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Posterior Ankle Impingement in Professional Soccer Players: Effectiveness of Sonographically Guided Therapy

Philip Robinson1 and Steve R. Bollen2

1 Leeds Teaching Hospitals, St. James University Hospital, Chancellor Wing, Beckett St., Leeds LS9 7TF, UK.
2 Department of Orthopedic Surgery, Bradford Royal Infirmary, Bradford, UK.


Figure 1
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  		Fig. 1 —Photograph shows typical mechanism of initial injury. 24-year-old male soccer player being tackled receives medial force to left weight-bearing ankle that results in acute inversion injury in neutral position.

 

Figure 2
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  		Fig. 2A —25-year-old male soccer player with clinical posterior impingement. Axial T2-weighted fat-suppressed MR image (TR/TE, 2,000/90; echo-train length, 14) shows lateral process of talus (asterisk) with nodular posterolateral synovitis (arrowheads) extending to fibula (F). Note normal-appearing flexor hallucis tendon and fluid within sheath (arrow).

 

Figure 3
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  		Fig. 2B —25-year-old male soccer player with clinical posterior impingement. Sagittal T2-weighted fat-suppressed MR image (3,242/90; echo-train length, 9) shows lateral process of talus (asterisk) with nodular synovitis (arrowheads) lying posteriorly. Note thickened posterior intermalleolar ligament (arrow) separate from main area of synovitis.

 

Figure 4
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  		Fig. 2C —25-year-old male soccer player with clinical posterior impingement. Axial sonography image of posterolateral talus (T) obtained during injection shows nodular synovitis (arrowheads) with needle (arrows) placed before infiltration and injections.

 

Figure 5
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  		Fig. 3A —30-year-old male soccer player with clinical posterior impingement. Sagittal T2-weighted fat-suppressed MR image (TR/TE, 3,242/90; echo-train length, 9) shows os trigonum (lower arrow), joint effusion, and nodular posterolateral synovitis (arrowheads) between os trigonum and edematous posterior tibia (upper arrow).

 

Figure 6
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  		Fig. 3B —30-year-old male soccer player with clinical posterior impingement. Axial proton density-weighted MR image (2,903/15; echo-train length, 8) shows fragmented os trigonum (arrows) and thickened posterior talofibular ligament (arrowheads).

 

Figure 7
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  		Fig. 3C —30-year-old male soccer player with clinical posterior impingement. Axial sonography image of os trigonum (O) and adjacent fragment (Fr) obtained during injection shows nodular synovitis (asterisk) with needle (arrowheads) placed during infiltration and injection. Further infiltration was performed around fragments.

 

Figure 8
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  		Fig. 4A —23-year-old male soccer player with clinical posterior impingement. Sagittal T1-weighted spin-echo fat-suppressed MR image (TR/TE, 456/12) with gadolinium shows os trigonum (asterisk) separate from talus, indicating synchondrosis disruption. Nodular posterolateral synovitis (arrowheads) lies between os trigonum and posterior tibia. There is further synovial thickening (arrow) posterior to ossicle.

 

Figure 9
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  		Fig. 4B —23-year-old male soccer player with clinical posterior impingement. Axial T1-weighted spin-echo fat-suppressed MR image (456/12) with gadolinium shows low-signal nodular synovitis (arrow) between os trigonum (asterisk) and talus (T), with thickened posterior talofibular ligament (arrowheads) inserting into fibula (F).

 

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