Introduction: Ankle sprain is one of the common presentations in Accident and Emergency. Accurate diagnosis is critical and sometime difficult without special investigation such as Magnetic Resonance Imaging (MRI) or arthroscopy.

Aim: The purpose of this project was to evaluate magnetic resonance imaging (MRI) accuracy for diagnosing and defining ankle pathology.

Method: Retrospective review of 36 patients who underwent both MRI and Arthroscopy. All cases were seen by single orthopaedic surgeon with special interest in foot and ankle surgery. MRI scan were reviewed by consultant radiologist at our institute. Arthroscopy was used as a standard for comparing MRI results. Sensitivity and Specificity was calculated by qualified statistician.

Results: For osteochondral lesion the Sensitivity of 85.7 %, Specificity of 93.3% and Accuracy of 89.7% was noticed. Anterior and posterior tibiofibular ligament (ATFL and PTFL) pathology had a Sensitivity of 100 %, Specificity of 100% and Accuracy of 100%, while anterior inferior tibiofibular ligament pathology had a Sensitivity of 66.6 %, Specificity of 95% and Accuracy of 86.6%.

Conclusion: Although MRI is a useful tool in exclusion of pathological condition its sensitivity and accuracy in diagnosing ligament injury is not encouraging.