the spring ligament may encourage novel surgical
treatments looking to incorporate its repair or reconstruction into deformity
correction.
