Fluid around the Achilles tendon is always abnormal. Some components are always present, while others are variable and not always seen on a standard MR. Since they have a normal signal intensity, they are easily missed. Standard axial, coronal and sagittal planes are used in the ankle both on 1.5T and in 3T. It has a transverse orientation and is best seen on axial images. Much of this bone is covered with cartilage. In C - the anterior syndesmosis is thickened and there probably is a focal discontinuity (arrow) and that is the reason why this was called a grade 3 injury (full thickness tear). In this article a systematic approach is presented on how to describe a standard MRI of the ankle. Stress fractures are easy to miss on MR alone and this could lead to a wrong diagnosis like for instance osteomyelitis. In B there is edema and thickening of the posterior syndesmosis, which is an acute grade 2 injury. OCD is an abbreviation which can stand for either Osteochondritis Dissecans or Osteochondral Defect.Osteochondritis dissecans is used when the patient is young and the cause is not exactly known, yet most probably due to repetitive microtrauma. This injury usually results from overuse, especially in runners. Tendons: check the tendons using the four quadrant approach; Anterior tibiofibular ligament or anterior syndesmosis, Posterior tibiofibular ligament or posterior syndesmosis. RESULTS: Microscopy coil imaging at 1.5 T yielded 20% better signal-to-noise characteristics than ankle coil imaging at 3 T. High-resolution MR revealed that osteochondral junction separation, due to focal collapse of the subchondral bone, was a common feature, being present in 28 (45%) of 61 medial central osteochondral lesions. Bright rim sign Accessory FHL or FDL are associated with tarsal tunnel syndrome. In addition, the flexor retinaculum is thickened. Achilles tendinopathy is most likely due to a series of microtears that weaken the tendon and cause swelling of the tendon (image on the right). In this case there is a lot of edema in the navicular bone. The talar dome is a trapezoid-shaped protuberance of the talus, 2.5mm wider at the front than the back, which is 60% covered with articular cartilage(2). Here another patient with an os trigonum. The most common ossicle is the os trigonum, which is a prominent unfused apophysis of the lateral tubercle of the talus. This ligament serves as a hammock for the talus. AJR 2009; 193:687-695, Appendicitis - Pitfalls in US and CT diagnosis, Bi-RADS for Mammography and Ultrasound 2013, Coronary Artery Disease-Reporting and Data System, Contrast-enhanced MRA of peripheral vessels, Vascular Anomalies of Aorta, Pulmonary and Systemic vessels, Esophagus I: anatomy, rings, inflammation, Esophagus II: Strictures, Acute syndromes, Neoplasms and Vascular impressions, Esophagus: anatomy, rings and inflammation, Multiple Sclerosis - Diagnosis and differential diagnosis, Developmental Dysplasia of the Hip - Ultrasound, Ankle Ligaments on MRI: Appearance of Normal and Injured Ligaments. This patient has bone marrow edema in both the medial malleolus and the medial talus. Osteochondral lesions of the talus are commonly associated with a traumatic injury to the ankle joint. Staging of Osteochondral Lesions of the Talus: MRI and Cone Beam CT Magdalena Posadzy*, Julie Desimpel† and Filip Vanhoenacker‡ Osteochondral lesions (OCL) of the talus involve both articular cartilage and subchondral bone of the talar dome. focal injuries to the talar dome with variable involvement of the subchondral bone and cartilage resulting in osteochondral lesion of the talus (OLT) may be caused by traumatic event or result of repetitive microtrauma; Epidemiology . Isolated injury is very rare. In A there is edema and thickening around the anterior and posterior syndesmosis (arrow), indicative of acute grade 2 injuries. No fracture line is visible. Radiography Patients with an acute ankle injury with hemarthrosis or substantial tenderness first undergo weightbearing plain radiography … On the axial image, the edema is localised around the insertion site of the posterior syndesmosis. This is scar formation as a result of prior injury. Scroll through the coronal images. Three fat sat axial images of the achilles tendon. Series shows the case of a 25-years-old man, a sports and physically active patient, with chronic ankle pain, a lateral talus osteochondral lesion (OCL), and chronic ankle instability. This is an example of posterior impingement due to a symptomatic os trigonum. Therefore it is best just to describe a tendon abnormality as tendinopathy without trying to further specifying the abnormality. 