Abstract
Following ankle sprain, there can be many causes of disability including ligament injuries, soft tissue or bony impingement, Peroneal tendon tears, osteochondral defects (OCD), synovitis and Osteoarthritis (OA)
Aim: To assess the use of Ankle MRI in clinical decision-making in patients with pain and/or chronic instability following ankle sprains.
Method: A retrospective case note review was undertaken for all ankle scopes performed and all Ankle MRI ordered by a single surgeon (AOA) over a three-year period (April 2004 – April 2007).
Results: During this period 54 Ankle arthroscopies were performed. 24 had pre op MRI scans (16 ordered by AOA and 8 by others who then referred the patient) and 30 had no MRI. 8 case notes were not available.
In 43 of the 46 available notes the patients presented with either chronic ankle pain or instability following ankle sprain. 32 had Anterolateral soft tissue impingement on arthroscopy. Of these 24 had MRI scans with only 3 reporting a soft tissue impingement.
13 patients had lateral ligament reconstruction. All 13 of these patients showed signs of instability on examination under anaesthesia (EUA). Of these 9 had MRI scans with 4 reporting a ligamentous injury. Five other patients had MRI scans that showed a lateral ligament injury but had a normal EUA and did not undergo a ligament reconstruction.
10 patients had moderate to severe OA on arthroscopy of the ankle. Of these 4 had MRI scans with 2 reporting OA changes but 2 reported as OCD.
Conclusion: Analysing the available data suggests that the indication to perform an arthroscopy is not dependent on the results of the MRI scan but is a clinical one.
The decision to reconstruct/repair the lateral ligament complex is a clinical one dependent on patient symptom and the EUA findings.
Correspondence should be addressed to: D. Singh, BOFAS, c/o BOA, The Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE.
