Summary

The findings of this study suggest that cartilage and osteochondral lesions are more prevalent in athletes with an acute ligamentous ankle injury than previously reported in studies utilizing 1.5 T MRI.

Abstract

Aim

to evaluate the prevalence, size and anatomical location of cartilage and osteochondral lesions ((O)CLs) in athletes with an acute ligamentous ankle injury. The secondary aim was to determine the association of (O)CLs with injury of 1) the lateral ankle ligaments and 2) anterior syndesmosis.

Methods

for this prospective cohort study all acute ligamentous ankle injuries, in athletes (>18yrs) presenting to the outpatient department of a specialized Orthopaedic and Sports Medicine Hospital within 7 days post-injury, were assed for eligibility. Acute ankle injuries were excluded if 3T MRI could not be obtained within 10 days post-injury or if imaging demonstrated a frank fracture. A musculoskeletal radiologist assessed MR scans for the presence, location and size of (O)CLs. Morfology was graded using the Modified Berndt & Harty score, Griffith MRI score and ICRS score. In addition, injury of the lateral ankle ligaments and anterior syndesmosis was graded. A multivariate logistic regression analysis was performed to evaluate the association between (O)CLs and injury of the 1) lateral ankle ligaments and 2) anterior syndesmosis.

Results

between September 2016 and February 2020 a total of 171 acute ankle injuries in 166 athletes were included in this study. The overall prevalence of (O)CLs was 14%. (O)CLs of the talus and tibia were observed in 24 (14%) and 9 (6%) acute ankle injuries, respectively. Out of 33 (O)CLs, 28 (85%) were classified as cartilage lesions. Lateral ligament injury was observed in 72% of acute ankle injuries. Anterior syndesmosis injury in 38%. Multivariate logistic regression analysis demonstrated higher odds of (O)CLs in the presence of anterior syndesmosis injury (OR 2.16; 95% CI 0.90-5.16), however the association did not reach statistical significance.

Conclusion

In athletes with an acute ligamentous ankle injury a prevalence for (O)CLs of 14% was established using 3T MRI. The majority were cartilage lesions. No statistically significant association between (O)CLs and lateral ligament or syndesmosis injury was established. The findings of this study suggest that (O)CLs are more prevalent in athletes with an acute ligamentous ankle injury than previously reported in studies utilizing 1.5 T MRI.