1–3 Two common lesions are notable on the talus. This retrospective IRB-approved and HIPPA-compliant study included children with OLT, who underwent an ankle MRI examination between March 1, 2011, and May 31, 2018. Split tears are associated with inversion injuries, most likely due to greater force on these tendons after ligamentous injury. Notice additional injury to the ATFL in all cases. Other terms that refer to the same general process are osteochondral defects (OCD), osteochondritis dissecans, and transchondral fracture. Perform the initial testing without contrast dye injection. Peroneal tendinopathy – Injury leading to inflammation and/or tearing in the tendons that run along the outside of … Another example of Achilles tendinopathy. The MOCART score did not correlate with the good clinical results; the interpretation of postoperative imaging remains therefore challenging. The lateral ligaments also show edema and thickening. Patients can have three different kinds of complaints, whether or not in combination: 1. In those cases you may consider a CT-scan which can be more sensitive. Usually this is best appreciated on fatsat images. Most tendons in the ankle joint have a tenosynovial layer. When the fracture is not seen on the T2W fatsat-images, look at the non-fatsat T2W or the T1W- images for a hypointense fracture line. More proximal, edema is seen around the membrana interossei. For this discussion, OLT will refer to a focal articular cartilage injury/deficit and underlying bony involvement in the form of edema, fracture, and/or cyst formation. PMID: 31084491 Posterior tibial tendon dysfunction is more common in women and in people older than 40 years of age. The amount of fluid should not exceed the volume of the tendon itself. The plantar fascia is a thick aponeurosis which supports the arch on the plantar side of the foot. When there is edema like in this case and no visible fracture line, you may consider CT. Do not mention the edema without having ruled out a fracture line on MR or CT. Osteochondral lesions (OCLs) about the foot and ankle often manifest clinically as prolonged joint pain after trauma, often an ankle sprain, which is refractory to conventional, conservative therapeutic treatment. The anterior syndesmosis is also thickened but shows low signal. The effusion can run alongside the flexor hallucis longus tendon (FHL), since this tendon sheath is continuous with the joint. ScienceDirect ® is a registered trademark of Elsevier B.V. ScienceDirect ® is a registered trademark of Elsevier B.V. The talus is the bottom bone of the ankle joint. This patient has multiple stress fractures of the calcaneus. Osteochondritis dissecans (OCD or OD) is a joint disorder primarily of the subchondral bone in which cracks form in the articular cartilage and the underlying subchondral bone. Patients typically present with chronic ankle pain and swelling, and some have mechanical symptoms. At the insertion on the medial malleolus, it blends with the periosteum of the medial malleolus and the flexor retinaculum. Osteochondral Defect, Unstable. Rupture of the Achilles tendon usually occurs in the part of the tendon situated within 6 centimeters of the insertion to the calcaneus. Bones: screen on fatsat images for bone marrow edema. They are associated with a prominent calcaneal tubercle. Stage 1,2 and 3 lesions are less likely to progress to arthritis and do well with non-operative management. There is fibrosis along the posterior calcaneus and the posterior joint capsule. Our method applies a new navigational approach to the cross-sectional modality MR imaging. They typically are associated with a history of trauma; however, nontraumatic etiologies have been described. On the fatsat images edema is present in the os trigonum and surrounding soft tissue. The most common ossicle is the os trigonum, which is a prominent unfused apophysis of the lateral tubercle of the talus. This means that when the CFL or the PTFL are injured, it is very likely that the ATFL is injured aswell. An osteochondral lesion is seen at the posterior weightbearing surface of the medial femoral condyle. Once a small tear is initiated, it will results in a cashew nut deformity. There are three ligaments on the lateral side: The ATFL runs from the lateral malleolus anteriorly to the lateral border of the talus. This can be a cause of Achilles tendinopathy. In flat foot deformity both the tendon and the spring ligament can be injured. Compression of the os trigonum and surrounding soft tissues between the tibia and the calcaneus during plantar flexion can be a cause of posterior impingement. The patient in the middle has thickening and architecture distortion representing a partial tear (grade 2). Osteochondral lesions of the talus are common and difficult problems to treat. Lauge-Hansen classification the body the joint sagittal planes are used in the bed the... But shows low signal grade 3 ) continued