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MRI Findings Associated with Distal Tibiofibular Syndesmosis Injury

Kevin W. Brown1, William B. Morrison1, Mark E. Schweitzer1,2, J. Antoni Parellada1 and Henry Nothnagel1

1 Department of Radiology, Thomas Jefferson University Hospital, 111 S 11th St., Ste. 3390, Gibbon Bldg., Philadelphia, PA 19107.
2 Present address: Department of Radiology, New York University Hospital for Joint Disease, 3012 17th St., New York, NY 10003.



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  		Fig. 1A. —Acute distal tibiofibular syndesmosis injury in 29-year-old man. Axial proton density–weighted fast spin-echo image (TR/TEeff, 3,250/37) of right ankle shows disruption (arrow) of anterior syndesmotic ligament.

 


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  		Fig. 1B. —Acute distal tibiofibular syndesmosis injury in 29-year-old man. Axial fat-suppressed T2-weighted fast spin-echo image (4,783/60) of right ankle shows edema (arrow) in and around ligament. This criterion was used to identify ankles with acute syndesmosis injury.

 


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  		Fig. 2A. —Chronic distal tibiofibular syndesmosis injury in 46-year-old man. Note osteochondral lesion (arrowhead) at medial talar dome on both A and B. Axial proton density–weighted fast spin-echo image (TR/TEeff, 3,500/38) of right ankle shows thickened anterior syndesmotic ligament (arrow).

 


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  		Fig. 2B. —Chronic distal tibiofibular syndesmosis injury in 46-year-old man. Note osteochondral lesion (arrowhead) at medial talar dome on both A and B. Axial T2-weighted image (4,800/60) of right ankle shows no edema around ligament (arrow). This criterion was used to identify ankles with chronic syndesmosis injury.

 


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  		Fig. 3A. —Bone bruise in 16-year-old boy with acute syndesmosis injury. Arrowheads indicate medial talus, and arrows indicate edematous lateral ligaments. Axial T2-weighted fat-suppressed fast spin-echo image (TR/TEeff, 5,433/67) of left ankle shows marrow edema (arrowheads) in medial talus.

 


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  		Fig. 3B. —Bone bruise in 16-year-old boy with acute syndesmosis injury. Arrowheads indicate medial talus, and arrows indicate edematous lateral ligaments. Coronal fat-suppressed T2-weighted fast spin-echo image (3,167/76) shows that bone bruise is consistent with inversion mechanism of injury. Edematous lateral ligaments indicate acute injury. Bone bruises were found to have significant association with acute syndesmosis injuries.

 


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  		Fig. 4. —Osteochondral lesion in 46-year-old man. Coronal fat-suppressed T2-weighted fast spin-echo image (TR/TEeff, 5,783/68) of right ankle shows solitary hyperintense subchondral focus (arrow) at talar dome. Osteochondral lesions were found to be significantly associated with acute and chronic syndesmosis injuries.

 


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  		Fig. 5. —Tibiofibular joint congruity in 26-year-old woman without syndesmosis injury. Axial proton density–weighted fast spin-echo image (TR/TEeff, 4,000/30) of left ankle shows normal, smooth distal tibiofibular joint (arrows).

 


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  		Fig. 6. —Tibiofibular incongruity in 43-year-old man with chronic syndesmosis injury. Axial proton density–weighted fast spin-echo image (TR/TEeff, 3,450/36) of right ankle shows irregular tibiofibular joint (arrows). Incongruity of distal tibiofibular joint was found to be significantly associated with chronic syndesmosis injury.

 


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  		Fig. 7. —Prominent tibiofibular recess height in ankle of 26-year-old woman with chronic syndesmosis injury. Coronal fat-suppressed T2-weighted image (TR/TEeff, 7,350/68) of left ankle shows method for measuring tibiofibular height (arrow). Recess was measured from talar dome to superior extent of recess (solid lines). In this case, recess height measured 1.6 cm.

 

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