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MRI of ankle sprain: the association between joint effusion and structural injury severity in a large cohort of athletes

  • Musculoskeletal
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Abstract

Objective

To test the hypothesis if presence and amount of effusion in the tibiotalar and talocalcaneal joints are associated with an increased risk for severe structural injury in ankle sprains.

Methods

A total of 261 athletes sustaining acute ankle sprains were assessed on MRI for the presence and the amount of joint effusion in the tibiotalar and talocalcaneal joints, as well as for ligamentous and osteochondral injury. Specific patterns of injury severity were defined based on lateral collateral ligament, syndesmotic, and talar osteochondral involvement. The presence and the amount effusion (grades 1 and 2) were considered as risk factors for severe injury, while physiological amount of fluid (grade 0) was considered as the referent. Conditional logistic regression was used to assess the risk for associated severe injuries (syndesmotic ligament rupture and talar osteochondral lesions) based on the presence and amount of tibiotalar and talocalcaneal effusions.

Results

For ankles exhibiting large (grade 2) effusion in the tibiotalar joint (without concomitant grade 2 effusion in the talocalcaneal joint), the risk for partial or complete syndesmotic ligament rupture was increased more than eightfold (adjusted odds ratio 8.7 (95% confidence intervals 3.7–20.7); p < 0.001). The presence of any degree of effusion in any of the joints was associated with an increased risk for severe talar osteochondral involvement (several odds ratio values reported; p < 0.001), including large subchondral contusions and any acute osteochondral lesion.

Conclusion

The presence of tibiotalar and talocalcaneal effusions is associated with an increased risk for severe concomitant structural injury in acute ankle sprains.

Key Points

• For ankles exhibiting severe (grade 2) effusion in the tibiotalar joint after sprain, the risk for partial or complete syndesmotic ligament rupture increases more than eightfold.

• The presence of effusion in both tibiotalar and talocalcaneal joints is associated with an increased risk for severe ligament injury such as complete ATFL rupture as well as partial or complete syndesmotic ligament rupture.

• The presence of effusion in the tibiotalar or talocalcaneal joints after sprain is associated with an increased risk for severe talar osteochondral involvement.

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Abbreviations

ATFL:

Anterior talofibular ligament

CFL:

Calcaneofibular ligament

FOV:

Field of view

MRI:

Magnetic resonance imaging

NSMP:

National Sports Medicine Program of the State of Qatar

PTFL:

Posterior talofibular ligament

TE:

Echo time

TR:

Repetition time

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Acknowledgments

We thank very much the staff from Aspetar Orthopaedic and Sports Medicine Hospital for their help.

Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Department of Radiology, Hôpital Saint-Antoine, Sorbonne University, 184 Rue du Faubourg Saint-Antoine, 75012, Paris, France

    Michel D. Crema

  2. Institute of Sports Imaging, French National Institute of Sports (INSEP), Paris, France

    Michel D. Crema

  3. Department of Radiology, Quantitative Imaging Center, Boston University School of Medicine, Boston, MA, USA

    Michel D. Crema, Ali Guermazi & Frank W. Roemer

  4. Medical School, University of Belgrade, Belgrade, Serbia

    Branislav Krivokapic

  5. Institute for Orthopedic Surgery “Banjica”, Belgrade, Serbia

    Branislav Krivokapic

  6. Center for Medical Informatics, Belgrade, Serbia

    Predrag Gravilovic

  7. Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar

    Nebojsa Popovic & Pieter D’Hooghe

  8. Department of Radiology, University of Erlangen, Erlangen, Germany

    Frank W. Roemer

Authors
  1. Michel D. Crema
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  2. Branislav Krivokapic
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  3. Ali Guermazi
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  4. Predrag Gravilovic
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  5. Nebojsa Popovic
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  6. Pieter D’Hooghe
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  7. Frank W. Roemer
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Corresponding author

Correspondence to Michel D. Crema.

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Guarantor

The scientific guarantor of this publication is Michel D. Crema, MD.

Conflict of interest

Authors MDC, AG, and FWR are shareholders of Boston Imaging Core Lab (BICL), LLC. Author AG is a consultant with AstraZeneca, Genzyme, and Merck Serono. None of the other authors declare any conflict of interest.

Statistics and biometry

Branislav Krivokapic (University of Belgrade) provided statistical advice for this manuscript.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• Retrospective

• Cross-sectional study

• Performed at one institution

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Crema, M.D., Krivokapic, B., Guermazi, A. et al. MRI of ankle sprain: the association between joint effusion and structural injury severity in a large cohort of athletes. Eur Radiol 29, 6336–6344 (2019). https://doi.org/10.1007/s00330-019-06156-1

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  • DOI: https://doi.org/10.1007/s00330-019-06156-1

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