IMAGING IN LIGAMANTOUS INJURIES OF

ANKLE JOINT
B.SUHASINI,
RESIDENT,
BIR.

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RADIOLOGY 1
ANTERIOR IMPINGEMENT
SYNDROME- SagT1/PD& FS PD
FSE

Spur formation on ant tibial plafond and post talar neck

Athletes / football player ankle

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RADIOLOGY 2
ANTERIOR IMPINGEMENT
SYNDROME

Radiograph tibial exostosis

CT- Sag reformats
Effn, chondral changes , marrow
changes not seen

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RADIOLOGY 3
ANTERIOR IMPINGEMENT
SYNDROME
MRI-T1WI

1. Bony vs fatty spur

2.Subchondral sclerosis
3.Synovial thickening vs fluid
4.T1C+ - Synovial enhancement

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RADIOLOGY 4
ANTERIOR IMPINGEMENT
SYNDROME
MRI-T2WI
1. Hypo Osteophyte , fibrous
overgrowth
2. Hyper- effn, synovium ,
subchondral edema
3. Tram track lesions- cart defects
of talus

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RADIOLOGY 5
ANTERIOR IMPINGEMENT
SYNDROME
GRADING
1 abnormal osseous contour AI
tibia
2 Sharp interface of hypertrophic
bone
3 Tib exostosis 1- 1.3 cm , sharp
margins
4 Tib exostosis > 1.3 cm +- frag

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RADIOLOGY 6
ANTERIOR IMPINGEMENT
SYNDROME
DD
Tibiotalar arthritis , synovitis
Talar #
Loose body

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RADIOLOGY 7
ANTEROLATERAL
IMPINGEMENT SYNDROME

Synovitis & fibrosis of AITFL , ATFL

ANDlateral gutter

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RADIOLOGY 8
ANTEROLATERAL
IMPINGEMENT SYNDROME
Features:
1. Osteophytes
2.Loose bodies
3. Synovial thickening & adh bands
4. Meniscoid shaped lesions

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RADIOLOGY 9
 ANTEROLATERAL
IMPINGEMENT SYNDROME

Features: T1 WI
1. Osteophytes HYPO
2.Loose bodies
3. Synovial thickening & adh bands INT + CE
4. Meniscoid shaped lesions
5. Fat effacement ant to AITFL
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RADIOLOGY 10
ANTEROLATERAL
IMPINGEMENT SYNDROME
T2 WI
Hyper : Fluid and synovium
Hypo : Fibrosis & loose bodies
Int : Hyalinised mass and talar
chondromalacia

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RADIOLOGY 11
 ANTEROLATERAL
IMPINGEMENT SYNDROME
DD
OLT
PVNS
Syn osteo chondromatosis
Ganglion cyst
Retracted ATFL tear
Sinus tarsi syndrome

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RADIOLOGY 12
SYNDESMOSIS SPRAIN

Str / tear of inf tib fib syndesmotic lig

Inf TF jt diastasis 2.3 mm 7.3mm
ATFL , PTFL ,TTFL and int oss memb
are involved

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RADIOLOGY 13
SYNDESMOSIS SPRAIN
Radiographs
Ext rot stress film widened mortise
AP - > syn clear space - N < 6mm
CT
1-3 mm diastasis

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RADIOLOGY 14
SYNDESMOSIS SPRAIN

T1WI
Lig disruption
TF diastasis
Fib shortening
Lat fib subluxn
IO memb Ca 2+
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RADIOLOGY 15
SYNDESMOSIS SPRAIN
T2WI

Synd lig thickening , discontinuity,

hyperint

Int oss memb hypo Ca2+ / hge

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RADIOLOGY 16
 SYNDESMOSIS SPRAIN
DD
1. Post impingement
2. Fib #
3. Comp synd
4. Lat ankle instability

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RADIOLOGY 17
SYNDESMOSIS SPRAIN

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RADIOLOGY 18
DELTOID LIGAMENT SPRAIN

Partial / complete tear

Morphology - superficial TC [2cm *1cm]
and deep TT part[ 1.5 *1.5 * 1cm

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RADIOLOGY 19
DELTOID LIGAMENT SPRAIN

