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MRI of Spring Ligament Tears

Leon R. Toye1, Clyde A. Helms1, Brian D. Hoffman2, Mark Easley2 and James A. Nunley2

1 Department of Radiology, Musculoskeletal Division, Box 3808, Duke University Medical Center, Durham, NC 27710.
2 Department of Surgery, Division of Orthopaedic Surgery, Box 2923, Duke University Medical Center, Durham, NC 27710.



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  		Fig. 1A. —26-year-old man with lateral pain and normal-appearing spring ligament. Axial T2-weighted fast spin-echo fat-suppressed image (TR/TE, 4,000/70) of superomedial spring ligament shows normal spring ligament (arrows) thickness, signal intensity, and continuity. Incidental note is made of some mild edema within talar head, which likely reflects small contusion.

 


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  		Fig. 1B. —26-year-old man with lateral pain and normal-appearing spring ligament. Coronal MR image shows normal superomedial portion (arrows) and inferior portion of spring ligament. Superomedial portion blends with superficial fibers of deltoid ligament. Note that inferior portion of spring ligament can normally contain heterogeneous signal at its sustentacular attachment (arrowhead).

 


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  		Fig. 2A. —56-year-old woman with surgically proven spring ligament tear. Axial T2-weighted fast spin-echo fat-suppressed image (TR/TE, 4,000/70) of superomedial spring ligament shows abnormal thickening (arrows).

 


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  		Fig. 2B. —56-year-old woman with surgically proven spring ligament tear. Adjacent axial MR image shows increased signal in superomedial spring ligament (arrow). Posterior tibial tendon (arrowhead) is also abnormal.

 


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  		Fig. 2C. —56-year-old woman with surgically proven spring ligament tear. Intraoperative photograph obtained after medial ankle incision shows surgical probe within full-thickness tear (arrow) of superomedial spring ligament; posterior tibial tendon has been retracted out of image area.

 


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  		Fig. 3. —40-year-old woman with surgically proven spring ligament tear. Coronal T2-weighted fast spin-echo fat-suppressed image (TR/TE, 4,000/70) of spring ligament shows abnormal thickening, increased signal, and full-thickness gap (arrowhead) within superomedial portion. This is typical location of spring ligament tears and area seen by typical surgical exploration. Note abnormal thickening of more superficial posterior tibial tendon (arrow).

 


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  		Fig. 4A. —40-year-old woman with surgically proven spring ligament tear. Axial T2-weighted fast spin-echo fat-suppressed image (TR/TE, 4,000/70) of superomedial spring ligament shows heterogeneous increased signal and thickening (arrows) and reveals attenuation and full-thickness gap (arrowhead).

 


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  		Fig. 4B. —40-year-old woman with surgically proven spring ligament tear. Coronal MR image shows superomedial (arrowhead) and inferior (small arrows) portions of spring ligament. Note attenuated and wavy superomedial portion. Posterior tibial tendon (large arrow) is grossly abnormal.

 


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  		Fig. 5A. —59-year-old woman with abnormal MRI appearance of spring ligament that was described as "intact" at surgery. Axial T2-weighted fast spin-echo fat-suppressed image (TR/TE, 4,000/70) of superomedial spring ligament shows abnormal thickening of superomedial portion of spring ligament (arrows) and abnormal appearance of posterior tibial tendon.

 


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  		Fig. 5B. —59-year-old woman with abnormal MRI appearance of spring ligament that was described as "intact" at surgery. Coronal MR image also shows thickening of superomedial portion (arrows) of spring ligament.

 

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