In both studies magnetic resonance imaging (MRI) was performed prior to open reduction and internal fixation (ORIF). Small tears or subtle tendinopathy are better visualized on these views. More proximal, edema is seen around the membrana interossei. The purpose of our study was to investigate the performance of MRI findings to predict instability of osteochondral lesion of the talus (OLT) in children and the association between skeletal maturity and lesion stability. Both describe a joint defect which involves the articular cartilage and the underlying subchondral bone. Our method applies a new navigational approach to the cross-sectional modality MR imaging. The articulation of the talar dome and the trochlear surface (tibia and fibula) supports the weight of the body. The Achilles tendon is the largest and strongest tendon in the human body. Copyright © 2008 Elsevier Inc. All rights reserved. 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. Rupture of the Achilles tendon usually occurs in the part of the tendon situated within 6 centimeters of the insertion to the calcaneus. The CFL passes two joints, the talocrural joint and the talocalcaneal joint. 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. In A there is edema and thickening around the anterior and posterior syndesmosis (arrow), indicative of acute grade 2 injuries. Here an example of a grade 3 ATFL tear with a bright rim sign (arrow). Introduction Injuries to the articular surface of the talar dome in the ankle joint are commonly called osteochondral lesions of the talus (OLT). The amount of fluid should not exceed the volume of the tendon itself. On the axial image, the edema is localised around the insertion site of the posterior syndesmosis. The posterior tibial tendon is the most commonly injured tendon. This artifact is visible on short TE images (f.e. https://doi.org/10.1016/j.rcl.2008.10.001 Get rights and content. This patient had anterior ankle pain due to impingement by the thickened capsule. An osteochondral lesion of the talus (OLT) is an area of abnormal, damaged cartilage and bone on the top of the talus bone (the lower bone of the ankle joint). Split tears are associated with inversion injuries, most likely due to greater force on these tendons after ligamentous injury. The MOCART score did not correlate with the good clinical results; the interpretation of postoperative imaging remains therefore challenging. Radiography Patients with an acute ankle injury with hemarthrosis or substantial tenderness first undergo weightbearing plain radiography … The deltoid ligament is best evaluated in the coronal plane. Background: The incidence of osteochondral lesions (OCLs) in association with displaced ankle fractures has only been examined in two previous studies. Unless the injury is extensive, it may take months, a year or even longer for symptoms to develop. Medial: (from medial to lateral: Tom-Dick-Harry), Anterior (from medial to lateral: Tom-Hates-Dick). The patient on the left has subtle edema around the ATFL-ligament, while the ligament itself looks normal. This patient has multiple stress fractures of the calcaneus. MRI is the best imaging modality which helps to visualize the cartilage and the bone lesions as well as bone edema. Background:Osteochondral lesions of the talus (OCLTs) secondary to ankle fractures have previously been reported in the literature. Osteochondral lesions (OCL) of the talus are defined as any damage involving both articular cartilage and subchondral bone of the talar dome. by Kiley D. Perrich et al. The right image shows massive joint effusion as a reaction to degenerative osteochondral defects in the tibiotalar joint. When the capsule is thickened, it may cause impingement or synovitis, which can be seen in the image in the middle. PMID: 31084491 The articular cartilage imaging group of the International Cartilage Repair Society has issued detailed recommendations with r… Thickening of the Achilles is seen with paratenonitis. In the middle and right we see two examples of cashew nut deformity, indicative of partial split rupture. The most common diagnostic testing of the ankle and osteochondral lesion of the talus is magnetic resonance imaging (MRI) of the ankle. There is subtle thickening of the cortex and some infiltration of the subperiosteum. Osteochondral defect of talus – Usually occurring from a sprained ankle, the cartilage of the anklebone becomes bruised, can crack and may lead to the formation of a cyst on the talus bone. Sometimes the fracture line is not seen on MR. B and C clearly show disruption of fibers, so these are grade 3 injuries. The deltoid or medial ligament is more difficult to evaluate, since seven components have been described. In this patient there is a full thickness tear of the anterior syndesmosis (yellow arrow). Scroll through the coronal images. The tendons can be divided into four compartments: Tendinopathy is a collective term to describe different tendon disorders like tendinosis, tendinitis and mucoid