Distribution of Bone Marrow Edema Helps Assess Lateral Soft Tissues in Ankle Sports Injuries

Purpose or Learning Objective: Underdiagnosis of ankle soft tissue injury leads to ankle dysfunction and prolonged recovery. We correlated injuries to the complex of lateral ankle soft tissue structures with bone marrow edema (BME).

Methods or Background: We conducted a retrospective analysis of 200 patients (112 men, 88 women; mean age: 29 years; range: 16–47 years) with a history of recent trauma. Magnetic resonance imaging (MRI) was performed 2 to 4 weeks after injury (mean: 2.8 weeks). Two musculoskeletal radiologists analyzed soft tissue injury and BME. Interdependence was evaluated by Pearson's correlation.

Results or Findings: Injuries to lateral soft tissue structures were usually multiple. The most common finding was effusion (54%), followed by tenosynovitis (40%) and structural injury. Tenosynovitis was associated with BME in the tip of the lateral malleolus and injury to the superior peroneal retinaculum, calcaneofibular ligament (CFL), or articular capsule (P < 0.001).

Anterior talofibular ligament (ATFL) injury, commonly partial, was more often associated (P < 0.001) with CFL and posterior talofibular ligament (PTFL) injuries than being solitary. ATFL injury was statistically correlated significantly with CFL, articular capsule, and superior peroneal retinaculum injury (P < 0.001).

A BME distribution indicating inversion injury significantly correlated with ATFL, CFL, and PTFL injury (P < 0.001). An ATFL injury was associated with a CFL injury in 29 patients (63%). An injury to the ATFL significantly correlated with BME in the lateral malleolus, mostly in the tip, the medial part of the distal tibia, and the subchondral part of the medial trochlea tali.

Conclusion: BME location and knowledge of concomitant injury correlation helps predict and correctly assess the degree of injury to the lateral ankle soft tissue structure complex.

Publication History

Article published online:
26 May 2023