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Andreas Boss

Publications and source records attributed to Andreas Boss.

At least 19 recordsLinked to original sources
PubMed2007

Quantitative assessment of glomerular filtration rate with MR gadolinium slope clearance measurements: a phase I trial.

PURPOSE: To prospectively demonstrate the feasibility of quantifying the glomerular filtration rate (GFR) by assessing the renal clearance of gadolinium-based contrast medium from the extracellular fluid volume in healthy volunteers. MATERIALS AND METHODS: The study was approved by the ethics committee and the governmental drug administration department (registration number 4030139, EudraCT number 2004-002969-20, study protocol number 318/2004). Informed consent was obtained from 16 healthy volunteers (six female, 10 male; mean age, 24.5 years +/- 2.8 [standard deviation]). Thirteen volunteers (four women, nine men; mean age, 24.8 years +/- 2.7; range, 23-30 years) successfully contributed to the study. The GFR was assessed by recording the renal clearance of gadobutrol (3.75 mL, approximately 0.05 mmol per kilogram of body weight) at navigator-gated turbo fast low-angle shot magnetic resonance (MR) imaging. Time-signal intensity curves were constructed from manually drawn regions of interest in the liver, spleen, and renal cortex, and the GFR was calculated by using exponential fitting. Simultaneously obtained iopromide clearance measurements were the reference standard. Statistical evaluations included Bland-Altman plotting and analysis of the relative deviation from iopromide clearance. RESULTS: Evaluation of liver regions of interest revealed the lowest mean of paired differences from the iopromide clearance measurements (-5.9 mL/min per 1.73 m(2) +/- 14.6), with a mean GFR of 109.0 mL/min per 1.73 m(2) +/- 17.1 (134.1 mL/min per 1.73 m(2) +/- 35.4 for spleen, 100.7 mL/min per 1.73 m(2) +/- 25.1 for renal cortex) compared with a mean GFR of 103.1 mL/min per 1.73 m(2) +/- 9.4 measured by using iopromide clearance. The maximum deviation of MR-determined gadobutrol clearance values from iopromide clearance values was 29.2%. The mean disposition half-life of gadobutrol measured in the liver was 83.0 minutes +/- 14.2 (72.4 minutes +/- 20.2 in spleen, 92.6 minutes +/- 23.7 in renal cortex). CONCLUSION: The described MR imaging method enables absolute quantification of the GFR after routine contrast material-enhanced MR imaging.

Adult↗
PubMed2007

Bipolar radiofrequency ablation using internally cooled electrodes in ex vivo bovine liver: prediction of coagulation volume from applied energy.

OBJECTIVE: We sought to evaluate the relationship between parameters of bipolar radiofrequency (RF) ablation using internally cooled electrodes. MATERIALS AND METHODS: Bipolar RF ablations (n = 24) were performed in ex vivo bovine liver using an internally cooled applicator with 2 electrodes located on the same shaft. The power-output was systematically varied (20-75 W). On the basis of our experimental data, mathematical functions were fitted and the goodness-of-fit was assessed by the parameter R. RESULTS: The duration to induce an increase of tissue resistance and the amount of applied energy increased with a decreased power-output. The maximum short-axis was 4.5 cm (20 W) and required an application of 64 kilojoules (kJ). The volume of coagulation can be determined as a function of the duration of energy application (R = 0.954) and the amount of applied energy (R = 0.945). CONCLUSION: The amount of applied energy and the duration of energy application can predict the volume of induced coagulation and may be useful to control internally cooled bipolar RF ablation.

Animals↗
PubMed2006

Image-guided radiofrequency ablation of renal cell carcinoma.

The incidence of renal cell carcinoma is rising with the increased number of incidental detection of small tumours. During the past few years, percutaneous imaging-guided radiofrequency ablation has evolved as a minimally invasive treatment of small unresectable renal tumours offering reduced patient morbidity and overall health care costs. In radiofrequency ablation, thermal energy is deposited into a targeted tumour by means of a radiofrequency applicator. In recent studies, radiofrequency ablation was shown to be an effective and safe modality for local destruction of renal cell carcinoma. Radiofrequency applicator navigation can be performed via ultrasound, computed tomography or magnetic resonance guidance; however, ultrasound seems less favourable because of the absence of monitoring capabilities during ablation. On-line monitoring of treatment outcome can only be performed with magnetic resonance imaging giving the possibility of eventual applicator repositioning to ablate visible residual tumour tissue. Long-term follow-up is crucial to assess completeness of tumour ablation. New developments in ablation technology and radiological equipment will further increase the indication field for radiofrequency ablation of renal cell carcinoma. Altogether, radiofrequency ablation seems to be a promising new modality for the minimally invasive treatment of renal cell carcinoma, which was demonstrated to exhibit high short-term effectiveness.