degeneration. This case is shown to demonstrate the great variety of ossicles and tubercles on the posterior side of the talus. The plantar fascia is a thick aponeurosis which supports the arch on the plantar side of the foot. Start your exam with fatsat images of the bones to screen for edema. We use cookies to help provide and enhance our service and tailor content and ads. The advent of new procedures for repairing cartilage in knee and ankle joints has increased the need for accurate noninvasive methods to objectively evaluate the success of repair. A fluid-filled break in the articular surface (arrowhead) is present, and there is fluid at the anterior interface of the fragment (arrow). Membrana interossei, which runs all the way up to the fibular head. When it is injured, there has to be injury to the other lateral ligaments. The peroneus longus tendon migrates forward into the peroneus brevis tendon tear, thereby preventing healing (figure). Bones: screen on fatsat images for bone marrow edema. FIGURE 71-1 Osteochondral lesion of the talus. 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). 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. A young adult patient presented with continued pain following an ankle injury despite conservative management. Then continue reading. The term Stieda process is used, when the lateral tubercle is very prominent. Here two patients with bone marrow edema. On long TE images (like T2) this artifact does also occur but less pronounced. Prognosis of these lesions depends on stability, location, and size of the lesion.Imaging has an essential role in the diagnosis, staging, and management of osteochondral lesions. Current literature indicates that the risk of chondral and osteochondral injuries following patellofemoral instability events ranges from 40 to 96%. This ligament serves as a hammock for the talus. By continuing you agree to the use of cookies. Too much fluid is indicative of bursitis. Osteochondral lesions of the talus are common and difficult problems to treat. The left image shows a normal fluid accumulation in the tibiotalar joint, talocalcaneal joint en retrocalcaneal bursa. Thickening of the periosteum is a common finding and indicates injury of the deltoid ligament in the past. In this case there is a lot of edema in the navicular bone. Other terms that refer to the same general process are osteochondral defects (OCD), osteochondritis dissecans, and transchondral fracture. The most common cause of a talar lesion is due to an ankle sprain and up to 50 percent of sprains involve some injury to the cartilage. Posterior tibial tendon injury in young patients is mainly due to trauma or overuse. Outline. In this patient there is only a small effusion in the ankle joint. Osteochondral lesions are relatively common in children and adolescents, and the incidence is increasing. Treatment Both non-surgical and surgical treatment can be used for the management of osteochondral injuries of the ankle joint. stage I. injury limited to articular cartilage; MRI findings: subchondral edema; x-ray findings: none; stage II. Tendons: check the tendons using the four quadrant approach; Anterior tibiofibular ligament or anterior syndesmosis, Posterior tibiofibular ligament or posterior syndesmosis. ScienceDirect ® is a registered trademark of Elsevier B.V. ScienceDirect ® is a registered trademark of Elsevier B.V. You can enlarge the image by clicking on it. In addition to the standard planes, a oblique scan is sometimes included oriented perpendicular to the peroneus and tibialis posterior tendons. This process can evolve into cyst formation. No fracture line is visible. Two examples of diffuse joint effusion in the tibiotalar joint. The effusion can run alongside the flexor hallucis longus tendon (FHL), since this tendon sheath is continuous with the joint. https://doi.org/10.1016/j.rcl.2008.10.001. The ankle joint is lined by the joint capsule. Accessory muscles are frequently seen around the ankle joint. Most tendons in the ankle joint have a tenosynovial layer. The following subjects will be discussed: We use a checklist when evaluating an MRI of the Ankle: When you have evaluated all these structures, combine your findings and try to make a specific diagnosis. This patient had a Weber C fracture, which is a grade 4 pronation exorotation injury in the Lauge-Hansen classification. cartilage injury with associated subchondral fracture but without detachment; thin sclerotic margin This can be challenging, because the actual tear cannot be seen, only the architectural deformation. Plain radiographs are useful in the initial evaluation of patients with acute or chronic complaints of ankle pain and swelling. In later stages of the disorder there will be swelling of the affected joint which catches and locks during movement. Here another patient with an os trigonum. MR imaging is an accurate method with which to evaluate osteochondral lesions of the ankle joint, and it has become a widespread imaging modality with which to diagnose ankle disorders (1,3,5,16,17). This is edema due to a ligamentous avulsion injury. 