Lateral Gutter Ankle Mri

The objective of this article is to review the pathophysiology and clinical presentation of impingement syndromes at the ankle joint anterolateral anterior anteromedial posteromedial and posterior and the role of mri in evaluating impingement at the ankle joint and at extraarticular locations lateral to the ankle joint talocalcaneal and calcaneofibular.

Lateral gutter ankle mri.

Anterolateral ankle impingement has been known under the term anterolateral meniscoid lesion which is the result of synovitis in the anterolateral gutter. The atfl runs from the lateral malleolus anteriorly to the lateral border of the talus. 3 during an inversion ankle injury the anterior talofibular ligament and calcaneofibular ligament are affected as is the distal syndesmosis. It has a transverse orientation and is best seen on axial images.

Mri reliable visualizes ligamentous anatomy and pathology at the ankle and is being used with increasing frequency in patients following lateral ankle sprains. Repetitive synovial inflammation secondary to chronic lateral ankle instability produces a soft tissue mass consisting of hypertrophic synovial tissue and fibrosis within the lateral gutter. 18 over time microtrauma results in excessive hemorrhage scar tissue formation and synovial hypertrophy in the lateral gutter of the ankle eventually leading to impingement. The mr findings of an abnormal soft tissue mass or fibrous band in the anterolateral ankle gutter distinct from the anterior talofibular ligament suggest the diagnosis of anterolateral impingement 2 3.

This soft tissue structure is best visualized on axial or coronal images when joint fluid is present within the lateral gutter. Anterolateral ankle impingement 4. Ankle impingement can cause pain along the lateral ankle gutter white circle. X rays are often unremarkable but an mri or mr arthrogram may demonstrate the impingement.

Controversies exist about the accuracy of mr imaging in the diagnosis of anterolateral impingement. 7a a t2 weighted axial image reveals the characteristic low signal intensity soft tissue thickening arrow within the lateral gutter in a patient with anterolateral impingement following a remote ankle sprain. Return to sports is usually successful in athletes with this problem. Mr imaging typically depicts a meniscoid mass within the lateral gutter of the ankle that demonstrates low signal intensity with all pulse sequences fig 10.

This is the most commonly injured ligament of the ankle and it is also the first to be injured on the lateral side. The anterolateral ankle gutter is the most common site of ankle impingement. Anterolateral ankle impingement is a distinct entity often seen in young athletic patients and is likely secondary to repetitive microtrauma and microinstability. 3 over time a meniscoid lesion is often the result of the lateral ankle injury.