Carcinoma, Renal Cell↗
PubMed2006

Contrast-enhanced dynamic MR nephrography using the TurboFLASH navigator-gating technique in children.

The purpose of this work was to test the feasibility of an MR examination protocol for the comprehensive assessment of renal morphology, excretion and split renal function using a navigator-gated TurboFLASH sequence. A navigator-gated T1-weighted single-slice TurboFLASH sequence suitable for dynamic MR urography and nephrography was implemented. A protocol was developed allowing for assessment of urinary excretion and split renal function by recording the renal clearance of a gadolinium (Gd) diethylene-triamine-pentacetic-acid (DTPA) bolus. Ten patients aged between 14 months and 14 years (mean age 4.8+/-4.6 years) were evaluated with the following indications: pelvicalyceal dilatation (n=4), follow-up after pyeloplasty (n=1), duplex systems (n=3), large renal cyst (n=1), and renal insufficiency (n=1). Dynamic MR urography and MR split renal function were compared to MAG3 scintigraphy. Evaluation of morphology, excretion and function required 50-60 minutes examination time, plus 10 minutes for post-processing. The TurboFLASH sequence yielded image acquisition at nearly identical diaphragm positions allowing for accurate region-of-interest evaluation within the renal parenchyma and the urinary passage. Static and dynamic MR urography showed the morphology of the urinary tract and excretion with sufficient diagnostic imaging quality, and the results were in diagnostic compliance with scintigraphy. MRI and scintigraphy yielded similar results for split renal function with a correlation coefficient of R=0.968 determined by linear regression. Our conclusions were that the method is robust, easy to perform on a clinical 1.5 T MRI system, rapid to evaluate and post-process and, therefore, easy to incorporate into clinical routine. Compared to scintigraphy, the higher spatial resolution of the MR examination provides additional important information improving the management of the pediatric patients without the application of radioactive tracers.

Adolescent↗
PubMed2006

Morphological, contrast-enhanced and spin labeling perfusion imaging for monitoring of relapse after RF ablation of renal cell carcinomas.

MR perfusion imaging was applied for the assessment of completeness in the destruction of renal cell carcinomas by RF ablation (RFA) in a pilot study. An arterial spin labeling (ASL) approach was compared to conventional contrast-enhanced T1-weighted (CE-T1w) imaging. Ten patients suffering from renal cell carcinoma were treated by RFA. For the assessment of the extent of coagulation and for the detection of residual tumor, T1-weighted gradient-echo imaging, T2-weighted spin echo imaging and two different perfusion imaging techniques were performed before, 1 day and 6 weeks after RFA at 1.5 T. Perfusion imaging comprised CE-T1 weighted and FAIR-TrueFISP ASL imaging. Perfusion images recorded in the acute stage after RFA showed higher compliance to the definitive ablation volume reached after 6 weeks than T2-weighted images, which underestimated the true necrosis size. In the detection of residual tumor tissue, both modalities complimented each other. The exclusion of residual tumor tissue could more reliably be performed using perfusion-imaging methods. Both perfusion-imaging modalities showed sufficient imaging quality for post-interventional monitoring. Perfusion imaging provides a higher predictability of the completeness of tumor ablation and extent of coagulation than T2-weighted imaging alone. Since the results of the FAIR-TrueFISP sequence are promising, the administration of potentially nephrotoxic contrast media may be avoided in the respective patient cohort.

Aged↗
PubMed2006

Multipolar radiofrequency ablation with internally cooled electrodes: experimental study in ex vivo bovine liver with mathematic modeling.