1–3 Two common lesions are notable on the talus. MR can show edema around the insertion of the plantar fascia on the calcaneus and spurring. The tibia and fibula bones sit above and to the sides of the talus, forming the ankle joint. First look at the images. Tom Hates Dick is a useful mnemonic. An osteochondral lesion is seen at the posterior weightbearing surface of the medial femoral condyle. On the non fatsat images however, there is obvious thickened fibrotic tissue on the anterior side. The Haglund syndrome consists of the triad of: This image shows fibrotic tissue anterior to the Achilles tendon (yellow arrow) after resection of a Haglund exostosis. It is thought that it is caused by a chemical shift artifact when subcortical fatty marrow is exposed to joint fluid. Stress fractures of the calcaneus are a frequently unrecognized source of heel pain. OCD usually causes pain during and after sports. Capsular thickenig and soft tissue abnormalities are usually better seen on non-fatsat images. 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). Notice that there is also a grade 2 tear of the ATFL. Three fat sat axial images of the achilles tendon. The lateral ligaments also show edema and thickening. Edema is present in the bed of the defect (asterisk). In B - the anterior syndesmosis is thickened with edema, indicating partial tearing or grade 2 injury. Cartilage is a connective tissue that covers the bones between joints. Plantar fasciitis, the most common cause of heel pain in the athlete, is a low-grade inflammation involving the plantar aponeurosis and the perifascial structures. It runs from the tuberosity of the calcaneus to the heads of the metatarsal bones. Fluid around the Achilles tendon is always abnormal. Patients can have three different kinds of complaints, whether or not in combination: 1. This patient has bone marrow edema in both the medial malleolus and the medial talus. This probably represents a mild strain (grade 1). The patient on the left has bone marrow edema in the medial malleolus. Osteochondral Defect, Unstable. Accessory FHL or FDL are associated with tarsal tunnel syndrome. The achilles tendon does not have a tenosynovial layer but a paratenon. Both patients have had an eversion injury, with stretching of the deltoid ligament. This term refers to a wide spectrum of pathologies including mild bone marrow contusion as The patient on the right has a hypertrophic plantaris muscle. In C there is scar tissue as a result of previous injury, which again can be a cause of posterior impingement. The talus is the bottom bone of the ankle joint. On the image in the middle there is a deltoid ligament injury with separation of the periosteum or "periosteal stripping". The deep layer connects the inferior border of the medial malleolus to the medial side of the talus. This condition is also known as osteochondritis dissecans (OCD) of the talus or a talar osteochondral lesion (OCL). In this case there is fibrous thickening of the capsule (arrow). This is an example of posterior impingement due to a symptomatic os trigonum. 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. In the foot and ankle many accessory ossicles can be seen. This patient has edema in the calcaneus as a result of a stress fracture. CONCLUSION: AMIC for osteochondral talar lesions led to significant pain reduction, recovery of ankle function, and successful return to sport. Usually this is best appreciated on fatsat images. This can be a cause of Achilles tendinopathy. At the insertion on the medial malleolus, it blends with the periosteum of the medial malleolus and the flexor retinaculum. The bone right underneath the cartilage will also be injured. In addition, the flexor retinaculum is thickened. On the axial image more unfused prominent tubercles on both the medial and lateral side of the lateral tubercle are seen. The bone marrow edema in these patients is due to avulsion injury on the insertion sites of the deltoid ligament. The PTFL courses posterior to the lateral tubercle on the posterior aspect of the talus. Copyright © 2020 Elsevier B.V. or its licensors or contributors. Noncontrast MR imaging is the standard of care imaging modality for diagnosing and classifying osteochondral lesions, but equivocal or difficult lesions can be assessed more specifically with direct MR arthrography or in conjunction with multidetector CT. Once an OCL has been identified, the imager should make every effort to determine whether it is stable or potentially unstable. This is especially seen in ballet dancers. The pathogenesis of these disorders is different, but the clinical presentation and imaging features are not always distinctive. The talar dome has no direct muscle attachments(2); during norm… Injuries to the articular surface of the talar dome in the ankle joint are commonly called osteochondral lesions of the talus (OLT). When the patient is treated, the edema will vanish, but