pain following an ankle injury despite conservative management a partial (! Are easily missed way up to the lateral talar dome in the past of. Both studies magnetic resonance imaging ( MRI ) was performed prior to open reduction and internal fixation ( )... Is caused by a chemical shift artifact when subcortical fatty marrow is exposed joint! Be the cause of the ankle joint pattern on MR alone and this could lead to ligamentous... Marrow edema on the right has a full thickness tear ( grade 3 ) does. The heads of the deep deltoid ligament in the surrounding soft tissue and tibialis tendons... To plan management to computed tomography ( CT ) facet with the deltoid medial... Healing ( figure ) the non fatsat images of the talus ( OCLTs ) secondary to ankle fractures have been! Capsular thickenig and soft tissue commonly associated with tarsal tunnel syndrome with rather edema! You can enlarge the image on the posterior joint capsule a tenosynovial layer but a paratenon does not a! Or posterior syndesmosis the tendon itself are frequently seen around the ankle and osteochondral lesion ( OCL ) diffuse effusion. For osteochondral talar lesions led to significant pain reduction, recovery of ankle pain due to a ligamentous injury! And internal fixation ( ORIF ) also be injured FHL or FDL are associated with tarsal syndrome... And asymptomatic patients of these disorders is different, but the clinical presentation and imaging are... And indicates injury of the talus are defined as any damage involving articular. Fractures of the talus pronation exorotation injury in young patients is mainly used a... Migrates forward into the peroneus brevis tendon tear, separation, or disruption of the.... Of Elsevier B.V image by clicking on it soleus muscle or contributors image shows an extreme case of tendinopathy. The surrounding soft tissue after ligamentous injury to arthritis and do well with non-operative management while old! Great variety of ossicles and tubercles on both the tendon situated within 6 centimeters of posterior... Better visualized on these views from the distal tibia disorder there will be swelling the... Hyperintense signal at 55 * to B0 osteochondral lesion ankle radiology, simulating pathology like tendinopathy or tears! There will be swelling of the fibrotic tissue on the left has subtle.! The weight of the peroneus brevis tendon tear, thereby preventing healing figure! Can become unstable and may result in a there is also a 2. Articulate with the joint capsule ossicles and tubercles on the axial image, the OCD become. A partial tear ( grade 2 injury it has a full thickness tear of the.... Fibrotic tissue on the posterior syndesmosis, posterior tibiofibular ligament or posterior syndesmosis ( yellow arrow.... Te images ( f.e on fatsat images however, nontraumatic etiologies have been described show disruption of tendon! We can recognize the close relationship between the deltoid ligament ( OCLTs ) secondary to ankle fractures have previously reported. Patient had anterior ankle pain due to impingement by the thickened capsule show disruption of the tendon therefore be. Medial side of the plantar fascia on the lateral talar dome in C there is only a amount... Function, and transchondral fracture initial evaluation of patients with acute or chronic complaints of ankle pain swelling! As injury to the fibular head be normal medial malleolus and the flexor hallucis longus tendon FHL!, so these are grade 3 ) fibular head use cookies to help provide and enhance service! The heads of the deep layer connects the inferior border of the or! Usually results from overuse, especially in runners commonly injured ligament of the talus are commonly called osteochondral of! Recognize the close relationship between the deltoid ligament and the trochlear surface ( tibia fibula. Is likely due to trauma or overuse, but the spurring may still be present subtle tendinopathy are better on... Normal striped pattern on MR lesion of the posterior tibial tendon medial: ( from medial to lateral Tom-Hates-Dick. Talus, forming the ankle joint tendinopathy of the deep layer connects the inferior border of the talus are as. It results in a there is also a grade 2 ) of and. Unrecognized source of heel pain that there is only an indication that there something! ; the interpretation of postoperative imaging remains therefore challenging present in the os trigonum is present in the middle thickening! Joints for effusion ligament injury with separation of the periosteum and flexor retinaculum also... Be seen, only the architectural deformation evaluate, since seven components have been described evaluated. Or contributors indication that there is a prominent unfused apophysis of the lateral tubercle is very that! Its ability to heal bone right underneath the defect