PURPOSE: To evaluate the size and geometry of thermally induced coagulation by using multipolar radiofrequency (RF) ablation and to determine a mathematic model to predict coagulation volume. MATERIALS AND METHODS: Multipolar RF ablations (n = 80) were performed in ex vivo bovine livers by using three internally cooled bipolar applicators with two electrodes on the same shaft. Applicators were placed in a triangular array (spacing, 2-5 cm) and were activated in multipolar mode (power output, 75-225 W). The size and geometry of the coagulation zone, together with ablation time, were assessed. Mathematic functions were fitted, and the goodness of fit was assessed by using r(2). RESULTS: Coagulation volume, short-axis diameter, and ablation time were dependent on power output and applicator distance. The maximum zone of coagulation (volume, 324 cm(3); short-axis diameter, 8.4 cm; ablation time, 193 min) was induced with a power output of 75 W at an applicator distance of 5 cm. Coagulation volume and ablation time decreased as power output increased. Power outputs of 100-125 W at applicator distances of 2-4 cm led to a reasonable compromise between coagulation volume and ablation time. At 2 cm (100 W), coagulation volume, short-axis diameter, and ablation time were 66 cm(3), 4.5 cm, and 19 min, respectively; at 3 cm (100 W), 90 cm(3), 5.2 cm, and 22 min, respectively; at 4 cm (100 W), 132 cm(3), 6.1 cm, and 27 min, respectively; at 2 cm (125 W), 56 cm(3), 4.2 cm, and 9 min, respectively; at 3 cm (125 W), 73 cm(3), 4.9 cm, and 12 min, respectively; and at 4 cm (125 W), 103 cm(3), 5.5 cm, and 16 min, respectively. At applicator distances of 4 cm (>125 W) and 5 cm (>100 W), the zones of coagulation were not confluent. Coagulation volume (r(2) = 0.80) and RF ablation time (r(2) = 0.93) were determined by using the mathematic model. CONCLUSION: Multipolar RF ablation with three bipolar applicators may produce large volumes of confluent coagulation ex vivo. A compromise is necessary between prolonged RF ablations at lower power outputs, which produce larger volumes of coagulation, and faster RF ablations at higher power outputs, which produce smaller volumes of coagulation.

Animals↗
PubMed2006

Whole-body magnetization transfer contrast imaging.

PURPOSE: To demonstrate the feasibility of whole-body magnetization transfer (MT) contrast imaging. MATERIALS AND METHODS: Whole-body MT imaging was performed on eight healthy volunteers and five patients (mean age=40.5+/-17.8 years) with diagnoses of dermatomyositis (N=1), B-symptoms with suspicion of paraneoplastic disease (N=1), metastatic malignant melanoma (N=1), and multiple sclerosis (MS) (N=2). Measurements were carried out on a 1.5-Tesla whole-body MR scanner capable of parallel signal reception. A three-dimensional (3D) gradient-echo sequence (TR=17 msec, TE=4.8 msec, flip angle=10 degrees) was applied in combination with a Gaussian off-resonance MT preparation pulse acting at an off-resonance of 1.500 Hz with a 500 degrees effective flip angle. Whole-body images were constructed from five different body regions. RESULTS: In all subjects, whole-body MT contrast images were obtained within less than 20 minutes of measuring time. The images showed sufficient diagnostic image quality to assess the patients' pathologies. The MT ratios (MTRs, in percent units) for the volunteers were as follows: white matter (WM) 51.1+/-1.0, gray matter (GM) 42.2+/-1.3, skeletal muscle (mean value of four muscle groups) 50.3+/-2.1, liver 39.4+/-3.2, spleen 31.8+/-2.6, renal cortex 30.4+/-1.9, and renal medulla 25.6+/-1.3. The MTRs for the pathologies were as follows: skeletal muscle in dermatomyositis approximately 30, metastases in malignant melanoma 30.7-36.0, uterus myoma 49.3, and MS lesions 30-40. CONCLUSION: Our preliminary data indicate that MT contrast in whole-body MRI is feasible, and may be useful for rapid whole-body assessment of diseases that exhibit high contrast in MT imaging, such as MS and muscular disorders.

Adult↗
PubMed2006

Quantitative lung perfusion mapping at 0.2 T using FAIR True-FISP MRI.

