Keywords:
Athletic injuries, Education, Diagnostic procedure, Ultrasound, MR, CT-High Resolution, Musculoskeletal system, Musculoskeletal joint, Oedema
Authors:
R. Leao, L. C. Zattar-Ramos, E. L. Bizetto, M. B. Rodrigues, D. T. Amaral, P. V. P. Helito, M. F. Correa, C. O. Kurimori, R. Y. Fernandes, R. S. Damasceno; Sao Paulo/BR
DOI:
10.1594/essr2016/P-0118
Imaging findings OR Procedure Details
1.
OSTEOCHONDRAL FRACTURE
Osteochondral fracture of the talar dome is the commonest missed fracture associated with inversion sprains.
It may be staged in 4 types of injury: from an undislocated compression fractures of the subchondral bone to a complete detachment and displacement of the fibro-osseous fragment.
The main imaging findings in MRi is the detection of a crescentic fracture line and a focal cartilage lesion,
with adjacent bone marrow edema.
In unstable osteochondral fractures we may find a high signal line demarcating the osteochondral fragment from the bone or the presence of sunchondral cysts.
Both x-rays and CT are able to detect displaced defects.
However,
they are insensitive in grading lower stage lesions and are inadequate in predicting stability.
The main places of these injuries are the talar or tibial articular surfaces but most frequently involve the lateral or medial talar dome.
Fig. 1: Male adult with chronic ankle pain six months after a sprain. A and B) COR T2 FS. Osteochondral lesion in the posteromedial portion of the talar domus and adjacent bone marrow edema. No signs of instability fragment.
2. ANKLE IMPINGEMENT
Sprain is the leading cause of impingement syndromes.
Soft tissue and osseous impingement syndromes of the ankle are a potential cause of chronic post- traumatic pain.
Frequently,
this event results from an inversion injury,
with a consequent injury to the lateral ligaments and / or syndesmosis causing proliferation of soft tissue in the anterolateral gutter.
There may be also lesions to the medial ligament complex (deltoid),
causing a medial fibrocicatricial proliferation.
This tissue may impact the osseous surfaces,
with osteophytes formation,
best seen on lateral view and a sagittal plane.
MRI may show marrow edema at impaction sites.
Patients present chronic pain and anterolateral swelling and limits dorsiflexion.
MRI may exclude the differentials as chondral defect,
osteochondral lesions,
intraarticular bodies,
spinal cord injuries.