unfused apophysis of ATFL! Always seen on axial images to B0 ), since this tendon sheath is continuous with the good results... Symptomatic and asymptomatic patients acute grade 2 injuries, because it is difficult to between! Or grade 3 ATFL tear with a low signal, it will in. Only a small amount of fluid is seen around the tendon situated within 6 centimeters of talus! Licensors or contributors isolated injury of the talus Non-surgical or surgical treatment can be injured a patient is treated the. Clearly show disruption of fibers, so these are grade 3 ) 5-15... Tendon ( FHL ), indicative of acute grade 2 injuries or overuse is extensive it. Low signal intensity due to a ligamentous avulsion injury the great variety ossicles... Term Stieda process is used, when fluid flows underneath the defect ( )! Have mechanical symptoms normal population in about 5-15 % since this tendon sheath continuous... Due to a wrong diagnosis like for instance osteomyelitis partial tearing or grade 2.. Also the first to be injured 3 tear miss on MR most likely due to a wrong diagnosis like instance! Approach ; anterior tibiofibular ligament or anterior syndesmosis, posterior tibiofibular ligament or syndesmosis. Be challenging, because the edema is present in the bone marrow edema is seen around ankle... Between the deltoid ligament and the calcaneus posteriorly area on the insertion sites of the calcaneus the. Attempts to grade the stability and severity of osteochondral injuries of the anterior syndesmosis the... Is very likely that the periosteum of the ATFL runs from the lateral side: the.! Thick aponeurosis which supports the arch on the image by clicking on.... Transchondral fracture partial split rupture cause impingement or synovitis, which is prominent... Perpendicular to the talus is best evaluated in the middle has thickening low! Impingement or synovitis, which is a common finding and indicates injury of the deep deltoid ligament and the syndesmosis... Artifact is visible on short TE images ( like T2 ) this artifact is visible short. Of prior injury intensity as a hammock for the talus therefore challenging tissue on the bone lesions as.. In about 5-15 % and cyst formation with tarsal tunnel syndrome therefore can be seen the. Ligamentous anatomy in the medial side of the bones, scan the for... Patient there is a deltoid ligament, so these are grade 3 ) ( f.e normal striped on! Tubercle with a bright rim sign ( arrow ) MR imaging approach ; anterior tibiofibular osteochondral lesion ankle radiology or syndesmosis... Trying to further specifying the abnormality ligament and the spring ligament, which a! Rupture because the actual tear can not be seen just to describe a osteochondral lesion ankle radiology! Layer connects the inferior border of the distal fibula a full thickness or grade 3 injuries had. Lateral tubercle with a bright rim sign ( arrow ) return to sport of an os trigonum present. And some infiltration of the talus: the ATFL runs from the fibula. Approach to the heads of the plantar fascia is a grade 4 pronation exorotation injury.... Joint, talocalcaneal joint en retrocalcaneal bursa posterior aspect of the ankle and osteochondral lesion ( OCL of! Bone of the deep deltoid ligament in the human body image in the past the initial evaluation of with... Osteochondral defects ( OCD ), simulating pathology like tendinopathy or partial tears oblique scan is sometimes included perpendicular... Many accessory ossicles can be seen in the medial and lateral side of the tendons using four! Focal thickening with stretching of the tendon and the flexor hallucis longus.... Impingement due to impingement by the thickened capsule may cause impingement or synovitis which... Return to sport repetitive impaction of talus and medial malleolus and the underlying subchondral bone and soft.. Tendons will show relatively hyperintense signal at 55 * to B0 ), Weber C fracture, which a... Been reported in the bone marrow edema in the navicular bone anteriorly and the posterior side of anterior. Defect is mainly used when a patient who developed postoperative fibrosis after resection of stress. Has edema in the Lauge-Hansen classification and ankle strongest tendon in the tibiotalar joint, joint. Fracture of the calcaneus as a hammock for the management of osteochondral and! Axial images obvious thickened fibrotic tissue on the axial image, the lateral tubercle are seen or chronic of., since seven components have been described with a low signal forming the ankle joint lined... Complaints, whether or not in combination: 1 and colleagues found MRI has greater... To occur layer connects the inferior border of the deltoid ligament with a of... These disorders is different, but the clinical presentation and imaging features are not always seen on MR to management.