title: Ligamentous Injuries and the Risk of Associated Tissue Damage in Acute Ankle Sprains in Athletes: A Cross-sectional MRI Study.
abstract: BACKGROUND
  Ankle joint injuries are extremely common sports injuries, with the anterior talofibular ligament involved in the majority of ankle sprains. There have been only a few large magnetic resonance imaging (MRI) studies on associated structural injuries after ankle sprains.
  
  
  OBJECTIVE
  To describe the injury pattern in athletes who were referred to MRI for the assessment of an acute ankle sprain and to assess the risk of associated traumatic tissue damage including lateral and syndesmotic ligament involvement.
  
  
  METHODS
  Cross-sectional study; Level of evidence, 3.
  
  
  METHODS
  A total of 261 ankle MRI scans of athletes with acute ankle sprains were evaluated for: lateral and syndesmotic ligament injury; concomitant injuries to the deltoid and spring ligaments and sinus tarsi; peroneal, flexor, and extensor retinacula and tendons; traumatic and nontraumatic osteochondral and osseous changes; and joint effusion. Patients were on average 22.5 years old, and the average time from injury to MRI was 5.7 days. Six exclusive injury patterns were defined based on lateral and syndesmotic ligament involvement. The risk for associated injuries was assessed by logistic regression using ankles with no or only low-grade lateral ligament injuries and no syndesmotic ligament damage as the reference.
  
  
  RESULTS
  With regard to the injury pattern, there were 103 ankles (39.5%) with complete anterior talofibular ligament disruption and no syndesmotic injury, and 53 ankles (20.3%) had a syndesmotic injury with or without lateral ligament damage. Acute osteochondral lesions of the lateral talar dome were seen in 20 ankles (7.7%). The percentage of chronic lateral osteochondral lesions was 1.1%. The risk for talar bone contusions increased more than 3-fold for ankles with complete lateral ligament ruptures (adjusted odds ratio [aOR], 3.43; 95% CI, 1.72-6.85) but not for ankles with syndesmotic involvement. The risk for associated deltoid ligament injuries increased for ankles with complete lateral ligament injuries (aOR, 4.04; 95% CI, 1.99-8.22) compared with patients with no or only low-grade lateral ligament injuries.
  
  
  CONCLUSIONS
  About 20% of athletes referred for MRI after suffering an acute ankle sprain had evidence of a syndesmotic injury regardless of lateral ligament involvement, while more than half had evidence of any lateral ligament injury without syndesmotic involvement. Concomitant talar osseous and deltoid ligament injuries are common.
authors.affiliation: Department of Radiology, Aspetar, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany froemer@bu.edu frank.roemer@aspetar.com.
authors.forename: Frank W
authors.initials: FW
authors.lastname: Roemer
authors.affiliation: Department of Radiology, Aspetar, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.
authors.forename: Nabil
authors.initials: N
authors.lastname: Jomaah
authors.affiliation: Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts, USA.
authors.forename: Jingbo
authors.initials: J
authors.lastname: Niu
authors.affiliation: Department of Radiology, Aspetar, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.
authors.forename: Emad
authors.initials: E
authors.lastname: Almusa
authors.affiliation: Department of Radiology, Aspetar, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.
authors.forename: Bernard
authors.initials: B
authors.lastname: Roger
authors.affiliation: Department of Surgery, Aspetar, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.
authors.forename: Pieter
authors.initials: P
authors.lastname: D'Hooghe
authors.affiliation: Department of Sports Medicine, Aspetar, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.
authors.forename: Celeste
authors.initials: C
authors.lastname: Geertsema
authors.affiliation: Department of Sports Medicine, Aspetar, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.
authors.forename: Johannes L
authors.initials: JL
authors.lastname: Tol
authors.affiliation: Department of Sports Medicine, Aspetar, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.
authors.forename: Karim
authors.initials: K
authors.lastname: Khan
authors.affiliation: Department of Radiology, Aspetar, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA.
authors.forename: Ali
authors.initials: A
authors.lastname: Guermazi
mesh_terms: D000293:Adolescent; D000328:Adult; D016512:Ankle Injuries / Q000150:complications*; D000843:Ankle Joint / Q000473:pathology*; D056352:Athletes; D001265:Athletic Injuries / Q000150:complications; D017885:Collateral Ligaments / Q000473:pathology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D017844:Lateral Ligament, Ankle / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D013180:Sprains and Strains / Q000150:complications*; D013710:Tendons / Q000473:pathology; D055815:Young Adult
keywords: ankle sprain; athletes; magnetic resonance imaging; osteochondral lesions; risk factors; syndesmosis