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Wk 9, Case 4, Foot/Ankle MR - Review

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Report

Patient History

17 M left ankle injury during football game

Findings

ARTICULATIONS:

Bone: No acute fracture or bony injury.

Tibiotalar joint: No arthropathy or osteochondral defects.

Hindfoot: Partial fibrocartilaginous coalition of the posterior subtalar joint. No arthropathy or chondromalacia.

Midfoot: No arthropathy or chondromalacia.

LIGAMENTS:

Anterior inferior tibiofibular ligament: Torn and detached from the anterolateral tibia (Chaput's tubercle) and lateral malleolus (Wagstaffe's tubercle). Discontinuous and irregular morphology increased intrasubstance signal.

Posteroinferior tibiofibular ligament: Intact.

Transverse ligament: Intact.

Interosseous membrane and ligament: High-grade sprain with increased intrasubstance signal.

Anterior talofibular ligament: High grade tear.

Posterior talofibular ligament: Intact.

Calcaneofibular ligament: High grade tear.

Deltoid ligament complex: Intact.

TENDONS:

Peroneus Longus/Brevis: Intact.

Posterior Tibialis: Intact.

Flexor Compartment: Intact.

Extensor Compartment: Diffuse edema.

GENERAL:

Muscles: Diffuse reactive sprain throughout the inferior extensor musculotendinous compartments.

Soft Tissue: Diffuse subcutaneous edema and periarticular soft tissue swelling.

Plantar Fascia: Intact.

Joint Effusion: Small tibiotalar joint effusion/hemarthrosis.

Intra-Articular/Loose Bodies: None.

Impressions

1. High ankle sprain with complete tears of the anterior inferior tibiofibular ligament, and high-grade sprain of the interosseous ligament and membrane. Minimal passive diastasis.

2. Diffuse subcutaneous edema and periarticular soft tissue swelling.

3. Small tibiotalar joint effusion/hemarthrosis.

4. High grade two part low ankle sprain/tears of the anterior talofibular lig and calcaneofibular ligament.

5. Anterolateral peroneal retinacular stripping but no peroneus longus or brevis dislocation.



Case Discussion

Faculty

Stephen J Pomeranz, MD

Chief Medical Officer, ProScan Imaging. Founder, MRI Online

ProScan Imaging

Gitanjali Bajaj, MD

Assistant Professor

University of Arkansas for Medical Sciences

Edward Smitaman, MD

Clinical Associate Professor

University of California San Diego

Brian Y. Chan, MD

Assistant Professor of Musculoskeletal Radiology

University of Utah

Tags

Musculoskeletal (MSK)

MRI

Foot & Ankle

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