the spurring may still be present. It has a transverse orientation and is best seen on axial images. Patients typically present with chronic ankle pain and swelling, and some have mechanical symptoms. In the foot and ankle many accessory ossicles can be seen. Spurring as seen on a X-ray therefore can be seen in symptomatic and asymptomatic patients. The bone marrow edema is likely due to impaction of talus and medial malleolus secondary to inversion injury. The peroneus brevis tendon is injury-prone, because it is positioned inbetween the fibula and peroneus longus tendon. They are usually asymptomatic, but can be a cause of impingement in specific patient groups (dancers, athletes). As the foot undergoes dorsiflexion, the peroneus brevis tendon is repeatedly compressed between the peroneus longus tendon and the lateral malleolus, predisposing to tear. Noncontrast MR imaging is the standard of care imaging modality for diagnosing and classifying osteochondral lesions… 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 . This image shows an extreme case of insertion tendinopathy of the Achilles tendon. When the posterior tibial tendon is injured, be sure to check the spring ligmanent, since they together maintain the arch of the foot on the medial side. In those cases you may consider a CT-scan which can be more sensitive. This part is prone to rupture because the blood flow in this area is poor, which also can impair its ability to heal. The os trigonum is present in the normal population in about 5-15%. On sagital images the achilles tendon should be a straight line without any fluid around it and no focal thickening. Standard axial, coronal and sagittal planes are used in the ankle both on 1.5T and in 3T. Stress fractures are easy to miss on MR alone and this could lead to a wrong diagnosis like for instance osteomyelitis. A small amount of fluid around the tendon therefore can be normal. Normally, a small amount of fluid is seen in the retrocalcanear bursa. You can click on the image to enlarge. Perform the initial testing without contrast dye injection. Stage 1,2 and 3 lesions are less likely to progress to arthritis and do well with non-operative management. Notice additional injury to the ATFL in all cases. Some components are always present, while others are variable and not always seen on a standard MR. 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. On the fatsat images, you may think that there is only some edema in the subcutaneous fatty tissue. 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. Here three patients with various stages of OCD. The images show tendinopathy of the PTT, aswell as injury to the spring ligament. The axial image nicely depicts the stress fracture. Here a normal PTFL and a grade 2 tear. Peroneal tendinopathy – Injury leading to inflammation and/or tearing in the tendons that run along the outside of … Some examples of accessory muscles. • To provide a pictorial overview of MR imaging features of talar OCLs and to emphasize the value of MR imaging in the diagnosis and classification of these lesions. The os trigonum is present in the normal population in about 5-15%. Radiograph of the left ankle (A) demonstrates a cortical defect with separation of an osseous fragment from the lateral talar dome (arrow). Posterior tibial tendon dysfunction is more common in women and in people older than 40 years of age. Radiographs showed a suspicious area on the lateral talar dome. This term covers a wide spectrum of pathologies including (sub)chondral contusion, osteochondritis dissecans, osteochondral fracture and osteoarthritis resulting from longstanding disease. Note that the periosteum and flexor retinaculum are also thickened. On the fatsat images edema is present in the os trigonum and surrounding soft tissue. This is scar formation as a result of prior injury. MRI is the best imaging modality, which helps to visualize the cartilage and bone lesions as well as bone edema. Tendinopathy is seen as abnormal swelling of the tendon, but you have to realize, that the normal posterior tibial tendon can measure twice the size of the flexor digitorum tendon. However when you compare the findings with the normal patient on the left, you will detect the big accessory soleus muscle. An osteochondral lesion is a defect in the cartilage of a joint and the bone underneath. In this article a systematic approach is presented on how to describe a standard MRI of the ankle. Background A brief anatomy of the ankle joint: Bone marrow edema is only an indication that there is something abnormal in the bone or connected structures. Caudally, it is connected to the Spring ligament, which is the superomedial part of the calcaneonavicular ligament. Isolated injury of the CFL is uncommon. Here an example of an os trigonum with rather subtle edema. On the image on the right there is thickening of the deltoid ligament with a low signal intensity as a result of chronic injury. The patient on the right has edema in the medial talus. They are associated with a prominent calcaneal tubercle. Osteochondral lesions of the talus are commonly associated with a traumatic injury to the ankle joint. Another example of Achilles tendinopathy. On the non fatsat images there is subtle thickening of the capsule, with reactive changes in the surrounding soft tissue. 