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t ients ( I I I+ C), but the authors were unable to g ive re levant percen tages due to the reduced n u m b e r o f patients. Fur the rmore the clinical s igns o f lateral ankle instabili ty correlated more to the M R f ind ings than to the s tress radiographs , when c o mpar ing Group I + A and lI + B 1+2. But in the l ight o f variable invest igators this p roduces no statist ically s igni f icant data. A re t rospect ive r e -examina t ion o f the M R images by the 3 observers was done in the k n o w l e d g e of the f indings at surgery . This a l lowed the reasons under ly ing the in terobserver variabil i ty to be analyzed; the sensi t iv i ty thus ach ieved was I00%. W e think that the added informat ion gained f rom the M R actually improved our ability to treat patients. In contrast to that the n u m b e r o f pat ients who required operat ive intervent ion us ing our criteria increased, because we could detect patients with radiographica l ly undetec ted instability due to musc le spl int ing but who were manua l ly proved to have clear l igamentous instabili ty. Addi t ional injuries, such as s inus tarsi l igament ' ruptures, cartilage d a m a g e s or t endon lesions are visible on MRI (6). W e therefore conc lude that M R imag ing can const i tute a s igni f icant enr i chment o f our a r m a m e n t a r i u m to supp lemen t the diagnostic workup of ankle inversion trauma. On the other hand, the fact o f high sensitivity of the MRI is relat ivized by i t ' s h igher costs , which m a k e s a r e c o m m e n d a t i o n for rout ine inves t igat ion inopportune. However , it must be emphasized that the potential benefits of this modality can be achieved only when the adequately performed manual investigations showed a l igamentous instability which can not be confirmed at the stress radiography and if the MRI performed by, or under the supetwision of an experienced operator.

Eingeladener Kommentar zu: MR imaging vs. stress radiography in diagnosis of ankle inversion trauma