Perfusion measurements in lung tissue using arterial spin labeling (ASL) techniques are hampered by strong microscopic field gradients induced by susceptibility differences between the alveolar air and the lung parenchyma. A true fast imaging with steady precession (True-FISP) sequence was adapted for applications in flow-sensitive alternating inversion recovery (FAIR) lung perfusion imaging at 0.2 Tesla and 1.5 Tesla. Conditions of microscopic static field distribution were assessed in four healthy volunteers at both field strengths using multiecho gradient-echo sequences. The full width at half maximum (FWHM) values of the frequency distribution for 180-277 Hz at 1.5 Tesla were more than threefold higher compared to 39-109 Hz at 0.2 Tesla. The influence of microscopic field inhomogeneities on the True-FISP signal yield was simulated numerically. Conditions allowed for the development of a FAIR True-FISP sequence for lung perfusion measurement at 0.2 Tesla, whereas at 1.5 Tesla microscopic field inhomogeneities appeared too distinct. Perfusion measurements of lung tissue were performed on eight healthy volunteers and two patients at 0.2 Tesla using the optimized FAIR True-FISP sequence. The average perfusion rates in peripheral lung regions in transverse, sagittal, and coronal slices of the left/right lung were 418/400, 398/416, and 370/368 ml/100 g/min, respectively. This work suggests that FAIR True-FISP sequences can be considered appropriate for noninvasive lung perfusion examinations at low field strength.

Adolescent↗
PubMed2006

Quantitative ASL muscle perfusion imaging using a FAIR-TrueFISP technique at 3.0 T.

The feasibility of muscle perfusion imaging with diagnostic image quality was demonstrated using the FAIR-TrueFISP arterial spin labeling technique on a clinical 3.0 T whole-body scanner. In eight healthy volunteers (24 to 42 years old), quantitative perfusion maps of the forearm musculature were acquired before and after intense exercise. All measurements were carried out in a 3.0 T whole-body MR unit in combination with an eight-channel head coil. Pulsed arterial spin labeling and data recording were performed with an adapted FAIR-TrueFISP technique and quantitative perfusion maps were calculated on a pixel-by-pixel basis by means of the extended Bloch equations. Perfusion images with an in-plane resolution of 1 mm showed no significant distortions or blurring. Perfusion-time curves could be recorded with a temporal resolution of 6.4 s. Maximum perfusion in the musculature was found approximately 2 min after exercise, reaching values of up to 220 mL/min per 100 g of tissue with good delineation between the active muscles and the musculature not involved in the exercise. In conclusion, the TrueFISP pulsed arterial spin labeling technique allows patient-friendly assessment of muscular perfusion in a clinical whole-body scanner.

Adult↗
PubMed2006

MR-guided radiofrequency ablation: do magnetic fields influence extent of coagulation in ex vivo bovine livers?

PURPOSE: To prospectively determine if static magnetic fields of magnetic resonance (MR) imagers affect radiofrequency (RF) ablation coagulation volume and shape. MATERIALS AND METHODS: Ex vivo RF ablations of bovine livers were performed with magnetic field strengths of 0.2, 1.5, and 3.0 T and were compared with ablations performed outside the magnetic field in a control group. Two MR-compatible monopolar RF devices (internally cooled single and cluster electrodes) were systematically tested. Length of long axis (y-axis), length of two short axes (x- and z-axes), and coagulation volume and shape measured outside and inside different magnetic fields were compared with the Dunnett test. Significance level was set to .05. RESULTS: For the single electrode, no significant difference was observed between length of short axes and coagulation volume and shape measured inside and outside the magnetic field. Mean x- and z-axis lengths were 2.3 and 2.6 cm, respectively, outside the magnetic field; 2.4 and 2.4 cm, respectively, at 0.2 T; 2.5 and 2.6 cm, respectively, at 1.5 T; and 2.2 and 2.5 cm, respectively, at 3.0 T. Differences between length of long axis, length of short axis perpendicular to static magnetic field, and coagulation volume and shape achieved with the cluster electrode inside and outside the magnetic field were not significant. Mean x- and z-axis lengths were 3.9 and 3.9 cm, respectively, outside the magnetic field; 3.7 and 3.8 cm, respectively, at 0.2 T; 4.0 and 4.3 cm, respectively, at 1.5 T; and 3.8 and 3.8 cm, respectively, at 3.0 T. Differences between ablations performed at 1.5 T and those performed in the control group with the cluster electrode were significant (P = .026). In this case, a difference of 4 mm in the length of the short axis parallel to the magnetic field was detected, but there was no significant difference in coagulation volume. CONCLUSION: No significant differences in coagulation volume and shape could be recorded between RF ablations performed outside and those performed inside the static magnetic field.

Animals↗
PubMed2005

Interaction between grounding pads used for RF ablation therapy and magnetic resonance imaging.

