Roemer Frank W, Jomaah Nabil, Niu Jingbo, Almusa Emad, Roger Bernard, D'Hooghe Pieter, Geertsema Celeste, Tol Johannes L, Khan Karim, Guermazi Ali
Department of Radiology, Aspetar, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany
Department of Radiology, Aspetar, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.
Am J Sports Med. 2014 Jul;42(7):1549-57. doi: 10.1177/0363546514529643. Epub 2014 Apr 21.
Ankle joint injuries are extremely common sports injuries, with the anterior talofibular ligament involved in the majority of ankle sprains. There have been only a few large magnetic resonance imaging (MRI) studies on associated structural injuries after ankle sprains.
To describe the injury pattern in athletes who were referred to MRI for the assessment of an acute ankle sprain and to assess the risk of associated traumatic tissue damage including lateral and syndesmotic ligament involvement.
Cross-sectional study; Level of evidence, 3.
A total of 261 ankle MRI scans of athletes with acute ankle sprains were evaluated for: lateral and syndesmotic ligament injury; concomitant injuries to the deltoid and spring ligaments and sinus tarsi; peroneal, flexor, and extensor retinacula and tendons; traumatic and nontraumatic osteochondral and osseous changes; and joint effusion. Patients were on average 22.5 years old, and the average time from injury to MRI was 5.7 days. Six exclusive injury patterns were defined based on lateral and syndesmotic ligament involvement. The risk for associated injuries was assessed by logistic regression using ankles with no or only low-grade lateral ligament injuries and no syndesmotic ligament damage as the reference.
With regard to the injury pattern, there were 103 ankles (39.5%) with complete anterior talofibular ligament disruption and no syndesmotic injury, and 53 ankles (20.3%) had a syndesmotic injury with or without lateral ligament damage. Acute osteochondral lesions of the lateral talar dome were seen in 20 ankles (7.7%). The percentage of chronic lateral osteochondral lesions was 1.1%. The risk for talar bone contusions increased more than 3-fold for ankles with complete lateral ligament ruptures (adjusted odds ratio [aOR], 3.43; 95% CI, 1.72-6.85) but not for ankles with syndesmotic involvement. The risk for associated deltoid ligament injuries increased for ankles with complete lateral ligament injuries (aOR, 4.04; 95% CI, 1.99-8.22) compared with patients with no or only low-grade lateral ligament injuries.
About 20% of athletes referred for MRI after suffering an acute ankle sprain had evidence of a syndesmotic injury regardless of lateral ligament involvement, while more than half had evidence of any lateral ligament injury without syndesmotic involvement. Concomitant talar osseous and deltoid ligament injuries are common.
踝关节损伤是极为常见的运动损伤，大多数踝关节扭伤累及距腓前韧带。关于踝关节扭伤后相关结构损伤的大型磁共振成像（MRI）研究仅有少数几项。
描述因急性踝关节扭伤接受MRI检查的运动员的损伤模式，并评估包括外侧韧带和下胫腓韧带损伤在内的相关创伤性组织损伤风险。
横断面研究；证据等级为3级。
对261例急性踝关节扭伤运动员的踝关节MRI扫描结果进行评估，内容包括：外侧韧带和下胫腓韧带损伤；三角韧带、跟舟韧带和跗骨窦的合并损伤；腓骨、屈肌和伸肌支持带及肌腱；创伤性和非创伤性骨软骨及骨质改变；以及关节积液。患者平均年龄22.5岁，从受伤到进行MRI检查的平均时间为5.7天。根据外侧韧带和下胫腓韧带损伤情况定义了6种独立的损伤模式。以无或仅有轻度外侧韧带损伤且无下胫腓韧带损伤的踝关节为参照，采用逻辑回归分析评估相关损伤的风险。
在损伤模式方面，103例踝关节（39.5%）存在距腓前韧带完全断裂且无下胫腓韧带损伤，53例踝关节（20.3%）存在下胫腓韧带损伤，伴或不伴有外侧韧带损伤。20例踝关节（7.7%）出现外侧距骨穹窿急性骨软骨损伤。慢性外侧骨软骨损伤的比例为1.1%。外侧韧带完全断裂的踝关节发生距骨骨挫伤的风险增加超过3倍（调整优势比[aOR]，3.43；95%可信区间[CI]，1.72 - 6.85），但下胫腓韧带受累的踝关节未出现这种情况。与无或仅有轻度外侧韧带损伤的患者相比，外侧韧带完全损伤的踝关节发生三角韧带相关损伤的风险增加（aOR，4.04；95% CI，1.99 - 8.22）。
急性踝关节扭伤后接受MRI检查的运动员中，约20%存在下胫腓韧带损伤证据，无论是否伴有外侧韧带损伤，而超过一半的运动员存在外侧韧带损伤证据且无下胫腓韧带损伤。距骨骨质和三角韧带合并损伤很常见。
