Injuries of the lateral collateral ligaments of the ankle: assessment with MR imaging

Abstract

The aim of this study was to evaluate the ability of MRI to display injuries of the lateral collateral ligamentous complex in patients with an acute ankle distorsion trauma. The MR examinations of 36 patients with ankle pain after ankle distorsion were evaluated retrospectively without knowledge of clinical history, outcome and/or operative findings. The examinations were performed on a 1. 5-T whole-body imager using a flexible surface coil. The signs for ligamentous abnormality were as follows: complete or partial discontinuity, increased signal within, and irregularity and waviness of the ligament. The results were compared with operative findings in 18 patients with subsequent surgical repair. Eighteen patients with conservative therapy had a follow-up MR examination after 3 months. There was 1 sprain, 3 partial and 32 complete tears of the anterior talofibular ligament, and 5 sprains, 5 partial, and 7 complete tears of the calcaneofibular ligament. There were no lesions of the posterior talofibular ligament. Compared with surgery, MRI demonstrated in 18 of 18 cases the exact extent of anterior talofibular ligament injuries and underestimated the extent in 2 of 8 cases of calcaneofibular ligament injury. In patients with follow-up MRI after conservative therapy, a thickened band-like structure was found along the course of the injured ligament in 17 of 18 cases. The absence of ligament repair after conservative treatment was confirmed during operative revision in one case. The MRI technique allows for grading of the extent of injury of the lateral collateral ligamentous complex after acute ankle strain. It seems to be suitable for monitoring the healing process after conservative-functional treatment of ligament tears.

Traumatic injuries: imaging of peripheral musculoskeletal injuries

“…If the clinical stress test is positive, stress radiography can be performed; however, there is no consensus about the usefulness of stress radiography in acute ankle sprain, particularly about the cut-off talar tilt angle beyond which a ligament rupture would be certain, ranging from 5 to 30°. Presently, MRI is not regularly used for this indication, although it allows, with controlled positioning of the foot and with defined sections, visualization of injured lateral collateral ankle ligaments with high precision [43]. Subchondral bone bruise in the medial femoral condyle.…”

Follow-Up MR Imaging of the Alar and Transverse Ligaments after Whiplash Injury: A Prospective Controlled Study

“…Any high signal intensity due to edema or bleeding from acute mechanical injury would be expected to decrease as the acute responses resolve. [21][22][23] The unaltered signal intensity also does not support the theory that acute ligament injury invisible on MR images in the acute phase can cause the development of high signal intensity seen only at a later stage of injury, eg, after a repair process or due to accelerated degeneration. 11 We cannot completely rule out that such high signal intensity may occur later than 12 months after injury.…”

Fast and ultrafast non-echo-planar MR imaging techniques

“…A further improvement in T2-weighted imaging of the spine seems to be the utilization of a driven equilibrium RF pulse, allowing T2-weighted 3D imaging of the cervical spine with a repetition time as short as 211 ms within an acquisition time of 4 min 14 s [26]. As T2-weighted imaging has also been used in the past to study the integrity of joints, fast spin echo imaging has replaced the conventional SE protocols for the evaluation of ligamental injuries, documenting joint effusion, edema, or hemarthrosis as hyperintense signal regions on T2-weighted TSE images [57]. Both FLASH and FISP have been used for the evaluation of human articular cartilage [58]; however, for chondral abnormalities as a result of traumatic injury or arthritis the contrast between cartilage and joint fluid is The hyperintense distribution within the fetal brain is typical for the appearance of cerebrospinal fluid in the case of ventriculomegaly frequently inadequate.…”