Michel D Crema1,2,3, Branislav Krivokapic4,5, Ali Guermazi6, Predrag Gravilovic7, Nebojsa Popovic8, Pieter D'Hooghe8, Frank W Roemer6,9. 1. Department of Radiology, Hôpital Saint-Antoine, Sorbonne University, 184 Rue du Faubourg Saint-Antoine, 75012, Paris, France. michelcrema@gmail.com. 2. Institute of Sports Imaging, French National Institute of Sports (INSEP), Paris, France. michelcrema@gmail.com. 3. Department of Radiology, Quantitative Imaging Center, Boston University School of Medicine, Boston, MA, USA. michelcrema@gmail.com. 4. Medical School, University of Belgrade, Belgrade, Serbia. 5. Institute for Orthopedic Surgery "Banjica", Belgrade, Serbia. 6. Department of Radiology, Quantitative Imaging Center, Boston University School of Medicine, Boston, MA, USA. 7. Center for Medical Informatics, Belgrade, Serbia. 8. Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar. 9. Department of Radiology, University of Erlangen, Erlangen, Germany.
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.
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.
Entities:
Keywords:
Ankle injuries; Magnetic resonance imaging; Sprains and strains
Authors: Thomas P A Baltes; Javier Arnáiz; Liesel Geertsema; Celeste Geertsema; Pieter D'Hooghe; Gino M M J Kerkhoffs; Johannes L Tol Journal: Eur Radiol Date: 2020-10-07 Impact factor: 5.315