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Orthop J Sports MedOrthop J Sports MedOJSspojsOrthopaedic Journal of Sports Medicine2325-9671SAGE Publications Sage CA: Los Angeles, CA 10.1177/2325967118S0014410.1177_2325967118S00144ArticleAccuracy of MRI and Varus Stress Radiographs in Diagnosing Fibular
Collateral Ligament Injuries Provencher Matthew T. MD1Kane Patrick W. MD2DePhillipo Nicholas N. 1Cinque Mark 3Moatshe Gilbert MD3Murphy Colin 3Sanchez Anthony 3LaPrade Robert F. MD, PhD11 The Steadman Clinic, Vail, CO, USA2 Steadman Philippon Research Institute
Program, Georgetown, DE, USA3 Steadman Philippon Research Institute,
Vail, CO, USA27 7 2018 7 2018 6 7 suppl4 2018 AOSSM Annual Meeting Abstracts2325967118S00144© The Author(s) 20182018SAGE PublicationsThis open-access article is published and distributed under the
Creative Commons Attribution - NonCommercial - No Derivatives License
(http://creativecommons.org/licenses/by-nc-nd/4.0/), which
permits the noncommercial use, distribution, and reproduction of the article
in any medium, provided the original author and source are credited. You may
not alter, transform, or build upon this article without the permission of
the Author(s). For article reuse guidelines, please visit SAGE’s website at
http://www.sagepub.com/journals-permissions.Objectives:
To evaluate the diagnostic accuracy of magnetic resonance imaging and varus
stress radiographs for FCL tears, and compare these modalities to
intraoperative findings.

Methods:
All patients who underwent an isolated FCL or combined ACL/FCL reconstruction
by a single surgeon between 2010 and 2017 with preoperative varus stress
radiographs and MRI were included in this study. A control group was
comprised of patients with an MRI and intact ACL and FCL. Sensitivity and
specificity of diagnosing FCL injuries on MRI were determined based on
review by a fellowship-trained musculoskeletal radiologist. The sensitivity
of diagnosing an FCL injury based on varus stress radiographs was also
determined. Furthermore, the ability of both imaging modalities to identify
an FCL injury was stratified based on acute versus chronic etiology.

Results:
A total of 232 patients were included: 98 patients in the FCL tear group and
134 patients in the control group. Varus stress radiographs were determined
to be more sensitive in diagnosing FCL injuries compared to MRI, with an
overall sensitivity of 70% compared to 66%. Based on chronicity of the
injuries, MRI was more accurate for detecting acute FCL injuries than
chronic injuries (p=0.002), and varus stress radiographs were more accurate
for detecting chronic FCL injuries than acute injuries (p=0.041).

Conclusion:
To our knowledge, this is the first clinical study to directly compare the
diagnostic accuracy of FCL tear detection utilizing MRI and varus stress
radiographs in the same patient cohort. While varus stress radiographs
appear to have a higher accuracy overall, the results from our study support
the use of both varus stress radiographs and MRI in diagnosing FCL injuries,
as MRI is more sensitive in diagnosing an acute FCL tear, and varus stress
radiographs are more sensitive in diagnosing a chronic FCL tear.

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