Postoperative MR Imaging of the Foot and Ankle: Tendon Repair, Ligament Repair, and Morton's Neuroma Resection

ABSTRACT

This review article describes the postoperative magnetic resonance (MR) findings relating to surgery after tendon repair, ligament repair, and Morton's neuroma resection. The normal postoperative tendon is commonly thickened, showing signal changes that are most pronounced 3 to 6 months after surgery. Two years after tendon suture, the signal intensity should be low on T2-weighted images. The focus of the postoperative MR imaging after ankle repair is to detect the normal condition after the various surgical procedures (e.g., Broström, Watson-Jones, Evans, or Chrisman-Snook). The repaired ligament has to be visible, low signal intense on T2-weighted MR images, and the shape should be homogeneous. A high rate (26%) of so-called Morton's neuroma recurrences is seen in asymptomatic individuals after Morton's neuroma resection. Postoperatively, intermetatarsal bursitis MR abnormalities are more commonly encountered in symptomatic intermetatarsal spaces than in asymptomatic intermetatarsal spaces.

KEYWORDS

MR imaging - foot and ankle - postoperative MR imaging - artifacts - ankle - ligaments - tendons - MR - peripheral nerves

REFERENCES

• 1 Guermazi A, Miaux Y, Zaim S, Peterfy C G, White D, Genant H K. Metallic artefacts in MR imaging: effects of main field orientation and strength.  Clin Radiol. 2003;  58(4) 322-328
• 2 Hilfiker P, Zanetti M, Debatin J F, McKinnon G, Hodler J. Fast spin-echo inversion-recovery imaging versus fast T2-weighted spin-echo imaging in bone marrow abnormalities.  Invest Radiol. 1995;  30(2) 110-114
• 3 Maffulli N, Ajis A. Management of chronic ruptures of the Achilles tendon.  J Bone Joint Surg Am. 2008;  90(6) 1348-1360
• 4 Conway A M, Dorner R W, Zuckner J. Regeneration of resected calcaneal tendon of the rabbit.  Anat Rec. 1967;  158(1) 43-49
• 5 Fujikawa A, Kyoto Y, Kawaguchi M, Naoi Y, Ukegawa Y. Achilles tendon after percutaneous surgical repair: serial MRI observation of uncomplicated healing.  AJR Am J Roentgenol. 2007;  189(5) 1169-1174
• 6 Karjalainen P T, Aronen H J, Pihlajamäki H K, Soila K, Paavonen T, Böstman O M. Magnetic resonance imaging during healing of surgically repaired Achilles tendon ruptures.  Am J Sports Med. 1997;  25(2) 164-171
• 7 Shalabi A, Kristoffersen-Wiberg M, Aspelin P, Movin T. MR evaluation of chronic Achilles tendinosis. A longitudinal study of 15 patients preoperatively and two years postoperatively.  Acta Radiol. 2001;  42(3) 269-276
• 8 Hahn F, Meyer P, Maiwald C, Zanetti M, Vienne P. Treatment of chronic Achilles tendinopathy and ruptures with flexor hallucis tendon transfer: clinical outcome and MRI findings.  Foot Ankle Int. 2008;  29(8) 794-802
• 9 Yu J S. Pathologic and post-operative conditions of the plantar fascia: review of MR imaging appearances.  Skeletal Radiol. 2000;  29(9) 491-501
• 10 Yu J S, Smith G, Ashman C, Kaeding C. The plantar fasciotomy: MR imaging findings in asymptomatic volunteers.  Skeletal Radiol. 1999;  28(8) 447-452
• 11 Maffulli N, Ferran N A. Management of acute and chronic ankle instability.  J Am Acad Orthop Surg. 2008;  16(10) 608-615
• 12 Espinosa N, Smerek J, Kadakia A R, Myerson M S. Operative management of ankle instability: reconstruction with open and percutaneous methods.  Foot Ankle Clin. 2006;  11(3) 547-565
• 13 Broström L. Sprained ankles. VI. Surgical treatment of “chronic” ligament ruptures.  Acta Chir Scand. 1966;  132(5) 551-565
• 14 Gould N, Seligson D, Gassman J. Early and late repair of lateral ligament of the ankle.  Foot Ankle. 1980;  1(2) 84-89
• 15 Evans D L. Recurrent instability of the ankle; a method of surgical treatment.  Proc R Soc Med. 1953;  46(5) 343-344
• 16 Chrisman O D, Snook G A. Reconstruction of lateral ligament tears of the ankle. An experimental study and clinical evaluation of seven patients treated by a new modification of the Elmslie procedure.  J Bone Joint Surg Am. 1969;  51(5) 904-912
• 17 Maquieira G J, Moor B K, Espinosa N. Technique tip: percutaneous Chrisman-Snook lateral ankle ligament reconstruction.  Foot Ankle Int. 2009;  30(3) 268-270
• 18 Schibany N, Ba-Ssalamah A, Marlovits S et al.. Impact of high field (3.0 T) magnetic resonance imaging on diagnosis of osteochondral defects in the ankle joint.  Eur J Radiol. 2005;  55(2) 283-288
• 19 Zanetti M, Steiner C L, Seifert B, Hodler J. Clinical outcome of edema-like bone marrow abnormalities of the foot.  Radiology. 2002;  222(1) 184-188
• 20 Morton T. A peculiar and painful affection of the fourth metatarsal-phalangeal articulation.  J Med Sci. 1876;  71 37-45
• 21 Stamatis E D, Karabalis C. Interdigital neuromas: current state of the art—surgical.  Foot Ankle Clin. 2004;  9(2) 287-296
• 22 Espinosa N, Schmitt J, Saupe N et al.. MR imaging after resection of Morton neuroma: postoperative MR findings and histology in asymptomatic and symptomatic intermetatarsal spaces.  Radiology. 2010;  255(3) 850-856
• 23 Zanetti M, Ledermann T, Zollinger H, Hodler J. Efficacy of MR imaging in patients suspected of having Morton's neuroma.  AJR Am J Roentgenol. 1997;  168(2) 529-532
• 24 Zanetti M, Strehle J K, Kundert H-P, Zollinger H, Hodler J. MR imaging for suspected Morton's neuroma: effect on diagnostic thinking and therapeutic decisions.  Radiology. 1999;  213(2) 583-588
• 25 Bencardino J, Rosenberg Z S, Beltran J, Liu X, Marty-Delfaut E. Morton's neuroma: is it always symptomatic?.  AJR Am J Roentgenol. 2000;  175(3) 649-653
• 26 Zanetti M, Strehle J K, Zollinger H, Hodler J. Morton neuroma and fluid in the intermetatarsal bursae on MR images of 70 asymptomatic volunteers.  Radiology. 1997;  203(2) 516-520