OBJECTIVES: To characterize artifacts and imaging problems in the presence of conductive grounding pads for RF ablation therapy as well as potential heating problems due to induction of eddy currents in the pads. Strategies for avoidance of those problems are developed. MATERIALS AND METHODS: Underlying principles of interactions between grounding pads and MR imaging are reported. Influential parameters, e.g., orientation in relation to the magnetic field, shape of the grounding pad, sequence type (spin-echo versus gradient echo) and magnetic field strength (0.2 T, 1.5 T, 3 T) were varied in systematic phantom studies. Heating effects due to induced eddy currents were estimated theoretically and measured by infrared imaging in an adapted set-up. RESULTS: MR imaging artifacts are markedly dependent on the orientation and geometrical shape of the grounding pads. Visible signal extinction artifacts were more pronounced using spin-echo techniques than in gradient echo images and increased for higher field strengths. Suitable incisions in the grounding pad reduced eddy currents markedly and minimized image artifacts. Heating problems due to induced eddy currents by the RF transmitted for MR imaging were excluded by phantom measurements. CONCLUSIONS: Suitable positioning of the grounding pads and adaptation of their geometry provide clearly reduced artifacts in MR imaging.

Animals↗
PubMed2005

Magnetic susceptibility effects on the accuracy of MR temperature monitoring by the proton resonance frequency method.

PURPOSE: To evaluate the error of MR temperature assessment based on the temperature-dependent Larmor frequency shift of water protons, which can result from susceptibility effects caused by the radiofrequency (RF) applicator. MATERIALS AND METHODS: Local frequency shifts due to RF applicator displacements were simulated numerically by means of a three-dimensional elementary dipole model. Experimental examinations using a water tank phantom equipped with a high-precision screw thread were applied to examine temperature and movement effects for five commercially available, MR-compatible RF applicators. Measurements were performed at 1.5 Tesla. RESULTS: For single-needle electrodes perpendicular to the external field, a distortion of 0.1 ppm and 0.2 ppm was recorded at a distance of 17.5 mm and 12.5 mm, respectively, to the needle shaft. Cluster applicators and umbrella-shaped applicators caused distortions of 0.1 ppm up to distances of 36 mm. Sinusoidal dependence on applicator orientation was found with the highest values for perpendicular orientation and the lowest values for orientation parallel to the magnetic field. With a single electrode oriented perpendicular to the field at a distance of 1.5 cm and 2.0 cm, a needle displacement of 5 mm led to an error in temperature measurement of 16.3 degrees C and 7.5 degrees C, respectively. CONCLUSION: In MR temperature measurement, displacement of the RF applicator by patient movement or breathing leads to significant errors that have to be taken into account when PRF temperature maps are used to monitor tumor ablation in the presence of paramagnetic applicators.

Catheter Ablation↗
PubMed2005

Magnetic resonance-guided percutaneous radiofrequency ablation of renal cell carcinomas: a pilot clinical study.

OBJECTIVE: The objective of this study was to assess the feasibility and efficacy of magnetic resonance imaging-(MRI) guided percutaneous radiofrequency (RF) ablation of renal cell carcinomas (RCC). SUBJECTS AND METHODS: Twelve patients with RCC (63 to 82 years old) were treated with RF ablation in an interventional 0.2-Tesla open MR unit. Tumor sizes varied from 1.6 cm to 3.9 cm in maximum diameter (tumor volumes 1.9 cm3 to 28.7 cm3). RF procedures were entirely performed in the MR suite. For positioning of the MR-compatible RF-electrode, near real-time MR fluoroscopy by means of rapid gradient echo sequences (acquisition time approximately 2 seconds) was used. Monitoring of ablation was obtained by intermittent imaging with T1- and T2-weighted spin echo sequences. RESULTS: Accurate placement of the RF electrodes was possible in all cases using near real-time MR fluoroscopy. Eleven of 12 patients were successfully treated within 1 single session; 1 patient had to be retreated for tumor relapse at 13 months follow up. Mean number of electrode repositionings under MR guidance during 1 session was 1.7; ablation time ranged between 12 and 28 minutes. Mean duration of 1 treatment session was 5 hours. Coagulation volumes ranged from 7.3 cm3 up to 30.2 cm3. All patients now appear to be disease-free with a mean follow up of 10.3 months (range, 3-23 months). CONCLUSION: MRI-guided RF ablation of RCC in an interventional MR unit is safe and feasible. Fast MR imaging is a convenient method for rapid positioning of MR-compatible RF electrodes. MR monitoring of ablation procedure with T2-weighted imaging allows for immediate assessment of coagulation extent.

