Abstract

APPERANCE OF ANKLE JOINT LIGAMENTS ON MRI: NORMAL VERSUS INJURED LIGAMENTS, PICTORIAL ASSAY

Dr. Sumood Mohammed Darweesh*, Dr. Hayder Edrees Jawad and Dr. Raed Haleem Al-Saad

ABSTRACT

Ankle sprains have been cited as the most frequent sports injuries. MRI can depict ligamentous injury and has been used to differentiate ligament tear from other causes of ankle pain such as fracture, osteochondral injury or tendon injury. Farther more MRI has important role in most patient with chronic ankle instability (CAI). Most cases are treated conservatively, however some patient may end with chronic instability. So, surgery can achieve better outcome, especially in young, physically active patients with severe injury. The aim of this study to provide Further emphasis on a pictorial review on ankle ligamentous injury using MRI, comparing with normal ligament. In this cross sectional study, fifty patients whom referred to MRI examination of ankle joint for ankle pain or for evaluation of ankle injury were included. The study was conducted in Al-Sadder Medical City at MRI unit, using close type Philips Achieva 1.5 Tesla MR Machine. We exclude cases of chronic inflammatory conditions such as rheumatoid arthritis and ankle with neoplastic lesions. MR examination was done using the slandered ankle protocol with sequences T1 sagittal, T2 and STIR in axial and coronal sections. The studies were reported by specialist musculoskeletal radiologist. We focusing on the lateral ligamentous complex, characterized the three components, the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), and posterior talofibular ligament (RTFL), and how the injured ligament appears on MRI. The medial collateral ligaments have been included in this study and diagnostic criteria of their injury has been mentioned. Normal sinus tarsi were encountered and criteria of sinus tarsi syndrome were described. This study revealed that ATFL is the weakest of the ankle ligament, and the most liable to injury, best seen in axial section of fluid sensitive sequences. The PTFL and the deltoid ligaments are strong and less frequently injured than ATFL, and are commonly injured in association with ATFL tear. The PTFL best seen in axial section, the same level of ATFL or one section bellow. The deltoid ligaments best seen in coronal T1 and T2 weighted image, with normal ligament demonstrate intermediate signal intensity in striated pattern, with disruption, irregularity and loss of striation are indicator of injuries. Obliteration of sinus tarsi fat and increased signal intensity within are feature of sinus tarsi syndrome on MRI.

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