Magnetic Resonance Imaging of Acute Ankle Injuries
Abstract & Commentary
Synopsis: Careful examination of the entire ankle and subtalar joint, both in the acute and chronic setting, is a significant clinical suggestion of this paper.
Source: Tochigi Y et al. Acute Inversion Injury of the Ankle: Magnetic Resonance Imaging and Clinical Outcomes. Foot Ankle Int 1998;19(11):730-734
Twenty-four patients were studied in this series after an acute inversion injury of the ankle. MR imaging detected anterior talofibular ligament tears in 23, calcaneofibular ligament lesions in 15, posterior talofibular ligament lesions in 11, interosseous talocalcaneal ligament lesions in 13, cervical ligament lesions in 12, and deltoid ligament lesions in 8. There appeared to be a statistically significant relationship between the interosseous talocalcaneal ligament lesion and symptoms of giving-way and limitation of ankle motion. There was also a statistically significant relationship between cervical ligament lesions and giving-way and pain, as well as between the deltoid ligament lesion and giving-way. The authors were not able to address the association of clinical outcomes with the treatment modalities because the varieties of treatments rendered, as well as follow-up time, were not consistent. They were, however, able to draw some fairly significant conclusions among the ligament injuries, their locations, and persistent symptomatology.
Comment by James P. Tasto, MD
This MRI study brought to our attention a surprisingly high incidence of ligamentous injuries about the ankle and subtalar joint following acute inversion injuries. It is apparent that the simple ankle sprain oftentimes involves multiple ligamentous injuries about the ankle. Persistence of symptomatology, including pain and giving-way and feelings of instability, appears to be associated with injuries to the interosseous talocalcaneal ligament, the cervical ligament, and deltoid ligament. These are lesions that generally are not brought to the attention of the examiner but can result in some long-term disability. Careful examination of the entire ankle and subtalar joint, both in the acute and chronic setting, is a significant clinical suggestion of this paper. We may also find that the use of subtalar arthroscopy for diagnosis, as well as treatment of some of the ligamentous injuries of the cervical and interosseous ligaments, may play an increasing role in the management of these disorders. The paper did not address the appropriate clinical treatment of these lesions and did not outline for us the relationship between clinical outcomes and treatment modalities. It will be interesting in the future to see if we can draw some conclusions relative to the appropriateness of treatment of the ankle and subtalar joint in the acute setting.
References
1. Frey C et al. A comparison of MRI and clinical examination of acute lateral ankle sprains. Foot Ankle Int 1996;17:533-537
2. Meyer JM et al. The subtalar sprain: a roentgenographical study. Clin Orthop 1988;226:169-173
3. Verhaven EFC et al. The accuracy of three-dimensional magnetic resonance imaging in the diagnosis of ruptures of the lateral ligaments of the ankle. Am J Sports Med 1991;19:583-587
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