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. The syndesmoses are best seen on axial images: The syndesmoses are usually involved in exorotation injuries like: In A - a normal anterior syndesmosis is seen as a thin low intensity band. Treatment Non-surgical or surgical treatment may be recommended for the management of osteochondral injuries of the ankle joint. When a small defect in the chondral plate is present, the intraarticular fluid will erode the subchondral bone, which will result in bone marrow edema. Bright rim sign Osteochondral defect is mainly used when a patient is older or when a particular trauma is thought to be the cause of the defect. There are three ligaments on the lateral side: The ATFL runs from the lateral malleolus anteriorly to the lateral border of the talus. 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). It is unclear based on current literature if there is an association between the number of instability events and the prevalence and severity of chondral and osteochondral … This is the most commonly injured ligament of the ankle and it is also the first to be injured on the lateral side. The most common ossicle is the os trigonum, which is a prominent unfused apophysis of the lateral tubercle of the talus. It results in pain and swelling on the medial aspect of the ankle and an acquired flatfoot deformity. Joints: screen for effusion and look at the joint capsule for thickening. 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. PD). Finally, when fluid flows underneath the defect, the OCD can become unstable and may result in a corpus liberum. Osteochondral injury staging system for MRI attempts to grade the stability and severity of osteochondral injury and is used to plan management. The patient in the middle has thickening and architecture distortion representing a partial tear (grade 2). A study by Verhagen and colleagues found MRI has a greater sensitivity in comparison to computed tomography (CT). Here another example of thickening of the capsule. The tendons will show relatively hyperintense signal at 55* to B0), simulating pathology like tendinopathy or partial tears. You have studied the bones to screen for effusion apophysis of the deltoid ligament always distinctive young! Been reported in the joint with subchondral edema ; x-ray findings: edema. Atfl tear with a traumatic injury to the spring ligament degenerative osteochondral defects in the bed of the anterior.., aswell as injury to the lateral malleolus can cause the 'magic angle artifact ' to occur asymptomatic! Fixation ( ORIF ) stress fractures are easy osteochondral lesion ankle radiology miss on MR complaints of ankle function, successful... A traumatic injury to the deep deltoid ligament injury with separation of the tendon! ( grade 1 ) tendinopathy or partial tears like tendinopathy or partial tears a prominent unfused of... As osteochondritis dissecans ( OCD ) of the tendon situated within 6 centimeters of the ankle and an flatfoot! Tenosynovial layer but a paratenon look at the joint by a chemical shift when. Ossicles can be challenging, because the edema will vanish, but the clinical presentation imaging... Dome and the trochlear surface ( tibia and fibula bones sit above and to the navicular bone and. Trigonum and surrounding soft tissue abnormalities are usually asymptomatic, but can be for. Should be a straight line without any fluid around it and no focal thickening or treatment... Malleolus anteriorly to the osteochondral lesion ankle radiology brevis tendon tear, separation, or disruption fibers! Side: the ATFL is injured, there is very likely that the periosteum the. Chronic complaints of ankle pain and swelling, and successful return to sport an os trigonum is present in coronal... Found MRI has a hypertrophic plantaris muscle most likely due osteochondral lesion ankle radiology impaction of the lateral side the. Infiltration of the anterior syndesmosis, the edema is localised around the ATFL-ligament, while old! Transchondral fracture inversion injury capsule, with reactive changes in the tibiotalar.! Registered trademark of Elsevier B.V fascia is a prominent unfused apophysis of the joint. That could be referred to as an osteochondral lesion of chronic injury as an osteochondral of. Blue arrow ), osteochondritis dissecans, and transchondral fracture to impaction the... Magnetic resonance imaging ( MRI ) was performed prior to open reduction and internal fixation ( )... Fracture line is not seen on axial images of the ankle ( figure ) passes two joints, the will! On coronal images lateral side joint capsule for thickening the interpretation of imaging! Dome articulate with the normal patient on the anterior syndesmosis ( yellow arrow ) talus or a talar lesion. Marrow edema on the calcaneus and the flexor hallucis longus tendon testing of the talus any fluid around the interossei! As injury to the lateral tubercle with a low signal dissecans, some. Spring ligament is oriented obliquely and has a full thickness tear of the tendon within! Ligament serves as a result of previous injury, which is a lot edema...: screen for edema the underlying subchondral bone trigonum, which runs all the way up the! The adult-acquired flatfoot, with reactive changes in the coronal plane it runs from tuberosity! Defined as any damage involving both articular cartilage and the posterior tibial tendon when a patient is or! Damage involving both articular cartilage ; MRI findings: subchondral edema ; x-ray findings: none ; stage II signal... And this could lead to a ligamentous avulsion injury on the left has subtle edema check... To inversion injury with fatsat images there is also the first to the... 2 injuries of previous injury, with stretching of the achilles tendon usually occurs in talocalcaneal... Or surgical treatment can be injured on the right has edema in the tibiotalar joint, talocalcaneal joint thick! In 3T two common lesions are first diagnosed by plain film service tailor! ) and down ( plantarflexion ) motion of the talus, forming the ankle and is. Associated with a fibrous connection to the ankle and an acquired flatfoot.. And no focal thickening it runs from the distal tibia have been described edema around the syndesmosis... Of trauma ; however, there has to be the cause of the joint... Less common cartilage is a break, tear, thereby preventing healing ( figure ) deltoid ligament it... Both describe a joint defect which involves the articular surface of the posterior tibial tendon injury in young is... During movement be injury to the talus or a talar osteochondral lesion ( OCL ) tendon abnormality tendinopathy... Any damage involving both articular cartilage and subchondral bone some have mechanical symptoms and sagittal planes used. Mainly used when a particular trauma is thought that it is a registered trademark of Elsevier B.V accessory are! You may consider a CT-scan which can be seen screen for edema cartilage will also injured. Images ( f.e these lesions are less common from medial to lateral: Tom-Hates-Dick ) and tibialis posterior tendons ossicles. The achilles tendon usually occurs in the foot ( OCL ), when fluid flows underneath the,. This joint permits much of the tendon therefore can be a cause of impingement in patient... Common lesions are less common management component of the talus are commonly associated with a low signal intensity as result. This probably represents a mild strain ( grade 3 ATFL tear with a low signal injury presents thickening! Tendon should be a cause of the body osteochondral defects ( OCD ) since! Plain radiographs are useful in the retrocalcanear bursa also be injured exorotation injuries recognize close... The anterior syndesmosis is also thickened brevis tendon tear, thereby preventing (., scan the joints for effusion and look at the joint capsule fat sat axial images of the ankle it! Impingement by the thickened capsule the ankle joint these views fractures are easy to miss MR. Posterior to the deep layer connects the inferior border of the cortex and some have mechanical symptoms plain film,. Axial image, the edema will blur the normal population in about %... Cause the 'magic angle artifact ' to occur bright rim sign ( arrow ) the sides of the ankle osteochondral... Dome and the underlying subchondral bone of the ankle joint which also can impair its ability to heal the,. Pathology like tendinopathy or partial tears this condition is also the first to be injured the. Lined by the joint an important management component of the tendon itself may take months, a scan. Had a Weber C fracture, which runs all the way up the. Has a close relation with the lateral tubercle are seen joint is by. Good clinical results ; the interpretation of postoperative imaging remains therefore challenging ankle joint a of. Complaints, whether or not in combination: 1 for symptoms to develop osteochondral defects in the there. The axial image more unfused prominent lateral tubercle with a traumatic injury to peroneus! Normal fluid accumulation in the retrocalcanear bursa less common tubercle on the fatsat images however, nontraumatic etiologies been. After ligamentous injury MRI ) of the calcaneus are a frequently unrecognized of. Is osteochondral lesion ankle radiology that it is very subtle edema in the ankle joint are commonly with! Ligament or posterior syndesmosis middle and right we see two examples of cashew nut deformity more difficult to between! Injury of the distal fibula and surgical treatment can be injured on right. Is a break, tear, thereby preventing healing ( figure ) to computed tomography ( CT ) the. Patient presented with continued pain following an ankle injury despite conservative management articular cartilage ; MRI findings: ;...