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RADIOLOGY 20
DELTOID LIGAMENT SPRAIN

MRI
Med malleolus - #
,subchondral edema
Lig- discontinuity , edema,
ossifn marrow , degen
changes
Ax &cor deep vs
superficial
FFS PD FSE
neurovascular structures

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RADIOLOGY 21
DELTOID LIGAMENT SPRAIN

DD
1. Normal lig
2. Accessory ossfn centre Acc navicular
3. Fracture - MM
4. Impingement
5. TPTD

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RADIOLOGY 22
DELTOID LIGAMENT SPRAIN

GRADING
I Stretch
II Partial tear
Iii Complete tear

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RADIOLOGY 23
CALCANEOFIBULAR LIGAMENT
SPRAIN

Lateral malleolus to lateral surface of

calcaneus
2cm * 4-6mm
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RADIOLOGY 24
CALCANEOFIBULAR LIGAMENT
SPRAIN

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RADIOLOGY 25
CALCANEOFIBULAR LIGAMENT
SPRAIN
MRI
Partial / comp tear
Lig laxity
Irregular contour
Ass edema/
tenosynovitis
Att fibers

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RADIOLOGY 26
CALCANEOFIBULAR LIGAMENT
SPRAIN

DD
1. # ant pr calc. ,lat pr talus, fibula, base of 5th
metatarsal
2. Sprain ATFL,bifurcate lig , lisfranc lig
3. OLT
4. Subtalar coalition

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RADIOLOGY 27
ANTERIOR TIBIOFIBULAR LIG
TEAR

5mm * 12mm
Anterior border of lat malleolus anterior to
lateral articular facet of talus

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RADIOLOGY 28
ANTERIOR TIBIOFIBULAR LIG
TEAR
MORPHOLOGY
1.Interruption
2. Irregular contour
3. Laxity
4. Thickening
5. Edema
6. Capsule rupture
7. Effn
8. Hge
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RADIOLOGY 29
ANTERIOR TIBIOFIBULAR LIG
TEAR

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RADIOLOGY 30
ANTERIOR TIBIOFIBULAR LIG
TEAR
DD
1.Stress # , ant pr calc, lat pr talus# ,cal/talar
neck # ,fib #
2.Per tendon dysfn
3.OLT

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RADIOLOGY 31
SYNDESMOTIC IMPINGEMENT

Synovitis and scar after injury to syndesmotic

lig

Characterised by inflamed synovium and

synovial nodules

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RADIOLOGY 32
SYNDESMOTIC IMPINGEMENT

MR features of loose bodies, synovitis, free

fluid ,ganglion cysts

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RADIOLOGY 33
SYNDESMOTIC IMPINGEMENT

DD
1.Ant impingement
2.Post impingement
3.#base of 5th metatarsal
4.Achilles tendon injury
5. OLT
6.Peroneal tendon dysfn

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RADIOLOGY 34
POSTERIOR IMPINGEMENT

Edema of TTFL,ATFL,PTFL&Tibial slip

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RADIOLOGY 35
POSTERIOR IMPINGEMENT

DD
1.Os trigonum syndrome
2.OLT
3.PTFL strain
4.Peroneal subluxn
5.Subtalar arthritis
6.Tarsal coalition

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RADIOLOGY 36
 POSTERIOR IMPINGEMENT

Hypertrophy / tear with edema /fibrosis

Periostitis
Syn thickening
Ganglion cyst

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RADIOLOGY 37
SINUS TARSI SYNDROME

Injury to contents of tarsal canal and sinus

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RADIOLOGY 38
SINUS TARSI SYNDROME

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RADIOLOGY 39
SINUS TARSI SYNDROME

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RADIOLOGY 40
SINUS TARSI SYNDROME

T2WI & T1CE

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RADIOLOGY 41
SINUS TARSI SYNDROME

DD
1. Ganglion
2. Lipoma
3. Infl. Arthritis
4. Tarsal coalition
5. Subtarsal arthrosis
6. Bifurcate lig sprain
7. Lateral ankle lig sprain
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RADIOLOGY 42
BARNARD INSTITUTE OF
RADIOLOGY 43