Aged↗
PubMed2005

Identification and functional characterization of the muscarinic receptor M3 in the human keratinocyte cell line HaCaT.

In the epidermis muscarinic cholinergic receptors are expressed in keratinocytes during normal differentiation and in regeneration of the skin. The muscarinic receptors were implicated to regulate proliferation, migration and differentiation of keratinocytes. Therefore, we characterized the muscarinic receptor in the spontaneously immortalized human keratinocyte cell line HaCaT and studied its role in cell migration. By RT-PCR, Western blot and immunocytochemistry we show that HaCaT cells express the M3 receptor subtype. This receptor was further characterized by fluorometric measurement of calcium mobilization in cell suspensions. After muscarinic stimulation a peak reaction of intracellular calcium mobilization occurred followed by a plateau phase of extracellular influx which was reversible by atropine. In dose-response curves the effective concentrations of carbachol and acetylcholine were determined as 40 and 1 microM, respectively. The migratory activity of HaCaT cells was studied with the phagokinetic track assay. Treatment with the muscarinic agonist carbachol had no effect on cell migration. However, carbachol diminished the EGF-induced increase in migratory activity by about 26%. Interestingly, EGF and carbachol had additive effects on calcium mobilization.

Acetylcholine↗
PubMed2005

Thermal damage of the genitofemoral nerve due to radiofrequency ablation of renal cell carcinoma: a potentially avoidable complication.

OBJECTIVE: A technique is presented that may prevent damage to the genitofemoral nerve during percutaneous radiofrequency ablation of renal cell carcinomas. The genitofemoral nerve originates from the upper part of the lumbar plexus and descends laterally along the psoas major muscle, which is anatomically close to the kidney. During radiofrequency ablation, nearby healthy nerve tissue could be damaged by heat conductance. In the described technique, the radiofrequency applicator within the renal tumor is used as a lever to displace the kidney away from the psoas muscle. CONCLUSION: Three clinical cases are presented in this study. In one case, the technique was not applied, leading to coagulation of the genitofemoral nerve. In the other two cases, hazard to the genitofemoral nerve was averted by using the mentioned technique.

Aged↗
PubMed2003

Accuracy of arthroscopic assessment of anterior ankle cartilage lesions.

PURPOSE: The accuracy of arthroscopic evaluation of the size of an osteochondral lesion in the ankle joint was assessed in 10 cadaver feet. MATERIALS AND METHODS: A rectangular osteochondral defect was created in the anterior part of the talus. A 5 mm 30 degrees arthroscope was utilized for evaluation of the size of the lesion from an anterior midline portal under carbon dioxide. RESULTS: The size of the defect averaged 77.2 +/- 31 mm2 (24-10(8) mm2). The difference between area of the defect and measurement of three independent investigators averaged 52%, 49% and 49%, respectively. CONCLUSION: The assessment of the size of an osteochondral lesion in the ankle joint based on arthroscopy implicates over- and underestimation of the defect.

Ankle Joint↗
PubMedDate not supplied

Medial ankle instability: an exploratory, prospective study of fifty-two cases.

BACKGROUND: Very little objective data are available regarding medial ankle instability. HYPOTHESIS: Several structures contribute to the stabilization of the medial ankle, and, in the case of injury, they are not involved in a uniform way. STUDY DESIGN: Explorative, prospective case series. METHODS: Fifty-one patients (52 ankles; males 27, females 25; age 36.4 [16 to 60] years) were surgically treated because of medial ankle instability. All clinical findings and structural changes, as found by arthroscopy and surgical exploration, were compared with the clinical diagnosis and then addressed for surgical reconstruction. RESULTS: Pain in the medial gutter was noted in all ankles (100%). Arthroscopy verified a clinically expected additional lateral instability in 40 ankles (77%). At 4.43 years (2 to 6.5 years) after surgical reconstruction, the clinical result was considered to be good/excellent in 46 cases (90%), fair in 4 cases (8%), and poor in 1 case (2%). CONCLUSION: The clinical characteristics of medial ankle instability are a feeling of giving way, pain on the medial gutter of the ankle, and a valgus and pronation deformity of the foot that can typically be actively corrected by the posterior tibial muscle. Arthroscopy was shown to be a very helpful diagnostic tool in verifying medial instability.

Adolescent↗